End stage renal disease esrd program

CMS reevaluates the quality improvement activities in the contract and the goals the Network Organization are required to meet annually. The current contract for the Network Organizations has quality improvement activities designed to decrease the rate of blood-stream infections, increase the rate of kidney transplants, and increase the rate of patients dialyzing at home on a national scale.

The Network Organizations must choose a fourth quality improvement activity from: decrease number of dialysis patients being hospitalized, increase the number of patients that have a plan of care to address pain or depression, or increase the number of patients that are receiving assistance to return to work.

The Network Organization have always engaged patients, but this contract has specific requirements to engage patients and caregivers in quality improvement activities and other activities. The Network Organizations promote improved communication between patients and dialysis providers.

However, patients can always call Network Organizations to resolve grievances and access to care issues between patients and dialysis facilities. Your Medicare Rights and Responsibilities. Advance Directives Resource Center. Centers of Medicare and Medicaid Services Forms. Appendix H State Operations Manual. Nocturnal intermittent peritoneal dialysis NIPD is a machine-aided form of peritoneal dialysis. Transplantation dates back to , when the first successful transplant was performed on identical twins.

Successful transplants of kidneys from cadavers began in the early s. A successful transplant relieves the patient of the necessity of dialysis and usually improves the quality of life. At the time of the initiation of the program in , transplantation was considered to be a bridge therapy between periods of dialysis Kasiske et al. However, due to greatly improved graft success rates, transplantation is generally considered to be the optimal therapy for most patients.

Although the basic entitlement provisions of the legislation remain in place, there have been a number of legislative changes to the program over the years. The original legislation had limited Medicare entitlement to 1 year following a successful transplant.

This was extended in to 3 years, although many successful transplant recipients remain on Medicare after this point because they qualify under the disabled or age provisions of Medicare. In addition, the provisions increased coverage of kidney acquisition costs and provided for more complete coverage of home dialysis costs. MSP provides that, if a beneficiary has insurance other than Medicare, then the other insurer is responsible for medical costs prior to Medicare. Subsequently, it was raised to 18 months in , and then 30 months in In addition, OBRA resulted in the development of the composite rate payment system for dialysis.

This included an exceptions process which results in even higher payment levels, primarily to hospital-based facilities.

These rates remained largely unchanged until the Balanced Budget Refinement Act of , which increased the rates by 1. The development of quality of care measures did not take place in a vacuum. In , the National Kidney Foundation published the Dialysis Outcomes Quality Initiative, a set of guidelines for adequacy of hemodialysis, adequacy of peritoneal dialysis, vascular access procedures, and treatment of anemia National Kidney Foundation, Based on these previous efforts, HCFA has developed a set of 16 performance measures.

As previously noted, prior to the enactment of the legislation creating the ESRD program, there were severe limits on the number of persons who received treatment. As a result, the ESRD patient profile prior to was much different than it became under Medicare. In , the dialysis population was predominantly male 75 percent , overwhelmingly white persons 91 percent , and very young 7 percent over the age of By , there were equal proportions of males and females, black persons accounted for 35 percent of patients, and 46 percent of the dialysis population were over the age of 55 Evans, Blagg, and Bryan, In addition to providing access to treatment more in line with the underlying renal disease burden, Medicare coverage greatly expanded the number of patients receiving treatment.

Early estimates of the program were that as many as 10, new patients would initiate therapy each year and that the program would level out at about 35, beneficiaries Klar, Program enrollment has far outstripped initial estimates. Program incidence number of new patients each year was over 14, in , approximately 32, in , approximately 65, in , and reached 75, in —over 7 times the initial estimates. The reasons for this increase are not well understood and are generally referred to under the designation of expanded acceptance criteria.

Expanded acceptance treatment criteria are evident in two major areas—age and diabetes. In one-fourth of newly treated patients were 65 years or over. By , well over one-half of new patients were 65 years or over at the time of renal failure. In the years before the Medicare ESRD program, diabetes was usually considered a contraindication to treatment.

By , persons whose renal failure was due to diabetes still accounted for only 10 percent of new patients. In , 45 percent of new patients had renal failure due to diabetes. This expansion has occurred without specific design or intent. It appears that, as nephrologists and dialysis centers became more successful at treating these more fragile patients, referrals for treatment increased accordingly. As previously noted, the two basic therapies are dialysis and transplantation.

From the beginning of the program until the mids, there were rapid increases in both the number of transplants and in transplant success rates Hariharan et al. As a result, the percent of patients with a functioning kidney transplant more than doubled, from 10 percent to 22 percent by Eggers, Since , growth in the number of transplants has slowed, largely because of the limitation in the number of donated cadaver kidneys.

Much of the growth in the number of transplants in recent years is due to increasing numbers of living donor transplants. Living donors accounted for 20 percent of all kidney transplants in and 34 percent in Thus, despite the fact that transplant success rates are improving, the ever increasing dialysis population has offset these transplant gains.

From to , the percent of Medicare ESRD beneficiaries with a functioning graft has remained largely unchanged.