HCA Healthcare hosts CMS Administrator Verma, health leaders for discussion on advancing kidney health

On Friday, September 18, HCA Healthcare hosted Seema Verma, Centers for Medicare and Medicaid Services (CMS) Administrator and White House Coronavirus Task Force member, as well as representatives of several kidney health organizations in Nashville, Tenn. to discuss kidney care transformation.

Dr. Jonathan Perlin, HCA Healthcare’s clinical operations group president and chief medical officer, led healthcare leaders in a roundtable conversation focused on improving health outcomes for the approximately 37 million Americans living with chronic kidney disease (CKD).

“I want to thank you all for being here today. I’m looking forward to the conversation, and we want to hear from you as part of our larger effort to improve kidney health,” Administrator Verma addressed the group. “We’re making sure that we’re doing everything that we can to increase the transplantation rate and procure as many organs as we can.”

The kidney crisis, by the numbers

“Kidney disease is a major, prominent and prevalent condition,” commented Dr. Perlin. The numbers are overwhelming:

• Kidney diseases are the ninth leading cause of death in the United States
• 1 in 3 Americans are at risk for CKD
• 15% of the U.S. adult population has CKD (more than 1 in 7 adults)
• Approximately 90% of those with CKD don’t even know that they have it
• In 2017, more than 500,000 patients received dialysis treatment, and more than 200,000 lived with a kidney transplant
• 100,000 Americans today are waiting for a kidney transplant
• On average 13 people die every day while waiting for a kidney transplant

As care providers work to mitigate the spread of coronavirus (COVID-19), the kidney patient community is markedly vulnerable to the virus. People with kidney disease and other severe chronic medical conditions are at higher risk for more severe illness. Additionally, individuals with end-stage renal disease (ESRD) have higher rates of hospitalization when diagnosed with COVID-19.

“There are too many at risk patients who progress to late-stage kidney failure, the mortality rate is too high, treatment options are too expensive and the quality of life is simply too low,” Dr. Perlin expressed. “There are not enough kidneys donated to meet the demand for transplants.”

What followed was a proactive dialogue involving in-person and virtual roundtable participants from several different advocacy groups:

• Centers for Medicare and Medicaid Services
• HCA Healthcare
• TennCare
• Vanderbilt University
• Meharry Medical College
• Senator Lamar Alexander
• S. Representative Phil Roe
• National Kidney Foundation
• American Society of Nephrology
• ESRD Networks
• Tennessee Kidney Foundation
• Monogram Health
• Baxter
• DaVita
• Home Dialysis Alliance
• DCI
• Amedisys

The discussion built on the Executive Order on Advancing American Kidney Health and followed CMS’ announcement of its new transformative model of care for Medicare beneficiaries with chronic kidney disease, which emphasizes the use of home dialysis and transplantation to improve the quality of life of Medicare beneficiaries with ESRD. The new model “focuses on prevention and better quality of life for our Medicare beneficiaries, so they can spend less time in dialysis centers and more time living fuller lives,” said Administrator Verma.

“We think there is a tremendous opportunity to change how we deliver care in this country around end-stage renal disease,” said Brad Smith, director of Center for Medicare & Medicaid Innovation. Smith spoke on efforts to increase in-home dialysis and transplant rates, and to mitigate risks for ESRD patients during COVID-19. “Our ESRD patients are one of our highest risk groups in the country. If you get COVID and you have ESRD, you’re eight times more likely to pass away than the average American.”

Recognizing the need to look at innovative models of kidney care, roundtable participants eagerly spoke about how to identify and engage people in early stages of chronic kidney disease and how to prepare them to pursue home-based dialysis and transplants.

A leader in live donor kidney transplants, HCA Healthcare was selected to be the host site of the dialogue aimed to break down the silos between advanced kidney disease, kidney failure and transplant.

“At HCA Healthcare we have the privilege of more than 35 million annual patient encounters. We are, in the aggregate, the largest provider of Medicare, Medicaid and uncompensated care services,” Dr. Perlin remarked at the event.

According to the Organ Procurement and Transplantation Network (OPTN), in 2019 HCA Healthcare performed a total of 418 live donor kidney transplants, more than any other hospital system in the country.

“We generate really good outcomes across a populate that is more heterogeneous, more diverse, than the U.S. population at large. Using our scale, we’re changing the lives of real people, whose lives are improved by the independence that a transplant grants them,” Dr. Perlin said.

As a tool to increase live donor transplantation rates, HCA Healthcare’s live kidney donor program and Living Donor Playbook provides guidance on removing barriers for living donors.

HCA Healthcare’s kidney transplant program is led by Dr. Adam Bingaman, national medical director of solid organ transplant at HCA Healthcare and director of abdominal transplant at Methodist Specialty and Transplant Hospital.

Under Dr. Bingaman’s leadership, the San Antonio, Texas-based hospital set a record for the most live donor transplants performed at a single center, with 231 performed in 2019. That same year, Methodist Specialty and Transplant Hospital performed the most transplants for Hispanic patients in the U.S. and also performed 377 overall kidney transplants, accounting for the fourth overall most kidney transplants in the nation.

Knowing all too well how kidney disease impacts the whole family, living donor and father, Daryl Harrell, joined the discussion virtually. His son’s life was saved through an expeditious living donor transplant performed by Dr. Bingaman.

“Kidney disease does not just impact 37 million Americans. It’s 37 million and their companions. This is a family disease and the number of folks affected by it is dramatic,” said Dr. Bingaman.

“What these new incentivizations generate is the breaking down of silos that have for too long existed. This is incentivizing us to come together. Patients want to be cared for under one umbrella, not different silos,” added Dr. Bingaman. “From nephrologists in their offices to dialysis units to the transplant centers, we’re coming together to solve this issue.”

Also joining the discussion virtually, Amber Pettis, kidney transplant recipient and National Kidney Foundation Kidney Advocacy Committee member, thanked the roundtable for the work being done around the policies and treatment options that improve the quality of life of the thousands of individuals, and their families, living with CKD. She recently took to the NKF Advocacy in Action blog to reiterate the need to achieve higher rates of home dialysis and transplantation:

“As an ESRD patient, I’ve experienced several treatment options including in-center hemodialysis, peritoneal dialysis and transplantation. Transplantation saved my life and dialysis care was the bridge to that new life. While transplantation was the treatment option that worked best for me, it is important to recognize that there is not a ‘one size fits all’ solution when it comes to kidney care.

It is critical that ESRD patients have access to all treatment options and are provided the necessary education to make an informed decision about their care. These policies allow greater access to all treatment options and can lead to a better quality of life for those living with ESRD.

CKD patients around the nation depend on advancements in kidney care polices to sustain life.”

Thank you to Administrator Verma and all participants for joining HCA Healthcare to construct a better system for America’s kidney patients: heathier tomorrows and more lives saved.