Hemodialysis.com

Hemodialysis.com: How did you become interested in chronic kidney disease and dialysis care?

My background is in industrial engineering, which I majored in at Lehigh University in Pennsylvania.  After graduation I joined a medical device company called Cobe Laboratories., which specialized in blood therapies including dialysis devices.  Cobe  was acquired by Gambro, where I worked in the Renal Division for nine years, including as Director of Marketing and Advanced Technologies. 

What has kept me in the renal care industry is that I really enjoy how technology, economic constraints and clinical objectives can come together to increase the quality of life for patients affected by kidney disease. At NxStage we recognize our responsibilities to patients, providers and payers, while operating within a mercurial and constrictive economic environment.

Hemodialysis.com: What do you see as the main advantages to home hemodialysis?

Studies have confirmed the previously anecdotally reported benefits of more frequent dialysis experienced by many home hemodialysis patients. Compared to three-times-weekly in-center hemodialysis, daily, more frequent home hemodialysis may offer health and quality of life benefits including less stress on the heart, better blood pressure control with fewer medications, and a lower risk of death.

There are also significant quality of life improvements including a quicker recovery time after treatment and improved appetite.  Studies show that patients experience better mental health with more energy and vitality and few depressive symptoms when performing more frequent dialysis with the System One. 

Home hemodialysis affords patients increased flexibility in scheduling work and recreational activities.  Perhaps most importantly individuals experience a greater sense of being in control of their treatments and life.

Hemodialysis.com: What are some the developments of NxStage and Medisystems that you are most proud of?

I am most enthusiastic about the fluid management system offered in the NxStage One system. It is simple, elegant and very safe and unique to our product.

Another area we are very proud of concerns water purification and delivery. 

Water is a key challenge for all dialysis providers, including in-center facilities. With the NxStage technology design, we can protect patients from a broad range of water issues.

NxStage has even been able to accommodate a patient whose home was supplied with water from a bucket well system.

Hemodialysis.com: What are some of the challenges facing the home hemodialysis community?

At NxStage we recognize there are a cascade of issues as a new market is developed and established.

Home hemodialysis is a new way of delivering dialysis care that requires close cooperation and an ongoing relationship between the patient, a family or friend partner, nursing staff and the supervising nephrologist. For a variety of reasons, home hemodialysis is not suitable for every situation or patient.  We believe that approximately 10-15% of the patient population is appropriate for home hemodialysis.  At the present time, at little over 1% of dialysis patients are successfully hemodialyzing at home with our System One.

Proactive folks looking for increased flexibility are more likely to select this therapy. We are aiming to close the demographic divide with more and better education of both patients and providers.

Hemodialysis.com: How do cost and reimbursement issues affect dialysis modality choice?

Comparing the cost of more frequent home hemodialysis to conventional in-center hemodialysis is a little like comparing apples to oranges.  While the cost of home hemodialysis care may be somewhat higher than for in-center dialysis, these costs are for more treatments and improved outcomes.

The Freedom Study of home hemodialysis, now being conducted by Nxstate, is a prospective study of Medicare patients who convert to home hemodialysis with the NxStage® System One™, is examining hospitalization days per patient per year. If the study confirms a decrease in more costly hospitalization stays in home hemodialysis patients, the overall cost of providing home hemodialysis may be comparable to or even less than in-center hemodialysis.

Reimbursement issues remain a substantive challenge to providing home hemodialysis to a wider ESRD population. 

While the CMS has been supportive of home hemodialysis on one level, the inconsistencies in the medical justification and educational provisions make reimbursement for home hemodialysis unpredictable.  Nephrologists’ hesitancy to go ‘all in’ to advocate for a new modality is understandable if the community has going payment rate and reliability concerns.

At Nxstage, we believe in both the technology and patient benefits home hemodialysis provides.  We have made substantive inroads in closing the payer coverage gap, most notably when United Healthcare published a medical coverage policy update that provides payment for more frequent home hemodialysis.  We are confident that with continued education of all members of the kidney care community, more ESRD patients will choose home hemodialysis as their preferred dialysis modality.