The recent article on the risks associated with catheter use for patients requiring dialysis (“Dialysis patients get substandard care despite guidelines,” ModernHealthcare.com, June 23) didn't identify policy solutions that could reduce catheters and lead to increased use of grafts and fistulas, the preferred forms of dialysis access.
While the Fistula First campaign created long-overdue awareness about the advantages of permanent access and helped drive its increased use, more needs to be done to accelerate the pace of change. Kidney Care Partners, the nation's leading kidney-care coalition that advocates for patient-centric federal policy, has urged the CMS to disincentivize the use of catheters through differential weighting of the CMS measure in the quality incentive program. Similarly, we have advocated creating a graft measure to incentivize this form of permanent access, which can avoid the situation where patients who are not good candidates for a fistula fall back to catheter use.
These two common-sense adjustments to federal policy can decrease the use of catheters, which is good for patients and ultimately good for Medicare, since the timely insertion of permanent access—either a fistula or a graft—reduces the potential for infections and increases patient survival and quality of life.