By Kasia Michalik
If you ask a nurse, physician, administrator, technician, or anyone else in the renal community they will all tell you that there is always room for change and improvement for patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) to receive the best care.
Barry Straube, MD, director of the Marwood Group and former chief medical officer for the Centers for Medicare & Medicaid Services (CMS), talked about important issues that had yet to be addressed during the last day of the National Renal Administrators Association (NRAA) conference on Friday, October 12.
He said he feels that there are some clinical outcomes that haven't been addressed, such as: volume control, dialysis time, patient rehabilitation, quality of life, and functional status. In addition to those listed above, ESRD costs are growing and a continued burden on those with the disease.
Although a majority of ESRD patients are using Medicare as a primary source of insurance, those non-Medicare patient rates are growing.
There's no doubt that ESRD care is improving when it comes to keeping patients alive, he said, but transplantation is not keeping pace with the growing numbers and CKD identifications and management is lacking.
Less than one percent of ESRD patients are represented as Medicare patients, Straube added, but they account for 6.2 percent of total Medicare costs. In addition, peritoneal dialysis (PD) and home hemodialysis (HHD) cost less but are used less.
Straube said there has been improvement made in anemia management, dialysis adequacy in terms of solute, all-cause mortality and hospitalization, and some preventive services like immunizations. Although those improvements have been made, significant gaps remain such as infections, fluid control, cardiovascular disease, nutrition, patient safety, and options to in-center dialysis such as PD, HHD or transplantation.
"I want to add that, whether you know or not, with my new career I deal with investors on Wall Street and around the world and they're very interested in what the U.S. state of medicine is doing," Straube said.