WASHINGTON -- President Donald Trump outlined an agenda to improve preventive treatment of kidney disease Wednesday, zeroing in on a condition that afflicts more than 30 million Americans and costs more than $100 billion in annual Medicare spending.
The executive order Trump signed aims to improve quality and cut costs by refocusing care on prevention. The initiative's overarching goals are to reduce the number of new patients with end-stage renal disease by 25% by 2030, and to have 80% of ESRD patients either receiving in-home dialysis or transplants by 2025.
"I am here to say we are fighting by your side and we are determined to get you the best treatment in the world," Trump said.
The administration is also looking to double the number of kidneys available for transplant by 2030, in part through a public awareness campaign and by compensating donors for things like lost wages and child care.
"Those people, I have to say, have never gotten enough credit," Trump said, referring to donors. "What they do is so incredible."
More than 100,000 patients were awaiting new kidneys in 2016, according to the National Kidney Foundation, making up the bulk of patients awaiting an organ transplant. Health and Human Services Secretary Alex Azar said Wednesday that transplants are the "end game" for kidney patients, noting that half of patients on dialysis die within five years.
The executive order includes the introduction of five new payment demonstrations, including one that will compel providers to participate. The demonstrations will, among other things, create incentives for dialysis providers to offer the treatment in a patient's home. Center for Medicare and Medicaid Innovation Director Adam Boehler told reporters the models will be "broad and sweeping," impacting over half the country.
The announcement comes amid reports that Trump will soon nominate Boehler to lead the Overseas Private Investment Corp., which drives private investment in developing economies. Boehler declined to confirm the reports.
The condition's price tag is partly why it has become one of the administration's focal points. Kidney disease accounts for roughly one in five dollars spent in Medicare, totaling $113 billion in 2016.
The dialysis market also remains highly concentrated, with just two major players -- DaVita and Fresenius -- dominating it. Delivering in-home dialysis could be a significant cost saver, since just 12% of kidney patients begin dialysis at home.