The traditional service rate for service rate (FFS) is not suitable to meet the complex needs of patients with chronic diseases, including chronic renal disease (ERC). As spiral costs and population health decrease, value -based care (VBC) has a solution that can remodel how the health system is close to ERC management and can serve as a model of how we treat other chronic diseases.
The field of nephrology faces significant challenges, specifically with the growing cost of care of patients with multiple health conditions. The FFS model does not meet the needs of these patients with chronic diseases and encourages quantity, not quality, care, leading to frequent hospital visits and re -entering. VBC presents an alternative approach, encouraging suppliers to maintain patients’ health instead of reacting complications after they occur.
This change towards preventive and coordinated care can help address the physical and social factors that influence health results, allowing nephrologists to work more with their patients. Given the scarcity of kidney specialists and their many responsibilities in several medical care environments, value -based models can provide the resources and support systems that can make the management of chronic and effective diseases possible.
The current panorama of renal care and its limitations
ERC affects more than 35 million Americans and represents more than 24% of Medicare’s full budget. According to the FFS payment model, suppliers earn money according to the services they provide instead of the quality of the results achieved. This creates incentives that favor the treatment of complications instead of preventing them. Since patients with ERC often should bounce in different specialists for their conditions, duplicate tests, conflicting treatments and lost opportunities for comprehensive care are common.
By linking incentives to the results of the patient, preventive services and profitability, the adoption of a VBC model could help solve this systemic failure. Instead of rewarding volume, value and quality would be at the forefront. This change would ultimately address the root problems that make the current renal care model expensive and ineffective.
The management of separate conditions results in fragmented attention that does not address the patient’s needs, especially since these conditions are interrelated. The commonly overlooked areas are related to underlying inequalities such as income, education, food security and transport. All these contribute to a high risk of previous start and a faster progression of kidney disease, which emphasizes further the failures of a avo -poiled approach to care.
Challenges with the increase in the Nephrologist’s workforce
The shortage of the workforce of the nephrology rephes to another of the greatest obstacles to offer more optimal renal care, since there are not enough specialists to meet demand. This voice of scarcity in part of the geography, since newly trained nephrologists typically gravitate to urban areas, while rural communities are undoing.
Medicine students often lack exposure to the duration of outpatient nephrology, and erroneous concepts on the management of complex and chronic conditions and professional perspectives, including the opportunity of income and the work-life balance, discourage the search for the specialty.
These limitations of the workforce need creative solutions, and VCB can play a role. In VBC, the nephrologist, the leader of a multidisciplinary attention team is. These interdisciplinary teams (IDT) include advanced practice suppliers, nurses, dietitians, pharmacists and social workers, extending the scope and effectiveness of nephrologists to provide comprehensive care. Technologies such as telemedicine can also close geographical shortage, providing the experience of specialists and IDT to patients regardless of their location.
VBC models can improve the balance between work and life, adding a new income flow and reducing the doctor’s depletion. Nephrologists can focus on the prevention and construction of patient relationships, instead of stirring through high volume appointments. As job satisfaction improves, there will be more interest in the nephrology professional among students.
The panorama of renal care policy
Health financing gives the way in which suppliers operate in the industry. The Medicare and Medicaid Service Centers (CMS) shape how renal attention is provided in the US. Through the payment policy, more than 80% of US residents with kidney disease in the terminal stage have a traditional medicare of ancient advantage. The current FFS payment model used by CMS has led to a dramatic growth in medical care costs, especially in patients with complex chronic diseases such as ERC.
The renal care options model (KCC) was created by the Centers for Innovation of Medicare and Medicaid (CMMI) to transform the provision of renal care and show how changes in policies can create incentives to obtain better results with controlled costs. From the reduction of progression to renal insufficiency and the increase in home treatment options to the expansion of access to the kidney transplantation, this model has remodeled financial incentives for suppliers and encourages them to concentrate on helping patients to live longer and healthier.
The first results of the KCC model are promising, which shows a significant improvement in patient results. Many renal care entities (KCE) within the model are promoting Medicare savings, but the impact on the general costs of Medicare has not yet been determined. CMMI recently announced that the Comprehensive Renal Care Program (CKCC) in the KCC model will be extended until 2027 to continue collecting data on the general impact of the program. As the continuous KCE focus on health maintenance and prevention, it is anticipated that hospitalization and other expensive excessive services are reduced.
Enable a future based on value
The future success of nephrology care will depend on the strategies for early detection and prevention that can delay the progression of the disease. This will require the detection of high -risk populations along with rapid intervention when problems arise. Technology will also play an increasingly important role in this transformation, with systems such as remote monitoring that allow continuous monitoring or patient’s health to avoid frequent visits to the artificial office and intelligence that identifies patients with the highest risk of complications. Both innovations can help allow specific interventions and prevent expensive emergencies.
Addressing health disparities must also become a priority, since renal disease affects certain populations. A VBC model will help, since it incorporates addressing social determinants of health in treatment planning and creates incentives to improve results within unattended populations.
A systemic change from FFS to VBC would represent more than a change of payment model, but a holistic transition towards patient -centered medical care that prioritizes the results on the activity. Long -term success will require collaboration among political leaders, medical care providers and patients, so nephrology can establish the precedent of how coordinated preventive care creates better results while controlling costs.
Photo: Peterschreiber.Media, Getty Images
Dr. Tim Pfleder is the medical director of Evergreen Nephrology. Dr. Pfederer has spent 30 years taking care of patients with kidney disease, in addition to serving as former president of the Association of Renal Physicians, and other organizations promised to improve medical care at the national level. He is an experienced and clinical medical leader with experience in general nephrology and interventionist, quality and security of the Dialysis, Care, Coding and Billing Center based on value, and local and national lawyer for nephrology and patient practices.
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