When CMS authorized outpatient dialysis centers to provide treatment for Medicare beneficiaries with acute kidney injury (AKI), it resolved some concerns about access to care for patients. However, it presented some new challenges for dialysis providers.
All too often, AKI patients would have to travel long distances, driving past several dialysis centers, to get to a facility that could manage their care on an outpatient basis, worsening the burden of their illness. As an academic medical center treating patients with AKI on an outpatient basis, the patients were seen every treatment by the physician and had individualized plans of care. This was felt to be one of the reasons for high rates of recovery in the medical center, where we saw 42% of patient regain kidney function within 90 days.
With the ability to now dialyze AKI in any in-center hemodialysis facility alongside ESRD patients, there was much greater access to care for this population. But there was some concern that the patients would receive less individualized care, and perhaps we would see a decline in the rate of recovery. However, through education of team members and close oversight by the physicians using the same protocol as used earlier in the medical center, UVA continues to see the kidney recovery rates in our outpatient clinics: greater than 40%, or 1 in every 2.5 patients within 90 days.
As it appears now, the early results demonstrate that you can provide care for this patient population in a more economical manner, without any decline in outcomes. It would be helpful for CMS to do a claims analysis to see if these statistics are consistent for all patients with a diagnosis of acute kidney injury requiring dialysis before and after the change in regulations.
Deborah A. Cote, MSN, RN, CNN NE-BC
Administrator, Dialysis Program
University of Virginia Health System
Editorial Advisory Board member, Nephrology News and Issues
Disclosures: Cote reports no relevant disclosures.