Rural Health at Risk: The Need to Reinstate Home Kidney Disease Testing

Chronic Kidney Disease (CKD) presents a formidable challenge, particularly for rural populations who are disproportionately affected by limited access to healthcare resources, socioeconomic disparities, restricted access to healthy food options, and higher rates of comorbidities like diabetes and hypertension. The consequences of undiagnosed CKD are severe, leading to increased morbidity, mortality, and healthcare costs in these underserved communities.

A recent Wall Street Journal editorial titled “Bureaucrats vs. Kidney Patients” sheds light on a troubling decision by the National Committee for Quality Assurance (NCQA) to limit kidney testing, which could disproportionally disadvantage rural patients. Less than a year ago, the NCQA, which sets quality metrics for health plans and providers, removed a guideline-compliant screening test for kidney disease. The quality metrics are linked to financial incentives, especially for Medicare Advantage plans, and the removal of the test from its list of approved tests for people with diabetes will limit options for the most at-risk group. 1 in 3 Americans with diabetes will likely develop CKD.

Kidney disease is the fastest-growing non-communicable disease in the U.S., with thirty-seven million Americans affected by chronic kidney disease. However, 90% are unaware of the disease until it’s too late. A simple urine test that can detect kidney damage and is often the earliest indicator of kidney disease has been a convenient tool for early detection. It is particularly beneficial for those in 61 million Americans who live in rural areas where access to laboratory tests and medical services is often limited and challenging.

The Wall Street Journal reports that the decision to remove the accessible testing option, that could be done at the doctor’s office or the home, and restrict testing to be lab-based only, cited a coding error. The decision, which was challenged by experts, seemed rooted in bureaucratic procedures rather than patient care.

For many rural populations, lab testing is significantly limited and can require great travel distance which is why guidelines recommend using point-of-care kidney testing when lab testing is limited, which is more accessible and can be done at home or the doctor’s office. For patients in rural areas, lab tests can require significant travel and time off work, creating substantial barriers to care and significant delays where a more accessible test can facilitate a diagnosis and a path for treatment.

Dr. George Bakris, a leading expert in the field, and a co-author of the American Diabetes Association guidelines has criticized the NCQA’s decision, emphasizing that a point of care test is “dramatically better” than no test at all. Eliminating accessible and home kidney testing options risks rural patients undiagnosed when testing can help them get on a path to treatment, avoiding dialyses and waitlists for kidney transplants. The CKD crisis in the U.S. already cost Medicare over $153 billion in 2022.

The decision to exclude this critically accessible test to one of the country’s leading causes of death, despite endorsements from top kidney experts, is a step backward. NCQA overlooks the impact of this decision on rural communities, which risks widening existing health disparities and leaving behind those most needing accessible and frequent screenings.

Given the disproportionate impact on rural populations, policymakers must take action. We urge the Congressional Rural Caucus to advocate for reinstating point of care testing in the NCQA’s quality metrics. Ensuring that all individuals, regardless of their geographic location, have access to timely and accurate CKD screening is crucial for advancing health equity and improving outcomes for millions of Americans.

By prioritizing comprehensive, broad, and accessible screening strategies, we can prevent CKD progression, reduce healthcare costs, and, most importantly, save lives. It is time to prioritize patient needs and ensure that the tools necessary for early detection and management of CKD are available to all.