MEDICARE ANNOUNCES STRONG GAINS IN CARE FOR PATIENTS WITH KIDNEY DISEASE
The Centers for Medicare & Medicaid Services (CMS) today reported significant progress in improving care for patients with kidney disease, exceeding the Nation’s Healthy People 2010 goal for vascular access for kidney disease 5 years ahead of schedule.
For the fourth quarter of 2005, the fistula adoption rate for American kidney patients reached 41 percent, which represents an increase of 24 percent over the baseline rate of 33 percent in 2003.
This achievement is largely due to the work of the national Fistula First Breakthrough Coalition, a group of kidney disease stakeholders, including CMS, that is working together to improve and extend lives for thousands of people living with chronic kidney disease.
“The Fistula First coalition has made lifesaving progress since it began,” said CMS Administrator Mark B. McClellan, M.D., Ph.D. “Fistulas reduce serious infections, complications leading to hospitalizations, and mortality often associated with other forms of vascular access for kidney patients. This is a model of how we can work together to improve health and reduce costly complications.”
Fistula First addresses the urgent need for patients who suffer from End Stage Renal Disease (ESRD) to have safer, higher-quality access to hemodialysis through a fistula—a "connection" surgically created by joining a vein and an artery in the forearm that allows blood from the artery to flow into the vein for safe and easy access for dialysis. It is a key component of CMS’ push to make the American healthcare system more patient-centered.
“By providing a method of dialysis that is safer, longer lasting, and less likely to cause infection, fistulas are seen as the gold standard for vascular access,” said Barry Straube, M.D., acting CMS Chief Medical Officer and nephrologist.
“The Fistula First initiative is an excellent example of how real improvements can be made in our healthcare system by working with providers to change processes, impart knowledge and increase education on state of the art techniques,” Dr. Straube said.
Patients who receive dialysis with an access method other than a fistula have a 20 to 70 percent greater chance of death in the first year after their placement. In addition, fistulas cost less to place and maintain than other forms of access and are associated with less rework and complications requiring hospitalization.
“Fistulas make a real, proven difference in the health of dialysis patients -- and also save taxpayer money,” said Brenda Dyson, President of the American Association of Kidney Patients (AAKP). “AAKP's commends CMS's leadership in mobilizing the kidney community to improve fistula use --- and CMS's demand for better patient care!”
Partner involvement and support has also been a critical component in making the Fistula First initiative a success. By marshalling the knowledge and leadership of organizations and experts throughout the renal community, CMS has identified and put into place key practices to jumpstart the rate of fistula adoption.
“The Fistula First Coalition is one of the nation’s most innovative and effective quality improvement activities, and the Institute for Healthcare Improvement (IHI) is proud to have been associated with it from the start,” said Don Berwick, M.D., M.P.P., President and CEO of the IHI. “The Coalition shows how members of a healthcare community, in this case the ESRD community, can bring distinct experiences and capabilities, along with proven improvement methods, to achieve a common goal.”
Physicians on the frontlines providing care echo Berwick’s sentiment. “As a small town doctor, I feel honored to be part of this initiative,” said Dr. Vo Nguyen of Olympia , WA , a nephrologist who has over 90% of his patients dialyzing with a fistula. “It is unthinkable to keep more than half of our citizens on dialysis with substandard vascular access, exposing them to higher risks of death and complications.”
As part of the CMS efforts to improve patient outcomes and align them with payment systems, the Agency has also implemented various pilot demonstration projects that include explicit quality incentives for providers. These projects make quality incentive payments based on a variety of performance measures, including measures related to establishing and maintaining vascular access.
As part of one of these demonstration projects, Kaiser Permanente of Southern California is one partner experiencing the combined clinical success and cost savings envisioned by CMS with Fistula First. “Since working with Medicare in a Managed Care Demonstration Project, we have been able to align our payment system with high quality outcomes and accelerate improvement,” said nephrologist Peter Crooks, Kaiser Permanente Renal Program.“Now over 65% of our hemodialysis patients have a fistula.”
The coalition’s goal is 66 percent fistula adoption by 2009. Vascular access complications account for 16 to 25 percent of all hemodialysis patient admissions,contributing to about $1.5 billion in Medicare costs annually. McClellan added that CMS is committed to further collaborative steps on reporting and payment systems that provide more support for improving quality and reducing overall Medicare costs.
For more information on Fistula First, please visit www.fistulafirst.org or http://www.cms.hhs.gov/ESRDQualityImproveInit/04_FistulaFirstBreakthrough.asp