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House Ways and Means hearing presses Medicare payment changes to spur kidney‑care innovation; patient urges wider access to home dialysis
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Summary
Lawmakers and witnesses at a House subcommittee hearing called for Medicare payment reforms, more kidney research funding, and expanded patient education to increase home dialysis and transplants. Witnesses urged extending transitional payments and redirecting post‑TDAPA funds so dollars follow patients.
At a House Ways and Means subcommittee hearing, members and witnesses urged federal action to modernize Medicare payment rules, increase kidney research funding, and expand access to home dialysis and transplantation.
"Dialysis is the reason I am alive," Ashley Littleton, an end‑stage renal disease patient from Clarksville, Tennessee, told the panel as she described starting dialysis at 27, the burdens of in‑center treatment, and the life changes made possible by switching to home hemodialysis. Littleton said home care allowed her to return to work and regain control, but she warned that many patients arrive at dialysis without clear information about options and called for repeated, patient‑centered education.
Clinicians and industry witnesses told the committee that payment design is a major barrier to innovation. "TDAPA lasts for two years," John Butler, president and CEO of Akebia Therapeutics, said of CMS's transitional drug add‑on payment adjustment, adding that the program's temporary nature and the way funds are redistributed after the period create a "payment cliff" that prevents durable patient access to new therapies. Butler and other witnesses urged passage of the Kidney Care Access Protection Act (HR 6214), which would extend transitional payments and reallocate post‑TDAPA reimbursements so money follows the patient when a product is used.
Dr. Suzanne Watnick, a professor of medicine at the University of Washington and health policy scholar at the American Society of Nephrology, told members that kidney research remains underfunded compared with other disease areas and emphasized upstream strategies: "We want people never to walk through those dialysis treatment doors," she said, calling for more primary‑care screening, expanded kidney disease education benefits to earlier stages (stage 3 through stage 5), and a coordinated federal approach to kidney health.
Dr. Robert Taylor, chief medical officer at Dialysis Clinic, Inc. (DCI), described his network's not‑for‑profit model and recommended including Medicare Advantage in alternative payment models and strengthening incentives for transplantation and home dialysis. Taylor warned that rural clinics are vulnerable when reimbursement does not cover operational costs and stressed the need for annual payment updates that reflect labor and supply trends.
Members from both parties pressed witnesses about specific obstacles to home therapy uptake: patient home environment and caregiver availability, gaps in provider training and education, and the existing configuration of the ESRD bundle payment. Multiple members said roughly 15% of ESRD patients currently receive treatment at home despite survey evidence that 40–50% of patients express interest in home modalities. Witnesses recommended expanding patient education earlier in disease progression and implementing payment mechanisms that pay for innovation only when used for individual patients.
Lawmakers also discussed coverage protections and related legislation. Ranking Member Doggett and others urged elimination of waiting periods for certain disabled beneficiaries (the Stop the Wait Act), broader Medigap protections for younger ESRD patients (Close the Medigap Act), and support for bills to preserve private coverage coordination before transitioning to Medicare (the Restore Protections for Dialysis Patients Act, HR 2199). Members raised racial and geographic disparities, transportation dependencies in rural areas, and measures to support living organ donors, including legislation to increase donor reimbursement caps.
The subcommittee did not take any formal votes. Members were given two weeks to submit written questions for the record; witness statements and submitted materials will be added to the formal hearing record. The discussion set a legislative agenda centered on payment reform (including TDAPA changes), expanded patient education, and increased federal support for research and transplantation as steps to reduce the human and fiscal toll of kidney failure.
