Background

On July 10, 2019, President Donald Trump signed an Executive Order to launch Advancing American Kidney Health, a new initiative designed to improve the lives of Americans with kidney disease by expanding treatment options and reducing health care costs. The initiative proposes various changes, including revising rules to ensure kidneys reach patients quicker, moving more patients into home dialysis, encouraging development of artificial kidneys, increasing the number of kidneys available for transplantation, and changing reimbursement for kidney disease treatment.

As directed by the Executive Order, the U.S. Department of Health and Human Services (HHS) announced  that the Centers for Medicare & Medicaid Services (CMS), through its Center for Medicare and Medicaid Innovation (CMMI), released a proposed required payment model and four optional payment models to adjust payment incentives to encourage preventative kidney care, home dialysis, and kidney transplants. The Department’s Assistant Secretary for Planning and Evaluation (ASPE) also released a paper entitled Advancing American Kidney Health.

Executive Order

• Advancing American Kidney Health (HHS wepage)
• Advancing American Kidney Health (HHS document)
• Executive Order on Advancing American Kidney Health (7/10/19)
• HHS Press Release: HHS Launches President Trump’s ‘Advancing American Kidney Health’ Initiative (7/10/19)
• CMS Press Release: HHS To Transform Care Delivery for Patients with Chronic Kidney Disease (7/10/19)
• Advancing American Kidney Health Paper

Activities & Implementation

• CMS Kidney Care Choices Model
• CMS Fact Sheet: Proposed ESRD Treatment Choices (ETC) Mandatory Model
• CMS Fact Sheet: Kidney Care First and Comprehensive Kidney Care Contracting Models
• CMS Proposed Rule: Medicare Program; Specialty Care Models to Improve Quality of Care and Reduce Expenditures (CMS-5527-P)
• CMMI Request for Applications for the Kidney Care Choices Model ~ Applications due 1/22/20
• CMS Final Rule: Medicare Program: End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, etc. (CMS-1713-F)
• CMMI Webinar Series on Kidney Care Choices Model (11/19)
• Trump Administration Proposes New Rules to Increase Accountability and Availability of the Organ Supply (HHS Press Release, 12/17/19)
• CMS Proposed Rule: Organ Procurement Organization (OPO) Conditions for Coverage Proposed Rule: Revisions to Outcome Measures for OPOs (CMS-3380-P)
• CMS Fact Sheet: Organ Procurement Organization (OPO) Conditions for Coverage Proposed Rule: Revisions to Outcome Measures for OPOs
• Health Resources & Services Administration (HRSA) Proposed Rule: Removing Financial Disincentives to Living Organ Donation (42 CFR Part 121)
• HRSA Fact Sheet: Notice of Proposed Rulemaking (NPRM) to amend the regulations implementing the National Organ Transplant Act of 1984 (NOTA)

Response from ANNA

"The Advancing American Kidney Health initiative provides an opportunity for nephrology nurses and the American Nephrology Nurses Association (ANNA) to be strategic and forward thinking about what we have to offer as a profession," said ANNA President Tamara Kear, PhD, RN, CNS, CNN, FAAN. "Successful implementation of the initiative will require the active involvement of nephrology nurses who possess the necessary education, training, and clinical skills to provide the most effective care to patients with kidney disease in all settings. Nephrology nurses must not only be at the table as the American Kidney Health initiative is implemented, we must have a leading role as full partners with the HHS and CMS, industry leaders, practitioners, and patient organizations as the initiative moves forward. ANNA and our colleagues in the kidney care community will continue to work together to share updated information and resources with our members throughout this process."

ANNA News & Updates

• Advancing American Kidney Health – The Time for Nurses to Act Is Now (Message from ANNA President Tamara Kear, Nephrology Nursing Journal, November/December 2019)
• Nurses Look at Challenges, Opportunities of Advancing American Kidney Health (Nephrology News & Issues, December 2019)
• Sessions at 2019 ANNA Nephrology Nursing Practice, Management, & Leadership Conference (10/12-14/19) address Advancing American Kidney Health Initiative (see details)
• An Era of Transformation (Message from ANNA President Tamara Kear, Nephrology Nursing Journal, September/October 2019)
• ANNA Submits Comments to CMS Regarding CMS-1713-P: Medicare Program; ESRD PPS, Payment for Renal Dialysis Services Furnished to Individuals with AKI, ESRD QIP (9/25/19)
• ANNA Submits Comments to CMS Regarding CMS-5527-P: Medicare Program; Specialty Care Models to Improve Quality of Care and Reduce Expenditures (9/16/19)

Response from Kidney Care Community

• Letter from the Alliance for Home Dialysis to CMS Regarding CMS-5527-P: Medicare Program; Specialty Care Models to Improve Quality of Care and Reduce Expenditures (9/16/19)
• Letter from Kidney Care Partners to CMS Regarding CMS-5527-P: Medicare Program; Specialty Care Models to Improve Quality of Care and Reduce Expenditures (9/15/19)
• Kidney Care Partners Supports Trump Administration’s Executive Order on Kidney Care (7/10/19)

Additional Resources/News

• HHS Kidney Care Policy Changes Incentivize CKD Care, Home Dialysis, and Transplantation (Summary from Renal Physicians Association, 7/19)
• New Payment Models Proposed by Advancing American Kidney Health Initiative Executive Order (Infographic) (American Society of Nephrology)