Policy changes in kidney care would boost quality, cut costs, and other letters

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.

Dr. Edward R. Jones

Regarding “Free-standing ERs eye lobbying to win state approval for growth” (July 6, p. 14), as a San Antonio physician, I have seen these free-standing emergency rooms pop up every few miles in affluent areas. In a city with plenty of hospitals, I see no valid need for these businesses. Real emergencies should still go to hospital-associated ERs. The other problems can easily be treated at urgent-care centers that are also plentiful and much less expensive than ERs.

As someone who has no financial interests either way, in these times of trying to decrease medical expenses, more patients in ERs will increase healthcare premiums for all of us. Outpatient surgery centers are much less expensive than hospitals and are not analogous to free-standing ERs.

Dr. Robert Luedecke