Kidneys Kidney disease is theninth-leading cause of death in the United States and accounts for20 percent of annual Medicare spending, or about $110billion.

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President Donald Trump on Wednesday announced a bold plan toimprove care to patients with kidney disease, which he claimedwould save thousands of lives each year and billions of dollars fortaxpayers.

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“It could be higher if it works the way we anticipate,” Trumpboasted in a 25-minute speech to dozens of kidney patients, their familiesand kidney care providers in Washington.

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The initiative aims to dramatically increase the number ofpatients getting dialysis at home, rather than in costly dialysiscenters, and double the annual number of kidneys available fortransplants. About 100,000 Americans are waiting for a kidney transplant. TenAmericans die each day because of the shortage of organs, Trumpsaid.

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Kidney disease is the ninth-leading cause of death in the UnitedStates and accounts for 20 percent of annual Medicarespending, or about $110 billion, administration officials said.

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Trump's strategy centers on changing how Medicare pays doctorsand dialysis centers to boost their incentives to help patients getdialysis at home and keep them healthy enough to be eligible fortransplantation. This would be a far cry from the current system,which focuses on in-patient dialysis center treatment.

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Dr. Mark Rosenberg, president of the American Society ofNephrology, said he was pleased that some of the new payment modelsoffered by the Centers for Medicare & Medicaid Services haveonly “upside” potential for doctors. He said doctors now get paidmore to see their patients at the dialysis center than at home. Asa result, there is little incentive to promote home dialysisoptions.

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“I have been a kidney doctor for 35 years, and this is the mostgame-changing thing ever to happen,” he said.

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The authority to make such major changes without congressionalapproval comes from the Centers for Medicare and MedicaidInnovation (CMMI), which was created by the 2010 Affordable CareAct.

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On Tuesday, the Trump administration was in a federal appealscourt in New Orleans arguing the entire health law should bedeclared unconstitutional.

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“If the law is invalidated, the Innovation Center, and all itsauthorities, would be eliminated,” said Nicholas Bagley, aUniversity of Michigan law professor.

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In touting the new effort, Health and Human Services SecretaryAlex Azar and CMMI Director Adam Boehler spoke about how kidneydisease has affected their families. Azar noted his father was ondialysis for several years before receiving a kidney transplant.Boehler said an aunt died while on dialysis.

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Since 1973, all Americans with end-stage kidney disease havebeen entitled to coverage through Medicare.

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The administration said it would expand the number of kidneysavailable for transplant by increasing public awareness about theneed for living donors and help those who donate a kidney.Currently, their medical costs are covered but the president's plan wouldprovide financial assistance to cover day care and time missed fromwork. Trump said the initiative would also hold organ procurementorganizations more accountable so that fewer usable organs arediscarded.

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Trump said his plan would help 17,000 additional Americans get akidney transplant each year by 2030. The policy would also help11,000 more Americans get hearts, lungs and livers annually.

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Kidney transplants cost less than having patients spend years ondialysis, according to government figures. Dialysis treatment runson average about $89,000 a year,while a kidney transplant surgery averages about $32,000 andpost-surgery care runs about $25,000 per year. Trump estimated hisplan would save families and taxpayers $4.2 billion a year. “Thisis a dramatic and long overdue reform,” he said.

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In the United States, only about 12 percent of patients get dialysis at home, far lowerthan in other countries, Trump said. The plan calls for increasingthat share to 80 percent by 2025.

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Nichole Jefferson, 47, of Dallas, who is awaiting a secondtransplant to replace a transplanted kidney that is failing, saidgetting the treatment at home is much less taxing. She had homedialysis for four years, before her initial transplant in 2008.

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“It's great to be at home where I was more comfortable and morerelaxed and the care was in my hands,” she said in an interview atthe Trump event. By getting dialysis at night while she slept, shewas able to work during the day and take part in family events.

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She had to go to a center for the dialysis when the homedialysis stopped working. “I was depressed to be in the center tiedto a chair for four hours next to people I did not know,” she said.Patients often have dialysis several days a week.

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Other patient advocates applauded Trump's plan.

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“The administration's commitment to charting a new course forkidney health will help revolutionize transplantation and dialysisand advance new innovations, therapies and treatments, whichpatients everywhere have been waiting on for far too long,” saidKevin Longino, CEO of the National Kidney Foundation and a kidneytransplant patient.

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DaVita, the Denver-based company that is the largest provider ofhome dialysis in the country, offered a more muted response, sayingit looked forward to working with the administration. The company'sstock, which fell in recent days ahead of the announcement, roseabout 5 percent Wednesday.

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Administration officials said many aspects of their plan wouldbegin next year. Health providers in half the country will berequired to participate in one of the new payment models in whichthey will face some financial risk for caring for patients. Doctorsand health systems will have options to take on more financialrisk, which means they could make more money or lose more moneybased on the health of their kidney patients.

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Patients, however, will continue to be able to choose theirdoctors and dialysis providers.

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Joe Grogan, head of the White House Domestic Policy Council,said the kidney disease issue “fits in the wheelhouse of items thepresident likes to confront. … The current quality of outcomes arepathetic in this area.”

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About half of patients on dialysis die within five years, Azarsaid.

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Kaiser HealthNews (KHN) is a national health policy news service. It is aneditorially independent program of the Henry J. Kaiser Family Foundation whichis not affiliated with Kaiser Permanente.

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