The Value of Primary Care Provider Involvement in the Care of Kidney Failure Patients on Dialysis

Ahmed, Salman; Mendu, Mallika L.

doi:10.2215/cjn.01370220

Cited by 1 publication

(1 citation statement)

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“…PCPs need a basic understanding of the different modalities of KRT and the steps for evaluation. Currently, PCPs lack the training (34) to become the key advisors on KRT decisions, despite their potential greater insights into individual patients’ goals and broader health and social factors than nephrologists. Electronic health records (EHR) may provide the nexus for education and dialogue between providers and patients.…”

Section: Operationalizing the Modelsmentioning

confidence: 99%

Keys to Driving Implementation of the New Kidney Care Models

Kshirsagar

Weiner

Mendu

et al. 2022

CJASN

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Contemporary nephrology practice is heavily weighted toward in-center hemodialysis, reflective of decisions on infrastructure and personnel in response to decades of policy. The Advancing American Kidney Health initiative seeks to transform care for patients and providers. Under the initiative’s framework, the Center for Medicare and Medicaid Innovation has launched two new care models that align patient choice with provider incentives. The mandatory ESRD Treatment Choices model requires participation by all nephrology practices in designated Hospital Referral Regions, randomly selecting 30% of all Hospital Referral Regions across the United States for participation, with the remaining Hospital Referral Regions serving as controls. The voluntary Kidney Care Choices model offers alternative payment programs open to nephrology practices throughout the country. To help organize implementation of the models, we developed Driver Diagrams that serve as blueprints to identify structures, processes, and norms, and generate intervention concepts. We focused on two goals that are directly applicable to nephrology practices and central to the incentive structure of the ESRD Treatment Choices and Kidney Care Choices: (1) increasing utilization of home dialysis, and (2) increasing the number of kidney transplants. Several recurring themes became apparent with implementation. Multiple stakeholders from assorted backgrounds are needed. Communication with primary care providers will facilitate timely referrals, education, and comanagement. Nephrology providers (nephrologists, nursing, dialysis organizations, others) must lead implementation. Patient engagement at nearly every step will help achieve the aims of the models. Advocacy with federal and state regulatory agencies will be crucial to expanding home dialysis and transplantation access. Although the models hold promise to improve choices and outcomes for many patients, we must be vigilant that they not do reinforce existing disparities in health care or widen known racial, socioeconomic, or geographic gaps. The Advancing American Kidney Health initiative has the potential to usher in a new era of value-based care for nephrology.

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Section: Operationalizing the Modelsmentioning

confidence: 99%