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Wish D.,Centers for Dialysis Care Inc | Johnson D.,Dialysis Clinic Inc. | Wish J.,Indiana University
Clinical Journal of the American Society of Nephrology | Year: 2014

After Medicare’s implementation of the bundled payment for dialysis in 2011, there has been a predictable decrease in the use of intravenous drugs included in the bundle. The change in use of erythropoiesis-stimulating agents,which decreased by 37%between 2007, when its allowance in the bundle was calculated, and 2012, was because of both changes in the Food and Drug Administration labeling for erythropoiesis-stimulating agents in 2011 and cost-containment efforts at the facility level. Legislation in 2012 required Medicare to decrease (rebase) the bundled payment for dialysis in 2014 to reflect this decrease in intravenous drug use, which amounted to a cut of 12%or $30 per treatment. Medicare subsequently decided to phase in this decrease in payment over several years to offset the increase in dialysis payment that would otherwise have occurred with inflation. A 3%reduction from the rebasing would offset an approximately 3% increase in themarket basket that determines a facility’s costs for 2014 and 2015. Legislation inMarch of 2014 provides that the rebasing will result in a 1.25% decrease in the market basket adjustment in 2016 and 2017 and a 1%decrease in the market basket adjustment in 2018 for an aggregate rebasing of 9.5% spread over 5 years. Adjusting to this payment decrease in inflation-adjusted dollarswill be challenging formany dialysis providers in an industry that operates at an average 3%–4% margin. Closure of facilities, decreases in services, and increased consolidation of the industry are possible scenarios.Newermodels of reimbursement, such as ESRDseamless care organizations, offer dialysis providers the opportunity to align incentives between themselves, nephrologists, hospitals, and other health care providers, potentially improving outcomes and saving money, which will be shared between Medicare and the participating providers. Copyright © 2014 by the American Society of Nephrology.

Krishnan M.,DaVita HealthCare Partners Inc | Brunelli S.M.,DaVita HealthCare Partners Inc | Maddux F.W.,Clinical and Scientific Affairs | Parker T.F.,Renal Ventures Management | And 4 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2014

The Centers for Medicare and Medicaid Services oversees the ESRD Quality Incentive Program to ensure that the highest quality of health care is provided by outpatient dialysis facilities that treat patientswith ESRD. To that end, Centers for Medicare and Medicaid Services uses clinical performance measures to evaluate quality of care under a pay-for-performance or value-based purchasing model. Now more than ever, the ESRD therapeutic area serves as the vanguard of health care delivery. By translating medical evidence into clinical performance measures, the ESRD Prospective Payment System became the first disease-specific sector using the payfor- performancemodel. Amajor challenge for the creation and implementation of clinical performancemeasures is the adjustments that are necessary to transition from taking care of individual patients to managing the care of patient populations. The National Quality Forum and others have developed effective and appropriate population-based clinical performancemeasures quality metrics that can be aggregated at the physician, hospital, dialysis facility, nursing home, or surgery center level. Clinical performance measures considered for endorsement by theNational Quality Forumare evaluated using five key criteria: evidence, performance gap, and priority (impact); reliability; validity; feasibility; and usability and use. We have developed a checklist of special considerations for clinical performance measure development according to these National Quality Forum criteria. Although the checklist is focused on ESRD, it could also have broad application to chronic disease states, where health care delivery organizations seek to enhance quality, safety, and efficiency of their services. Clinical performance measures are likely to become the norm for tracking performance for health care insurers. Thus, it is critical that the methodologies used to develop such metrics serve the payer and the provider and most importantly, reflect what represents the best care to improve patient outcomes. © 2014 by the American Society of Nephrology.

Wise M.E.,Centers for Disease Control and Prevention | Lovell C.,Dialysis Clinic Inc.
Seminars in Dialysis | Year: 2013

The US Centers for Disease Control and Prevention has conducted public health surveillance for healthcare-associated infections (HAIs) in dialysis facilities since the 1970s, evolving from facility-level surveys to patient-level surveillance systems. The Centers for Medicare and Medicaid Services (CMS) recently implemented incentives for all end-stage renal disease (ESRD) facilities to monitor and report patient-level quality indicators to the Centers for Disease Control and Prevention's (CDC's) National Healthcare Safety Network (NHSN) in accordance with the NHSN Dialysis Event Protocol. These CMS incentives have led to a rapid increase in dialysis facility NHSN enrollment during 2012. Ongoing challenges to HAI surveillance in this setting include variability in the surveillance process, assurance of data quality, and staff time and resource requirements. Use of existing electronic health records (EHR), especially in conjunction with detection algorithms, has increasingly been shown to produce valid and reliable estimates of HAI frequency in acute care hospitals. Given the large number of dialysis facilities that are now beginning to conduct surveillance using NHSN, the typical lack of dedicated infection prevention personnel in those facilities, and the widespread use of EHR in large dialysis provider organizations, the use of EHR will probably become a cornerstone of surveillance in these settings. Implemented properly, the use of EHR to support public health surveillance has enormous potential to focus and strengthen infection prevention activities in dialysis facilities. Systematic, ongoing validation efforts will be vital to ensure that reported data are accurate, permit valid comparisons of facility performance, and effectively support improved outcomes for dialysis patients. © 2013 Wiley Periodicals, Inc.

Dialysis Clinic Inc. | Date: 2016-03-01

Biological tissue grafts; Biological organs, eye tissue, corneas, musculoskeletal tissue, skin, and other human tissue intended for subsequent implantation; Human allograft bone and tissue. Medical services in the field of organ and tissue donation, namely, obtaining consent, conducting donor screening and providing donor medical data; Organ and tissue bank services; Providing information in the field of organ and tissue donation.

Weiner D.E.,Dialysis Clinic Inc. | Brunelli S.M.,DaVita Clinical Research | Hunt A.,DaVita Clinical Research | Schiller B.,Satellite Healthcare Inc | And 5 more authors.
American Journal of Kidney Diseases | Year: 2014

Addressing fluid intake and volume control requires alignment and coordination of patients, providers, dialysis facilities, and payers, potentially necessitating a "Volume First" approach. This article reports the consensus opinions achieved at the March 2013 symposium of the Chief Medical Officers of 14 of the largest dialysis providers in the United States. These opinions are based on broad experience among participants, but often reinforced by only observational and frequently retrospective studies, highlighting the lack of high-quality clinical trials in nephrology. Given the high morbidity and mortality rates among dialysis patients and the absence of sufficient trial data to guide most aspects of hemodialysis therapy, participants believed that immediate attempts to improve care based on quality improvement initiatives, physiologic principles, and clinical experiences are warranted until such time as rigorous clinical trial data become available. The following overarching consensus opinions emerged. (1) Extracellular fluid status should be a component of sufficient dialysis, such that approaching normalization of extracellular fluid volume should be a primary goal of dialysis care. (2) Fluid removal should be gradual and dialysis treatment duration should not routinely be less than 4 hours without justification based on individual patient factors. (3) Intradialytic sodium loading should be avoided by incorporating dialysate sodium concentrations set routinely in the range of 134-138 mEq/L, avoidance of routine use of sodium modeling, and avoidance of hypertonic saline solution. (4) Dietary counseling should emphasize sodium avoidance. © 2014 National Kidney Foundation, Inc.

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