Misalignment between reimbursement and clinical guidelines for dialysis access intervention is unlikely to improve quality or efficiency of patient care

Abstract

In their article, Madden et al1 have appropriately focused our attention on recent changes in reimbursement for specific procedures used to prolong the lifespan of dialysis arteriovenous fistulae and grafts. In a constantly shifting effort to drive care for these patients to more cost-efficient venues, the Centers for Medicare and Medicaid Services (CMS) reimbursement has resulted in the proliferation of outpatient vascular access centers across the country. The positive aspects of this shift include avoidance of high hospital-based facility fees, preservation of high-capability hospital-based facilities for patients who need to be treated in these facilities, and potentially increasing patient satisfaction in a specialized facility that can expeditiously manage access complications with a team specifically designed for this purpose.