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Integrated care needs to include a CKD component
To the editor: I applaud your First Word column in the February issue of Nephrology News & Issues entitled “CMS must go beyond new technology to improve kidney care.” You make at least two critical points.
The first is we need to intervene earlier in CKD so that we reduce the number of individuals who go on to ESRD. New models that either incorporate this, or focus on it entirely, must be introduced. I believe we can do more to prevent both CKD and ESRD, and early prevention and intervention are the only ways over the long term that we can achieve this, along with true health care cost reduction. This means more attention needs to be paid to both diabetes and hypertension, which, together, are associated with about 60% of ESRD.
The fact that at least 30,000,000 Americans have CKD of one stage or another emphasizes the importance of prevention, with improved nutrition and physical activity right at the top of the list, diagnosis, and timely intervention. You correctly state that bypassing the major contributors to kidney disease and early stage kidney disease itself in the new models we are creating is like “giving a musician a guitar without strings.” The End-Stage Renal Disease Seamless Care Organization model, as important as it is, does not deal with the problem of kidney disease at the right end of things. We need something more that moves our efforts way upstream, and we need it now.
Your second point regarding paying for more frequent dialysis is on target. I am glad there is some encouraging news regarding flexibility in reimbursement on this front. Renal physiology certainly argues for this, let alone the evidence of patient well-being.
Barry H. Smith, MD, PhD
President and CEO
The Rogosin Institute
Professor of clinical surgery
Attending physician
New York Presbyterian-Weill Cornell Medical Center
New York