Medicare Compliance & Reimbursement

New CMS program sings the praises of a safer, more cost-effective kind of access.

Providers placing fistulas for dialysis will now have more opportunities to conduct that procedure, thanks to an initiative launched by the Centers for Medicare & Medicaid Services April 14.
 
Through a contract with the Institute for Healthcare Improvement, CMS hopes that "Fistula First" will significantly increase the use of fistulas in hemodialysis for Medicare beneficiaries with end stage renal disease, and take a bite out of the burgeoning costs and health risks associated with more commonly used grafts and catheters.

"Fistulas are the 'gold standard' for establishing access to a patient's circulatory system in order to provide life-sustaining dialysis," says CMS Administrator Mark McClellan. "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."

And with 270,000 beneficiaries currently on dialysis, with twice that number expected by 2010, "Fistula First" could avert a healthcare crisis. The National Kidney Foundation's Dialysis Outcomes Quality Initiative recommends placement of fistulas in 50 percent of new dialysis patients with a long-range usage goal of 40 percent overall. CMS estimates the number of current beneficiaries with fistulas at only 30 percent.

"We have a huge challenge ahead ... in changing practice to assure that AV fistulas are the first choice for every eligible patient." says Cathy Lewis, RN, chair of the Patient and Family Council of the National Kidney Foundation.

Under CMS supervision and funding, the "Fistula First" project team will be working with dialysis providers, physicians, professional societies and patient advocacy groups to press for an overhaul of dialysis protocols.

"One way this can be fostered is by making visible the successes of early adopters," says IHI improvement advisor Kevin Nolan. "Those practitioners and stakeholders who are first to follow the new recommendations and who generate clear improvement results ... can provide other practitioners with encouragement and practical know-how for implementing the recommended changes."

Lesson Learned: Providers using fistula-access dialysis have the all-clear sign to continue expanding that practice.