|| Summary of the Forum of ESRD Network's 4th Annual Creating a Culture of Quality Conference
The conference was convened in Baltimore on March 23-24, 2015. Link to PDF document download.
Editor's note: There are some good points here, but it fails to address the two long-term causes of stagnant
dialysis care in the U.S. These causes remain outside the control of any quality improvement group.
The first is that CMS and U.S. nephrology have never approached working-age dialysis patients differently than elderly dialysis patients. By lumping them all together, the only issues that get addressed are mortality and hospitalizations and a few others like safety and comfortable chairs. This approach drives almost no changes in technology or dialysis modalities. In terms of patient employment, U.S. dialysis care has gone backwards from where it was forty years ago.
The second is the Stark Law, which permits nephrologists to have ownership stakes in dialysis clinics. The effects of this law have been evolving over the decades. It originally led to the vast overutilization of fast, cheap dialysis treatments. It then led to businessmen usurping control of both dialysis care and medication regimens. Today, as a group, U.S. nephrologists will never take patient advocacy positions that conflict with the interests of their business partners (and/or bosses). The Stark Law was supposed to prevent abuse in the Medicare program. Instead, it has primarily promoted the business interests of dialysis corporations and nephrologists, leading to standards of dialysis care (i.e. enslavement to a life called dialysis) that nephrologists would never accept for themselves or their own family members.
Until the financial incentives are changed to increase dialysis patient employment and rehabilitation, U.S. dialysis care will remain horribly stagnant... and will never be able to attract the best young physicians into this specialty.
New leadership and ideas are needed. To start, I believe U.S. nephrologists owe U.S. dialysis patients a huge apology.