Surviving Future Vascular Access Reimbursement Reductions

Beginning in 2007, vascular access reimbursement rates have experienced significant reduction with more proposed in 2010. Many vascular access center owners are concerned about their ability to continue to treat patients in this reimbursement environment. This begs the question, “What should operators do now to survive future reimbursement reductions?”

The closure of vascular access centers due to reimbursement reductions is not a desirable outcome. Freestanding access centers provide convenient high quality care at costs lower than hospital. With a focus on fistulas, these centers serve an important role in salvaging and maintaining fistulas. In order to meet Kidney Disease Outcomes Quality Initiatives (KDOQI) guidelines and the Centers for Medicare & Medicaid Services (CMS) stretch goal of increasing the percentage of hemodialysis patients using fistulas to 66 percent by 2009, it is important that the maximum number of fistulas be created. Early failure, or failure of the newly created fistula to develop adequately for use, has always been a problem. As efforts to create more fistulas have intensified, it appears that the incidence of early failure has increased. In fact, the medical literature indicates that 20-50 percent of fistulas that are created never function, or fail within a very short period. These failed fistulas can be treated with a high expectation of success. This treatment is often performed at vascular access centers. Freestanding access centers play an important role in promoting fistulas and fistula prevalence has increased as the number of access centers has increased.

Access centers play an important role in kidney care and their continued presence in the kidney care value chain is important. The reality, however, is that all payers are looking for ways to reduce costs. There are several things vascular access centers need to do to protect their ability to continue to provide valuable services to their patients: Centers that will thrive must have superior cost structures, and the industry as a whole will need exceptional stakeholder engagement and support.