Joshua Rothenberg is the Chief Operating Officer for Dialyze Direct, which is based in Neptune, New Jersey, and provides hemodialysis to people in nursing homes, with plans to expand to residential homes. Recently, President Donald Trump announced an executive order to transform kidney care and shift more than 80 percent of patients on kidney dialysis in clinics to at-home care. We asked Rothenberg to explain the new rules and tell us about Dialyze Direct, which is a member of the Quality Institute.

Can you tell us what prompted you to start the company?

Years ago my mother-in-law was very ill and put on conventional dialysis at an outpatient dialysis center. While the dialysis kept her alive, I saw firsthand how quickly and drastically her quality of life and health declined. I advocated for her to get dialysis at home and multiple dialysis companies refused. Eventually I succeeded and I saw the enormous improvements in her health and quality of life. I reached out to our co-founder and chairman Henry Kauftheil, who had a reputation of establishing great businesses focused on making positive impacts to society. Together, we formed Dialyze Direct with the goal of making this form of treatment accessible to the patients who need it most.

How is dialysis at home different for patients in terms of quality, convenience, and safety?

Our world-renowned clinical team, led by Chief Medical Officer, Dr. Allen Kaufman, and Chief Nursing Officer, Alice Hellebrand, initially built our home dialysis model for the most complicated and costly patients, specifically geriatric dialysis patients residing in nursing homes. Our home dialysis model is gentler on the body and functions more like our actual kidneys function and is more effective in managing fluid levels in patients. We focus on managing the main causes of why these patients are being re-hospitalized at such a high rate in the first place.
We also place a great amount of emphasis in empowering the patient to combat their other co-morbidities and chronic issues. Our model is much more convenient, requires no transportation, and is safer. Our environments are very controlled. We maintain a close to 0% infection rate. We were able to show a 60 percent reduction in dialysis-related hospitalizations. … I can tell you that after my mother-in-law received home dialysis she lost pounds of fluid retained by her body. She was able to get off multiple blood pressure medicines. Most important, she wanted to live again.

Why is dialysis such an important issue for the nation?

The entire U.S. education system takes up 2.6% of the federal budget. Kidney disease alone takes up 1% of the federal budget — mostly patients over the age of 65. The current system is taxing on our health care system and does not necessarily lead to quality care and outcomes. Home dialysis is dramatically less costly in overall costs because there’s no transportation, fewer hospitalizations, and fewer costs for co-morbidities. A recent study found dialysis patients hospitalized more than six times in a year — and many are — can cost $219,000.

What states are you in now and what do you see for the next decade?

We have grown rapidly and so far we’ve dialyzed more than 10,000 patients. We currently operate in New York, Texas, Florida, Pennsylvania, Ohio, Illinois, and Indiana. We expect by the end of the year to expand into Maryland, Tennessee, Missouri, Wisconsin, Kentucky, and Michigan. Our goal is to be available nationally. We are optimistic our application to the New Jersey Department of Health to provide dialysis for nursing home patients in the state will be approved. And we look forward to rolling out our new residential home dialysis model in the future.

Recently the Centers for Medicare and Medicaid Services through an executive order by President Donald Trump changed the rules around dialysis. Can you explain those changes and what they will mean to people who need this treatment?

CMS is changing their reimbursement structure to incentive various stakeholders to increase the availability of home dialysis and kidney transplants in order to realign the federal government’s objectives with the best interests of patients. We are very excited to have led the charge of nursing home dialysis over the past five years and to be part of this major shift over to home dialysis care that will ultimately lead to better outcomes at lower costs — which is what healthcare should be about in the first place.