Medicare hopes to boost better option for dialysis

Initiative will seek help from primary care doctors to ensure that chronic kidney disease patients get timely referrals.

By Markian Hawryluk, AMNews staff. May 17, 2004.

Washington -- Medicare is trying to fundamentally change the standard of care for patients with end-stage renal disease, and it is reaching out to primary care physicians and specialists for help.

The motivation for the initiative is both to improve the quality of patient care and to save Medicare money. The effort could have an enormous impact. About 270,000 Medicare beneficiaries currently receive dialysis treatment, and the number is expected to double by 2010. Because ESRD patients automatically qualify for Medicare, the program bears the brunt of dialysis costs.

The plan, announced in April by the Centers for Medicare & Medicaid Services, focuses on the way doctors establish vascular access for dialysis patients. Most U.S. surgeons opt to use arteriovenous grafts or hemodialysis catheters, even though AV fistulas are typically a clinically superior method.

In the United Kingdom and Japan, where budgetary pressures forced physicians to turn to fistulas long ago, grafts are more the exception than the rule. But in the United States, fewer than a third of Medicare dialysis patients have an AV fistula.

The goal of the effort, called the Fistula First campaign, is use of fistulas in at least half of new dialysis patients.

"Fistulas are the gold standard for establishing access to a patient's circulatory system in order to provide life-sustaining dialysis," CMS Administrator Mark McClellan, MD, PhD, said in announcing the initiative. "They last longer, need less rework, and are associated with lower rates of infections, hospitalization and death for Medicare beneficiaries than other types of access."