title: Medicare reimbursement policies and hemodialysis vascular access outcomes: a need for change.
abstract: In March 2010, the Center for Medicare and Medicaid Services (CMS) convened several clinical technical expert panels (C-TEP) to provide recommendations for improving various aspects of hemodialysis management. One of the C-TEPs was tasked with recommending measures to decrease vascular access-related infections. The members of this C-TEP, who are the authors of this manuscript, concluded unanimously that the single most important measure would be to remove financial and regulatory barriers to timely placement and revision of hemodialysis fistulas and the concurrent avoidance of catheter use. The following position paper outlines the financial barriers to improved vascular access outcomes and our proposals for a future CMS demonstration project.
authors.affiliation: Division of Nephrology, University of Alabama at Birmingham, 1530 Third Avenue S., Birmingham, AL 35294, USA. mdallon@uab.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Allon
authors.forename: Lesley
authors.initials: L
authors.lastname: Dinwiddie
authors.forename: Eduardo
authors.initials: E
authors.lastname: Lacson
authors.forename: Derrick L
authors.initials: DL
authors.lastname: Latos
authors.forename: Charmaine E
authors.initials: CE
authors.lastname: Lok
authors.forename: Theodore
authors.initials: T
authors.lastname: Steinman
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control; D057785:Catheters / Q000009:adverse effects / Q000382:microbiology; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D006291:Health Policy / Q000639:trends*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D007674:Kidney Diseases / Q000628:therapy*; D006278:Medicare / Q000191:economics*; D017063:Outcome Assessment, Health Care / Q000191:economics*; D006435:Renal Dialysis / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D014481:United States