This article is more than 5 years old. Information may no longer be current.
The search continues for optimal dialysis
Click Here to Manage Email Alerts
Think of any product you would buy or service you would request from a vendor and being told it can be done with an “adequate” result. You agree to that level of quality and sign the agreement.
That has been the standard goal set forth and the basis for scientific formulas and payer definitions for many years when describing treatment for ESKD.
Indeed, the Kt/V measure to define adequacy does not reflect the work ethic of the kidney care professional — the multidisciplinary team of nephrologists, nurses, dietitians, patient care and biomed technicians and social workers who try to give patients in their charge the best possible dialysis they can in the time they have allotted. Chronic illness requires ongoing attention to patient care, both in the clinic and at home, but payment restraints push providers to the most efficient model available: in-center dialysis. That is why close to 90% of the 500,000-plus patients with kidney failure sit in a chair three times a week to have the product and service deliver “adequate” dialysis.
However, there is new interest in doing more and doing better — going beyond saving lives to restoring health, and the tools are starting to arrive to accomplish that.
The federal government supports innovation, like the use of artificial intelligence and telehealth. Legislation approved this year gives health care programs more flexibility in applying telemedicine to routine care and getting paid for the time spent with patients. Our Viewpoint article this month (page 11) discusses how this is a perfect solution for patients on dialysis in rural areas. However, nephrologists need to embrace it, and dollars need to be spent on infrastructure and equipment to make it happen.
Patients need to be offered the full array of therapy options. We heard good news in the last month that the Medicare Administrative Contractors (MACs) are backing down on restricting payment for more frequent dialysis (MFD). That came about after a groundswell of protest from patients, providers and manufacturers, and it convinced the MACs to reverse course on more stringent documentation for justifying MFD.
Embrace innovation that makes dialysis safer and easy to use. KidneyX has a long way to go toward providing financial resources for inventors; the $75,000 awards handed out last month – 15 total – may be enough to cover a down payment on some basic equipment and renting a facility. However, research is not cheap and takes many years of development. New device approval in the United States from the FDA can take an average of 7 years. Will that change if government itself has some “skin in the game” and is pressing investors to develop new devices for improving kidney care?
Do not just “speak” integrated care, make it happen. The renal community is awaiting details on announcements by HHS Secretary Alex Azar and others on creating a smooth clinical superhighway between the care of patients diagnosed with CKD and the eventuality of kidney failure. Along the way, there are options for pre-emptive transplants, perhaps intermittent dialysis with a wearable kidney and pharmacotherapy that can treat early signs of CKD. How will this be structured and reimbursed? Details are needed.
We are now near the completion of the 5-year Comprehensive ESRD Care Project, an ACO-modeled program focused on the idea that treating kidney disease can improve with a “seamless care” approach of patient management, not just ESRD management. So far, the public has only seen one report on the status of this program, little else. Will CMS breathe more life into it for another 5 years? The project involves more than 30,000 patients on dialysis.
There are lots of options on the table to take kidney care from “adequate” to “optimal.” Time to put them to good use.
- For more information:
- Mark E. Neumann is the Editor-in-Chief of Nephrology News & Issues.
- Reference:
- Van Norman G. Jrnl of Am. Col of Cardiology;2016;doi:10.1016/j.jacbts.2016.03.002.