Pol­icy changes in kid­ney care would boost qual­ity, cut costs

Modern Healthcare - - COMMENT -

The re­cent ar­ti­cle on the risks as­so­ci­ated with catheter use for pa­tients re­quir­ing dial­y­sis (“Dial­y­sis pa­tients get sub­stan­dard care de­spite guide­lines,” ModernHealthcare.com, June 23) didn’t iden­tify pol­icy so­lu­tions that could re­duce catheters and lead to in­creased use of grafts and fis­tu­las, the pre­ferred forms of dial­y­sis ac­cess.

While the Fis­tula First cam­paign cre­ated long-over­due aware­ness about the ad­van­tages of per­ma­nent ac­cess and helped drive its in­creased use, more needs to be done to ac­cel­er­ate the pace of change. Kid­ney Care Part­ners, the na­tion’s lead­ing kid­ney-care coali­tion that ad­vo­cates for pa­tient-cen­tric fed­eral pol­icy, has urged the CMS to dis­in­cen­tivize the use of catheters through dif­fer­en­tial weight­ing of the CMS mea­sure in the qual­ity in­cen­tive pro­gram. Sim­i­larly, we have ad­vo­cated cre­at­ing a graft mea­sure to in­cen­tivize this form of per­ma­nent ac­cess, which can avoid the sit­u­a­tion where pa­tients who are not good can­di­dates for a fis­tula fall back to catheter use.

These two com­mon-sense ad­just­ments to fed­eral pol­icy can de­crease the use of catheters, which is good for pa­tients and ul­ti­mately good for Medi­care, since the timely in­ser­tion of per­ma­nent ac­cess—ei­ther a fis­tula or a graft—re­duces the po­ten­tial for in­fec­tions and in­creases pa­tient sur­vival and qual­ity of life.

Dr. Ed­ward R. Jones Chair­man, Kid­ney Care Part­ners Washington, D.C.

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