Kidney Week 2025 Annual Meeting-Two Years of Change in the United States: Congress, the White House, and the Policies Impacting Kidney Care for Private Practice and Academia Alike

Video Transcription

Video Summary

The session, chaired by UTMB president and nephrologist Jochen Reiser with Dan Weiner, reviewed major U.S. federal policy shifts affecting kidney care over the past year, spanning research funding, immigration, dialysis payment models, and transplant regulation.<br /><br />Ankur Shah summarized disruption in the biomedical research ecosystem: delayed and terminated NIH grants, indirect cost caps, disbursement freezes, and a proposed “skinny budget” that would consolidate institutes and cut funding. Although NIH spending later caught up, new NIDDK R01 awards dropped (261 vs 431 year-over-year) due to a shift toward upfront full multi‑year grant funding. AHRQ new projects fell to zero, threatening dialysis quality research. Shah also warned immigration restrictions (J‑1 duration limits, H‑1B fees) could worsen nephrology workforce shortages, given high reliance on international trainees. He highlighted Medicaid and SNAP cuts, new copays and work requirements, ACA enrollment changes, and student loan caps as likely to increase coverage loss and worsen disparities, especially in rural areas.<br /><br />David White explained why kidney disease has been central to CMMI value-based care, reviewed the Advancing American Kidney Health initiative, and outlined current model changes: termination of the mandatory ETC model and major revisions to Kidney Care Choices; launch of the mandatory IOTA transplant model; and ongoing transplant-system modernization.<br /><br />Transplant nephrologist Juhan Inch detailed OPO performance rules leading to recertification tiers and potential decertification, OPTN modernization (more transparency, new IT, multiple contractors beyond UNOS), and living donor policy proposals to reduce financial barriers and discrimination.<br /><br />Pranav Garimella focused on payment barriers to dialysis innovation under the ESRD bundle, showing how short-lived add-ons (TDAPA/TPNIES) create “payment cliffs” that suppress adoption of effective new drugs and devices, and argued congressional and regulatory fixes are needed to modernize incentives for dialysis, hemodiafiltration, and emerging therapies like xenotransplantation.

Asset Subtitle

Moderator(s): Jochen Reiser, Daniel Weiner

Presentation(s):

Report from Capitol Hill: Reconciliation, Regular Appropriations, Recissions, and Routine Rancor - Ankur Shah
Medicare and Model Changes and What They Mean for US Clinicians - Tom Duvall, David White
Changes in Kidney Transplant Policies and Regulations and How to Explain Them to Patients - Yue-Harn Ng
Innovation Is Here: How Do We Pay for It? - Pranav Garimella

Meta Tag

Date 11/6/2025

Pathway 1 Other

Session ID 523387

Keywords

U.S. federal kidney care policy

NIH grant disruptions

NIDDK R01 award decline

biomedical research funding cuts

AHRQ dialysis quality research

indirect cost cap

skinny budget proposal

immigration restrictions J-1 H-1B

nephrology workforce shortage

Medicaid and SNAP cuts

ACA enrollment changes

CMMI value-based kidney care

Advancing American Kidney Health

ETC model termination

Kidney Care Choices revisions