Telehealth services for home dialysis patients and care for patients with acute kidney injury (AKI) will get a boost from changes to the Physician Fee Schedule and the End-Stage Renal Disease (ERSD) Prospective Payment System (PPS) announced by the Centers for Medicare & Medicaid Services (CMS) in October and November.
The changes, which go into effect in 2017, are part of an ongoing effort by the agency to improve care quality while lowering costs by changing the way care is delivered and clinicians are paid, according to the agency. The changes expand access to outpatient dialysis for patients with acute kidney injury (AKI), encourage telehealth consultations for home dialysis education and advanced care planning, and will allow patients to choose having their nephrologist lead their care.
The new Physicians Fee Schedule will let patients designate their nephrologist as their primary care provider. This allows them to avoid additional visits to a primary care physician on top of coming to a dialysis center three times a week or doing daily home dialysis, said Rajnish Mehrotra, MD, MS, a professor at the University of Washington and nephrology section chief at Harborview Medical Center in Seattle.
“It will be better for patients,” Mehrotra said. “Even nephrologists sometimes lose sight of the enormous burden that the treatment of ERSD places on patients.”
It may also allow nephrologists more time to provide high quality care. For example, Mehrotra noted managing high blood pressure or diabetes requires time for patient education and a good relationship between the patient and the health care team.
It also lays the groundwork for the development of new payment models that will reward nephrologists for coordinating the care of their patients.
“Clearly, this is an area that needs further exploration in demonstration projects, but it seems to be a reasonable first step in recognizing the care that many nephrology practices are already providing,” said Daniel Weiner, MD, MS, associate professor of medicine at Tufts University in Boston.