By Maggie Flynn | April 8, 2021. Find the full article here

For skilled nursing facilities, the ability to treat patients in place has far-reaching implications, perhaps most prominently in reducing unnecessary hospitalizations.

Usually that reduction is framed in terms of cost, with penalties for hospitals and SNFs alike if a patient returns to the acute care setting too soon. SNFs that perform well in preventing resident rehospitalizations can earn bonuses, for instance, through the Medicare Value-Based Purchasing (VBP) program.

But even though controversy exists around the effectiveness of that program, there are other benefits. Institutional special needs plans (I-SNPs), a Medicare Advantage program specifically for residents in long-term care facilities, have pointed to the clinical benefits of treating patients in place in any context, but particularly in times of major contagious illness where any interaction can be risky — and hospitals have sometimes been overwhelmed.

And for the residents themselves, treating in place prevents the hassle — and sometimes the trauma — of going to and from the SNF to a new setting. For some operators, dialysis services present an opportunity for SNFs to expand their ability to treat to patients in place — and find their footing in a post-COVID world.

Home hemodialysis in the skilled nursing setting would allow SNFs to avoid some of those rehospitalizations and improve patient outcomes, even before the pandemic, according to Jonathan Paull, chief compliance officer and general counsel at Dialyze Direct.

By offering this service, SNFs can attract new patients who might need it, in turn, improving their census; the operator SavaSeniorCare, for instance, sees adding dialysis services to its SNFs as a way to strengthen census even amid the changes wrought by the pandemic.

But there’s more to it even than that, Paull told SNN in late March.

“There’s another piece to it as well, what COVID has done to change the health care industry forever,” he said. “And that’s created a larger emphasis on on-site, home-based care. It put that into warp speed, because now everyone sees the benefits of what that means for the patients and for the health care industry. With the increased development of telehealth and everything that has come with that with COVID, the result is that you have a bunch of nursing facilities that are looking to move more services on site, in the nursing facility, as opposed to sending patients out for a service and bringing them back.”

With hospitals increasingly sending patients to the home rather than to the SNF setting, dialysis also provides a chance for SNFs to maximize their reimbursement under the Patient-Driven Payment Model (PDPM), which rewards providers for treating higher-acuity patients — a category that includes those who require dialysis, Josh Rothenberg, the chief operating officer and co-founder of Dialyze Direct noted.

This also makes them more vulnerable to illnesses such as COVID-19, as the Centers for Disease Control and Prevention (CDC) found in summer last year. And for dialysis patients who had to go off-site for their treatment, they had an automatic exposure risk with each trip.

“The fact is no matter how the infection control practices they tried to implement within the nursing home, there was this gap, patients that their lives depended on them going outside to a different facility and mingling with other populations and coming back to the nursing home,” Rothenberg pointed out.

Many SNFs and many states, realizing this, have started to take steps to expand their dialysis offerings. Dialyze Direct in March expanded in the state of Kentucky, after participating in a pilot program for SNF home hemodialysis run by the Bluegrass State’s Department of Health.

This was a six-month program for providers interesting in offering home hemodialysis in SNFs, with each dialysis provider allowed to start in one facility of their choice — though Rothenberg noted that he wasn’t aware of any other company participating in the pilot program. At the end of that time, the state surveyed Dialyze Direct and found it met the benchmarks and quality outcomes it was seeking, though Rothenberg and Paull told SNN they did not know which clinical indicators the state was examining.

Over the course of the pilot, Dialyze Direct worked with six patients; it is now working with a “few dozen” facilities in Kentucky, with a presence in about 125 facilities across its entire footprint: Florida, Illinois, Indiana, Kentucky, Maryland, New Jersey, New York, Ohio, Pennsylvania, Tennessee, and Texas. The company is currently expanding to an additional 170 to 180 facilities, Rothenberg said.

Dialyze Direct is planning this expansion in part because of the demand rising throughout several markets, but also because the Centers for Medicare & Medicaid Services (CMS) is focusing on expanding in-house, staff-assisted home dialysis in the nursing home, Rothenberg said.

One of the clearest indicators of that fact lies in an update to the State Operations Manual — “the Bible of nursing home surveyors,” Rothenberg noted — that CMS made a few years ago. It put an emphasis on the need to educate patients; nursing homes have to educate patients on the ability to have home dialysis on-site, and for any patients who want this service, they must either provide it or move the patient to a facility that can provide it.

For Rothenberg, this is one of the biggest signs of CMS’ focus on providing dialysis on-site.

“One nursing home owner … he told me that pre-PDPM, dialysis was another tool to be able to receive more rehab patients,” he told SNN. “Post-PDPM, it became essential in order to strengthen the financial model of the nursing facilities. Post-COVID, it became almost existential for them to have dialysis on-site.”

Dialyze Direct is pleased to announce the appointment of Stuart Paul as Chief Commercial Officer. Stuart has 25 years of experience in healthcare, with substantial experience managing private and public companies in the renal space.

Previously, Mr. Paul was Corporate Vice President at Abbott Laboratories, a global health care products leader, where he led a $700 million diagnostics business and had responsibility for integrating acquisitions, R&D, manufacturing, and commercial operations. He also served as General Manager at Quest Diagnostics, a global provider of diagnostic testing and information services.  Mr. Paul headed Quest’s $1.4 billion East regional division of the USA, and was responsible for managing all laboratory testing, patient services, logistics and commercial operations.

Mr. Paul also held several key senior operating positions at Gambro AB, a $2 billion global dialysis product and services company, and was part of the executive and private equity team that achieved a strategic exit and $4.3 billion sale of the company to Baxter International. While at Gambro, Mr. Paul was responsible for running and scaling a variety of businesses as Region President, including its $550 million of Asia-Pacific and Americas businesses, which he brought to new levels of revenue and profitability. He served as CEO of Rockwell Medical, a publicly traded company that focuses on the development and commercialization of treatments for anemia and chronic kidney disease. Mr. Paul received his MBA from Northwestern University with a concentration in Hospital & Health Services Management and his BA in Chemistry from Duke University.

Mr. Paul’s focus will be on Dialyze Direct’s commercial opportunities, including in the areas of sales and business development, provider relationships, payor relationships, marketing, and enhancing core value propositions. “Stuart’s proven operating experience in high-growth renal care, with a successful track record of executing commercialization strategies will be an instrumental addition to our leadership team, as we bolster Dialyze Direct’s presence around the country, serving our growing patient-base,” said Henry Kauftheil, Dialyze Direct’s Chairman. “We look forward to working closely with Stuart and leveraging his commercial and operational expertise.”

“I initially joined Dialyze Direct in a consultative capacity and quickly realized how well-positioned the company is for both explosive and profitable growth in providing home-based hemodialysis in the SNF and home markets,” said Stuart Paul. “I was impressed how the team managed through two significant waves of Covid-19 in nursing homes during 2020, and still achieved historically high patient census growth and treatment levels for the year. From my prior experience in dialysis companies, I suspected Dialyze Direct’s unique model significantly improves patient outcomes and recovery times, as well as reduces hospitalizations and costs. I am honored to now join Dialyze Direct as Chief Commercial Officer and to guide its commercial expansion as the US market leader in providing a safer, gentler and overall better home-hemodialysis treatment experience for geriatric patients in skilled nursing and home-care environments.”

Leading Kidney Care Company Continues Expansion of its Crucial Services

Dialyze Direct, a leading kidney care company pioneering breakthrough home-based solutions for patients in skilled nursing facilities (SNFs) suffering from kidney disease, announced today the official expansion of its in-SNF home dialysis model to the state of Kentucky. Dialyze Direct now services eleven states nationwide and continues to grow rapidly. The company’s progression is attributed to the high demand for a revitalized dialysis model to serve medically complex geriatric patients, which currently make up 50% of all dialysis patients.

“Over the past few months, we have had the privilege of working closely with the Kentucky Department of Health by participating in their pilot program for SNF home hemodialysis,” said Josh Rothenberg, Dialyze Direct’s Chief Operating Officer. “As the need for increased dialysis options becomes even more evident during these challenging times, we are proud to be among the first providers to support the substantial high-risk geriatric patient population in skilled nursing homes, for whom on-site care is crucial. There is a huge need for our model in Kentucky, and we are excited to meet it with the very best in-facility home dialysis care,” said Rothenberg.

Dialyze Direct provides comprehensive, turn-key home dialysis solutions that allow patients with end-stage renal disease (ESRD) to take advantage of the latest in patient-centric dialysis care. The company’s initial focus in the home dialysis market is on skilled nursing facilities (SNFs), in which many of the most medically challenging subset of dialysis patients reside. Dialyze Direct’s team of physicians, nurses, technicians, renal dietitians and social workers implement personalized plans of care in coordination with a patient’s primary medical team. This gentler treatment plan that can be provided up to five days per week (pursuant to physicians’ orders) consists of meticulously crafted protocols and procedures, that specifically tackle the unique fluid management challenges of geriatric dialysis patients, resulting in increased overall patient health and reduced hospitalizations. Dialyze Direct’s care model significantly reduces recovery time following dialysis treatments and eliminates the burden and exposure risks of transportation to dialysis clinics, thereby improving patients’ quality of life.

“We are excited to partner with Dialyze Direct to offer seniors a safe and comfortable place to receive dialysis care,” said Jeremy Bischoff, Executive Director of St. Matthews Care Center. “On-site dialysis at St. Matthews eliminates the need for perpetual quarantine that is often a result of a traditional outpatient settings. We are proud to provide an opportunity for dialysis patients to live fuller lives.”

Dialyze Direct’s expansion into Kentucky is part of its current growth strategy to meet increasing demand for in-SNF dialysis services. Kentucky marks the eleventh state in which Dialyze Direct is active, with expansion slated for several additional states within the next year.