title: Vascular access for HD: aligning payment with quality.
abstract: The Fistula First Breakthrough Initiative (FFBI) has improved the awareness of the value of fistula creation in patients with end-stage renal disease (ESRD). The FFBI Health Policy Workgroup has been charged with reviewing the relationship of policy and economic issues to this project. This article reviews the efforts and successes of renal community clinical activities and reemphasizes the economic impact of fistula creation and catheter reduction on the health care system. Major obstacles are discussed, and existing tools and efforts designed to address them are outlined. The FFBI Health Policy Workgroup then identifies less frequently recognized barriers to the achievement of the FFBI goals and suggests solutions to them. It concludes that nephrologists need to assume the leadership role and drive fistula creation and central venous catheter reduction to achieve programmatic success.
authors.affiliation: Health Policy Workgroup, Fistula First Breakthrough Initiative, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio 44512, USA. camedia@celvida.com
authors.forename: Chester A
authors.initials: CA
authors.lastname: Amedia
authors.forename: W Kline
authors.initials: WK
authors.lastname: Bolton
authors.forename: Trelles
authors.initials: T
authors.lastname: Cordray
authors.forename: Ray
authors.initials: R
authors.lastname: Hakim
authors.forename: Randy
authors.initials: R
authors.lastname: Howard
authors.forename: Jerry
authors.initials: J
authors.lastname: Jackson
authors.forename: Deuzimar
authors.initials: D
authors.lastname: Kulawik
authors.forename: Maryam
authors.initials: M
authors.lastname: Lyon
authors.forename: David
authors.initials: D
authors.lastname: Mahoney
authors.forename: Anthony
authors.initials: A
authors.lastname: Messana
authors.forename: Allen
authors.initials: A
authors.lastname: Nissenson
authors.forename: Lauren
authors.initials: L
authors.lastname: Oviatt
authors.forename: David
authors.initials: D
authors.lastname: Parlato
authors.forename: Sean
authors.initials: S
authors.lastname: Roddy
authors.forename: Craig
authors.initials: C
authors.lastname: Solid
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000191:economics* / Q000592:standards; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy*; D012052:Reimbursement, Incentive / Q000592:standards*; D006435:Renal Dialysis / Q000191:economics* / Q000592:standards