Peter Grauer, the chairman of Bloomberg LP, the parent company of Bloomberg News, is the lead independent director at DaVita.

Doctors say that home dialysis, while harder to set up and not suitable for every case, is more convenient and easier on patients’ bodies. And it can be less costly to deliver because it eliminates the need for nurses and other fixed costs like real estate.

“There is general sense there is under-utilization of home dialysis and under-exposure to to it,” said Jeffrey Berns, a nephrologist at the University of Pennsylvania. Patients are shunted to dialysis centers as a default, and once on it, they “rarely switch,” he said.

Doctors and nurses aren’t always knowledgeable about the in-home options and go with the easiest choice, especially in cases where patients present to specialists with advanced disease on the verge of dialysis. There may also be a financial incentive to keep the clinics going because some doctors have joint ventures with dialysis centers, receiving a portion of the profits.

Transplants are another area where there is considerable room for improvement. There are nearly 100,000 Americans waiting for a kidney transplant, and only about 20,000 get a transplant annually. Each year, thousands die waiting. In addition to increasing the availability of deceased-donor organs, doctors say there needs to be more education about the possibility of living-donor transplants.

Different Abroad
Kidney-disease treatment doesn’t have to be done the way it is in the U.S. Only 12% of Americans start dialysis treatment at home, compared with 80% in Hong Kong and more than half in Guatemala, Azar said in a March speech where he previewed some of the administration’s plans. Azar’s father suffered from end-stage kidney disease.

“It is under-penetrated right now because the system is dominated by large, for-profit dialysis providers,” said Michael Phillips, a doctor and managing partner at Intermountain Ventures, a unit of the hospital system Intermountain Healthcare.

The Intermountain hospital system has started a project that helps identify kidney patients earlier in the process, and educate them on their options before they need dialysis or a transplant. The goal is to get half of patients who need it using at-home dialysis within the next five years, up from the low teens now, he said.

At Johns Hopkins Medicine, doctors have more than doubled the number of dialysis patients getting in-home care in the past year, through a variety of education and training programs, said Chirag Parikh, head of the nephrology department there.

Ultimately, though, he said what is needed is whole new technology that can make dialysis an easier process on the body.