Kidney Week 2025 Annual Meeting-Better Kidney Care Requires Better Payment Systems

Video Transcription

Video Summary

The session opens with disclosures and recording information, then features three talks on kidney care policy, payment reform, and delivery models.<br /><br />Dr. Suzanne Watnick argues that dialysis care has stagnated compared with fields like oncology, partly because Medicare’s ESRD benefit and bundled payment system (designed for 2008-era priorities) discourages long-term investment in innovation. While short-term “band-aids” like TDAPA and technology add-ons help temporarily, she calls for both near-term fixes—rebasing the dialysis base rate, improving risk adjusters, strengthening patient-centered quality measures (using carrots, not only penalties), addressing disparities and social determinants, and increasing transparency—and long-term, disruptive reform that likely requires an Act of Congress. She emphasizes coalition-building, patient stories, data, and legislative strategy, and promotes a broader “kidney care” program focused on value, equity, and innovation.<br /><br />Dr. Eugene Lin explains how the 21st Century Cures Act enabled ESRD enrollment in Medicare Advantage (MA), making MA a major payer for dialysis. He contrasts fee-for-service Medicare with MA, highlighting MA’s profit incentives: narrow networks, prior authorization and denials, and steering toward cheaper drugs—while sometimes improving care coordination. MA can lower premiums and cap out-of-pocket costs and offers ancillary benefits (vision/dental/hearing), but may reduce access and complicate transplantation through network constraints. He notes MA overpayment concerns, heterogeneous plan quality, and a need for more ESRD-specific research.<br /><br />Dr. Mindu (Mass General Brigham) reviews AAKH models and early Kidney Care Choices results: improved home dialysis training, waitlisting, and “optimal starts,” but no first-year cost/utilization savings, prompting CMS to reduce or sunset some payments. She describes how health systems can operationalize kidney value-based care using EHR tools, registries, e-consults, decision support, and an advanced CKD program with coordinators, NP, and pharmacist to reduce hospitalizations and improve transitions.<br /><br />A panel stresses advocacy (including public comments on measures), guardrails in MA, transplant policy attention, and focusing on hospitalization/readmission reductions as near-term value targets.

Asset Subtitle

Moderator(s): Rasheeda Hall, Adam Wilk

Presentation(s):

Redesigning the Bundle: Yes, It Requires an Act of Congress, but What Else? - Suzanne Watnick
Half Your Medicare Patients Are Covered by Medicare Advantage: Where's the Advantage? - Eugene Lin
How Do Health Care Systems Think About Dialysis and CKD Care, and What Is a Nephrology Professional's Role? - Mallika Mendu

Meta Tag

Date 11/8/2025

Pathway 1 Other

Session ID 507261

Keywords

dialysis payment reform

Medicare ESRD benefit

ESRD bundled payment system

kidney care policy

rebasing dialysis base rate

risk adjustment in dialysis

patient-centered quality measures

health equity and disparities

social determinants of health

kidney care innovation

Act of Congress legislation

Medicare Advantage ESRD enrollment

prior authorization and narrow networks

transplant access and waitlisting

AAKH and Kidney Care Choices models