title: The future of the end-stage renal disease program.
abstract: The rapidly changing health care environment in the United States will affect the future of nephrology in several areas. Reductions in Medicare spending will affect graduate medical education, physician payments, and, eventually, payments for medical supplies and therapeutic agents. The resource-based relative value system (RBRVS) developed by the Health Care Financing Administration (HCFA) will be implemented over the next 4 years, and it is likely that similar plans will be adopted by other insurance carriers. Under this system, payments for the procedure of dialysis will be substantially reduced--decreases in Medicare reimbursement will range from approximately 30% to 60% depending on geographic location and current charges. However, the current economic pressures may have a beneficial effect on the practice of nephrology by providing an incentive to develop standardized practice guidelines that will eliminate wide variations in practices and minimize unfounded litigation. In the near future, attention must also focus on the training of nephrology fellows; ideas for future directions are presented.
authors.affiliation: Department of Hypertension/Nephrology, Cleveland Clinic Foundation, OH 44106.
authors.forename: E P
authors.initials: EP
authors.lastname: Paganini
mesh_terms: D005544:Forecasting; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D006278:Medicare / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics*; D014481:United States