Funding and planning: What you need to know for starting or expanding a home hemodialysis program Kirsten HOWARD, 1 Phil A. MCFARLANE, 2,3 Mark R. MARSHALL, 4,5 Deborah O. EASTWOOD, 6 Rachael L. MORTON 1,7 1 School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; 2 Division of Nephrology, St Michael’s Hospital, Toronto, Ontario, Canada; 3 Department of Medicine, University of Toronto, Toronto, Ontario, Canada; 4 Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; 5 Department of Renal Medicine, Counties Manukau District Health Board, Auckland, New Zealand; 6 Department of Medicine and Health of Older People, Waitemata District Health Board, Auckland, New Zealand; 7 Nuffield Department of Population Health, Health Economics Research Centre, The University of Oxford, Headington, UK Abstract Planning and funding a home hemodialysis (HD) program requires a well-organized effort and close collaboration between clinicians and administrators. This resource provides guidance on the processes that are involved, including a thorough situational analysis of the dialysis landscape, emphasizing the opportunity for a home HD program; careful consideration of the clinical and operational characteristics of a proposed home HD program at your institution; the development of a compelling business case, highlighting the clinical and organizational benefits of a home HD program; and careful construction and evaluation of a request for proposal. Key words: Home hemodialysis, funding, service planning, program start-up, administrative issues, medical director issues INTRODUCTION Making the correct fiscal case for change is a crucial step in developing a home hemodialysis (HD) program. Smaller programs or pilot projects can often be started and managed within existing hospital HD infrastructure with costs being absorbed into existing funding. Once pro- grams grow to beyond 5–10 patients, however, there is often a requirement for separate and specialized home HD infrastructure and staffing. Figure 1 compares the size of home HD programs between Japan and Australia/New Zealand. 1,2 In Japan, most home HD programs are small and are located within the hospital HD facilities. 1 In Australia/New Zealand, home HD programs are larger and, in most cases, enabled by specialized facilities and personnel. 2 Expanding a home HD program therefore requires substantial resources, and typically this requires a sound business case for financial investment. Functionally, a proposal to start or expand a home HD program can be regarded as a 3-step process: 1. Development of an overarching clinical and strategic framework. 2. Consolidation of these principles into a formal busi- ness case. 3. Execution and handling of a request for proposal (RFP). Correspondence to: M. R. Marshall, MBChB, MPH, FRACP, PO Box 37968, Parnell, Auckland 1151, New Zealand. E-mail: mrmarsh@woosh.co.nz; mrmarshall@middlemore.co.nz Hemodialysis International 2015; 19:S23–S42 © 2015 International Society for Hemodialysis DOI:10.1111/hdi.12243 S23