A Minimum Outcomes bill?

[cschwab]

I've been emailing a long-time member of DE and he suggested it might be a good idea to work on getting a bill for minimum outcome standards.  In order for the center to get paid the full amount dialyzors would have to have, for example, a KTV of 1.4 or higher.  If it was lower, the clinic would get paid on a sliding scale, 95% etc..

I've got some friends involved in politics and I've thought about approaching them with the idea, but I wanted to get some feedback first.

[cschwab]

Looks like a pay-for-performance plan is already in the works!

"CMS has been moving in exactly this direction for some time now. They call it "pay for performance" (P4P). The question is exactly what standards they'll use. Kt/V is actually not all that important--all it measures is removal of urea, a small molecule that is easily removed and doesn't reflect other toxins that are much more harmful. The ESRD Program within Medicare is a microcosm that they seem to be using for studying the bigger picture of healthcare. So, "bundling" came first to ESRD before being imposed on other aspects of health, and P4P will likely come to ESRD first, too.

I'm not sure any other bill is needed, since this is already in the plans."

http://forums.homedialysis.org/showthread.php/2528-A-Minimum-Outcomes-bill

[cschwab]

It doesn't look like pay-for-performance is going as well as hoped for.   I'm reading Medicare wants to look at one lab measurement, which is better than another lab measurement they have been look at (going to KTV rather than URR).  

But here is a comment about KTV:
"It makes very little sense to choose a tiny molecule that freely moves between cell walls as an index of how good dialysis is, when MOST of the molecules that need to be removed to keep you feeling your best are large and/or twisty and complex and much harder to get rid of. Kind of like having a septic tank cleaned by siphoning off the liquid on top while leaving all of the SLUDGE at the bottom..."
http://forums.homedialysis.org/showthread.php/2528-A-Minimum-Outcomes-bill

However we aren't seeing anything that would encourage the LENGTH of treatment:

"We know that 3x/week short treatments (<4 hours) contribute to tens of thousands of needless deaths just in the U.S. So why is this the standard of care? Why isn't there a minimum TIME requirement for treatments?."
http://forums.homedialysis.org/showthread.php/2528-A-Minimum-Outcomes-bill

Beth at Home Dialysis Central also had some good ideas about what should be looked at:
"In my opinion, there is a much better way to tell if patients are receiving optimal dialysis. Instead of using lab tests to measure what's in a a patients' blood, why not ask patients about their physical and mental functioning and how kidney disease affects their life, collect data on the percentage of pediatric patients that are in school, the percentage of working age patients who are working, the percentage of retirees who live active lives, and the percentage of patients who have correctable limitations that have not been addressed?"
http://forums.homedialysis.org/showthread.php/2528-A-Minimum-Outcomes-bill

[angieskidney]

Wow thanks for the links as I don't think a lot of people are aware of this. I remember my KT/V was always around 1.3 to 1.5 and they said that mine was higher than normal and that I was lucky. I never knew what was the ideal number however. I just went by what they said and wondered what effected it. After all I was only doing 3 1/2 hrs 3 times a week. I don't know if anything like this is being looked at in Canada but I think it is great that you brought this topic up. It is very important for overall well-being and normalcy.