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As one of the most devastating health crises in modern history, the COVID-19 pandemic has exacerbated our nation’s ongoing battle with another deadly disease: kidney disease. In the past year, we have seen clear evidence that millions of people with kidney disease are at a much higher risk of contracting the new coronavirus, being hospitalized and dying, underscoring how truly vulnerable this population of Americans is to the ongoing pandemic. .
As the Biden administration begins to tackle the colossal task ahead, members of the kidney care community hope that people with kidney disease will receive the legislative relief necessary to support their health and safety.
Successfully protecting this patient population will certainly not be an easy task. Kidney disease is a complex condition that is complicated by a number of factors and further complicated by the nature of COVID-19. For example, patients with end-stage renal disease (ESRD) are at increased risk of infections for multiple reasons, including immunosuppression. Patients with kidney disease frequently suffer from multiple comorbidities that also put them at increased risk for more severe outcomes and COVID-19-related mortality. Additionally, communities of color, already disproportionately affected by kidney failure, are experiencing significantly higher rates of COVID-19 infection and hospitalization.
Although kidney care providers and physicians have worked diligently to ensure that COVID-19 does not spread within their facilities, the infection is common among dialysis patients, particularly those residing in congregated settings, such as nursing homes. . One study also found that among dialysis patients who contracted COVID-19, the death rate exceeds 20%, more than ten times the fatality rate seen in the US.
There is no question that people with kidney disease in the US are at high risk of developing COVID-19. Therefore, it is essential that Congress and the Biden administration take the necessary steps to provide patients and physicians with the tools and resources to combat the disease.
Vaccines
As more vaccines become available, it is imperative that Congress provide adequate funding to ensure that patients and front-line staff can receive them and include dialysis facilities as vaccination sites for its vulnerable populations of dialysis patients. Successful vaccination efforts will depend on dialysis facilities receiving timely deliveries so that vaccines can be administered directly to patients and staff, with a particular emphasis on communities of color.
A recent survey, supported by the NAACP and UnidosUS, showed that only 14% of the more than 1,000 black respondents and 34% of the 258 Hispanics / Latinos surveyed “have greater or complete confidence that a vaccine will be safe.” Therefore, we also ask that Congress fund special grants for public awareness campaigns through the CDC, which should be available to trusted organizations in underserved communities and healthcare providers who work with these populations.
Permanent expansion of telehealth
Given the tremendous role telehealth has played in containing the spread of COVID-19, the kidney care community hopes that Congress will permanently expand the telehealth flexibilities that CMS implemented last year. Given the fragile health conditions and continuing uncertainties of this population, it is important that patients can continue to use these services beyond the public health emergency if it meets their needs and works within their plan of care.
Additional financial relief
Labor shortages, increased demand for supplies and equipment, and improved patient support services are putting pressure on kidney care providers. Critical steps to ensure these providers can continue to care for patients should include: extending the 2% Medicare hijacking exemption beyond March 31, 2021; offer relief to providers for reimbursement for personal protective equipment; allow dialysis facilities to be reimbursed for 100% of the “bad debts” allowed under the ESRD PPS; and grant full forgiveness of all payments received through the Medicare Advance and Accelerated Payment Program.
Part D coverage for FDA-approved drugs for CKD patients
Congress should guarantee Medicare Part D coverage for oral agents prescribed by the FDA to treat conditions associated with chronic kidney disease, that is, those patients who do not yet require dialysis or transplantation. Many people with kidney disease require treatments such as infusions in the outpatient departments of hospitals. This change would allow people with kidney disease to be treated at home with alternative oral therapies, such as iron deficiency anemia, while maintaining social isolation; mitigate your risk of contracting COVID-19; and free hospitals to treat seriously ill patients.
While the entire nation is hopeful that 2021 will mean a return to some sense of normalcy, and far fewer illnesses and deaths from COVID-19, the kidney community is grateful to Congress and the Biden Administration for all that they are doing. to take control of the pandemic. . We hope that you will pay particular attention to the needs of the renal community, which will go a long way toward halting the spread, hospitalizations, and mortality associated with this unprecedented healthcare crisis.
John butler, MBA, chairs Kidney Care Partners and is CEO of Akebia Therapeutics.
