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Physician-driven, Patient-centered Kidney Care

By tHoMAs WAtson, MD
There have been amazing medical advances in recent years – a non-smoking acquaintance in his 40’s was diagnosed with lung cancer several years ago, and instead of a life expectancy of six months, he is living comfortably taking a pill designed for his cancer, for which he had a genetic predisposition. We’ve seen these breakthroughs in many fields of medicine, but unfortunately, advancements in treatment for patients with kidney disease have lagged behind.
Due to the cost and complexity of care of kidney disease patients, one area of innovation in which kidney disease care is becoming a proving ground is care delivery. Patients with chronic kidney disease are generally medically complex, with higher rates of heart disease, cancer, and even gastrointestinal bleeding than the general population. They have significant care coordination needs focused on preventing worsening of kidney disease, preparation for kidney transplant, and unfortunately preparation for dialysis when appropriate.
All of these facets of care require extensive education. There are many appointments required with various specialists at many different facilities (for which patients require something as simple as transportation). Patients with kidney disease often require extensive and complex medication regimens. Hard-working nephrologists cannot provide all of this support alone, and deficiencies in care lead to worse outcomes for patients, increased hospitalizations, and greater cost to the healthcare system as a whole.
CMS and private insurance companies are acutely aware of these problems. As a result of a combination of the Affordable Care Act of 2010 and the Executive Order Advancing American Kidney Health of 2019, in addition to a change in eligibility for Medicare Advantage plans for patients with End-Stage Kidney Disease (ESKD), we now have an opportunity to partner with both CMS and private insurers to make radical changes to our care delivery models in an