ARI SHAPIRO, HOST:
Kidney disease affects millions of people and costs the government billions of dollars. Today, President Trump signed an executive order with ambitious goals for changing the way kidney disease is treated and paid for.
Trump signed the order in a room full of patients, kidney doctors and advocates.
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PRESIDENT DONALD TRUMP: For these patients, their loved ones and for the impacted - all those impacted by kidney disease, I'm here to say we are fighting by your side, and we're determined to get you the best treatment anywhere in the world.
SHAPIRO: NPR's Selena Simmons-Duffin has details about what the administration wants to do.
SELENA SIMMONS-DUFFIN, BYLINE: When someone has kidney disease, their kidneys don't do a good job of filtering toxins out of their bodies. Usually, there aren't any symptoms until they're really sick.
HOLLY KRAMER: Maybe the first time I'm seeing them is when I need to tell them, you need to start dialysis soon, and we need to get you listed for a kidney transplant.
SIMMONS-DUFFIN: That's Dr. Holly Kramer, a kidney specialist at Loyola University Chicago and the president of the National Kidney Foundation. Kramer says, right now, the financial incentives for providers is backwards. Dialysis is totally paid for by Medicare, but talking to patients about things like diet and exercise to prevent more harm to their kidneys is not.
The executive order calls for new incentives to providers for prevention. It also encourages them to get patients on dialysis at home, which Kramer points out is a return to an earlier time.
KRAMER: My mom, in the very early 1980s, was a home dialysis nurse. And we would drive around these rural areas in northwest Indiana. And I remember seeing the blue shag carpet with a gigantic dialysis machine on top of it and a person sitting in a lounge chair, you know, with the tubing coming out of their arm.
SIMMONS-DUFFIN: These days, only 12% of American patients are on home dialysis. The Trump administration wants to get that up to 80%. Kramer says that's going to be hard.
KRAMER: You need social support, and you need a clean house, and you need someplace to have equipment. And many of our patients live in areas where they don't even have a grocery store in their neighborhood. You know, they live in really small apartments that aren't clean.
SIMMONS-DUFFIN: Today, dialysis mostly happens in centers and strip malls. Trump administration officials say that's expensive and doesn't work well for patients. A lot of details aren't yet public about how they will get this all done or when. And previous administrations have tried to address some of these issues before with limited success. For doctors like Holly Kramer, and for patients, change can't come soon enough.
Selena Simmons-Duffin, NPR News.
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