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Disrupting A Stagnant Industry To Meet Patients Where They Are

By News Creatives Authors , in Small Business , at October 13, 2021

Chief Executive Officer at Outset Medical, a dialysis technology innovator focused on simplifying treatment for patients and providers.

Healthcare has seen groundbreaking innovation that has saved countless lives. The emergence of technologies from surgical robotics to the sequencing of the human genome has made medical care more patient-centric and efficient than ever before. But there is a major outlier — one that impacts over 550,000 Americans who rely on it for their very survival: dialysis.

Hemodialysis is a life-sustaining treatment for patients with kidney failure that removes waste products and excess fluids from the blood. Patients who suffer from end-stage renal disease (ESRD) require dialysis at least three days a week for three to four hours at a time. It’s a life-changing strain on patients’ quality of life, as it is taxing both physically and mentally. 

Despite these statistics, I think dialysis has seen little innovation over the last 30 years. What gives? The truth is, there is no one culprit. Between a couple of corporations that entered and cornered the market, vertical integration, restrictive regulations and a challenging reimbursement environment, it has been difficult for transformation to take root.

The dialysis industry has forced patients into a modality that benefits the treater, not the treated. In the 1970s, about 40% of dialysis patients were dialyzing at home. Now, that number has decreased to 12%, with most patients having to travel to a clinic to receive therapy. Treatment options have diminished, stripping patients of their independence and control over their own health, quality and length of life, and ability to maintain employment. 

My company is one of the few that provide hemodialysis systems for use in the home. We’ve also partnered with organizations such as Innovate Kidney Care and Moving Health Home to educate, empower and change the status quo to do what’s right for patients. 

We’re now at a point where we can’t ignore unsustainable deficiencies. The question is not whether transformational change is needed, but rather how quickly we can address long-standing barriers and provide meaningfully better options for patients. 

Making At-Home Dialysis A Reality

Reimagining the future and empowering patients to dialyze on their own schedule at home will require broad commitment across the kidney disease community. One piece of this complex puzzle is ongoing enhancements to Medicare reimbursement models that have historically encouraged in-center hemodialysis as the default treatment for patients beginning dialysis. To address the high cost of care and improve patient quality of life, in 2019, the Department of Health and Human Services announced a goal of having 80% of new ESRD patients start dialysis at home or receive a transplant by 2025. Earlier this year, the mandatory ESRD Treatment Choices (ETC) Model began as the policy complement, with the aim of driving greater use of home dialysis by rewarding providers with additional payment if they meet home targets and empowering ESRD beneficiaries with the freedom to choose the treatment that works best with their lifestyles.

While these initiatives are a big step forward, other policy levers must be pulled to create meaningful change. For example, some nephrologists — doctors who specialize in treating diseases of the kidney — are paid less per month for patients who dialyze at home versus in-clinic. If we want to encourage more home dialysis, we should equalize the payment physicians receive, no matter where the patient receives treatment. 

Additionally, we need to allow for greater competition in the dialysis services market. Competition spurs innovation and greater choice for patients. As new settings of care have emerged that are more convenient and preferred by patients, aspects of the Conditions for Coverage are in need of modernization. On top of this, state regulations often make it difficult for new market-entrants to get established and provide patients with choice. I believe these barriers need to be removed. We also need clearer, simplified regulations and guidance for who and how efficient home training can be provided to patients and care partners in ways that create convenience and flexibility. 

This is just the beginning of what we can do as an industry to restore dignity and self-worth to chronic kidney disease patients. The dialysis market is enormous and growing, so there is plenty of room for new innovators. Companies looking to join the effort to transform this space can create impact by listening to patients. Spending time with patients in the dialysis clinic and in their homes will reveal opportunities to solve problems that might otherwise be overlooked.

Another way the next generation of renal entrepreneurs can create impact is to focus on novel solutions, whether technology, digital health or services, that help enable macro-currents in the space. For example, increasing the utilization of home dialysis is now a major focus for payors, health systems and CMS. One of the obstacles for some patients in adopting home dialysis is a fear of cannulation (inserting needles into the arm to access the circulatory system). An enabling technology such as a painless, easy cannulation tool would likely have a ready market waiting. Enabling innovation that supports major trends already in motion increases the likelihood of adoption and would serve meaningful purpose.

Another key area of need is increasing access to and education about dialysis treatment options for socioeconomically disadvantaged kidney disease populations before they crash into dialysis in the hospital. New market entrants with novel solutions for addressing unmet needs and reducing barriers for patients by closing long-established health equity gaps will have a place at the table in future years.

The end goal is to expand where and when patients can dialyze by meeting them where they are — at home — and to increase the number of patients who can successfully treat at home on their own schedule. So many other sectors of the healthcare industry have seen immense innovation. It’s time we in the dialysis community lead on innovation versus playing catch up. Kidney disease patients deserve nothing less.

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