Since 2004, Medicare (or Centers for Medicare & Medicaid Services) has linked the level of reimbursement for nephrologists to the number of patient visits per month. The highest payment is for 4 visits each month. The effect of this has been 3-fold: first, patient's are being seen more frequently; second, it has fueled the growth of physician-extenders who can also see these patients although the nephrologist has to provide overall oversight and see the patient at least once each month; and it has prompted some to argue that this will result in improved outcomes whereas others have been quite skeptical.
In a paper in JASN earlier this month, Slinin et al presented an observational analysis using the USRDS database. Their research question was: do the number of provider visits to dialysis patients each month associate with patient outcomes? Their answer was "yes" for first-time hospitalization (adjusted HR=0.96; 95% CI=0.95–0.97), but not for all-cause mortality (adjusted HR=0.98; 95% CI=0.96–1.01).
Of course, the problems with such an analysis are many, including the use of an administrative data-base with its inherent issues with accuracy of information and classification bias and the effect of residual, to name a few. As well, some outcomes that are very important, like patient quality of life are not measured and even easily measurable. However, the article is interesting and does reinforce the idea that frequency of visits to a dialysis patients might matter. Seeing patients on dialysis - at least every week and often times even at every dialysis treatment - is practiced in many countries around the world. However, in the US a vista at each dialysis treatment is easier said than done - partly because of the size of the US dialysis patient population, but also because distances also sometimes considerable especially in rural areas, and the number of nephrologists in some areas is quite constrained. Nevertheless, the article adds to the evidence that seeing patients at least 4 times a month may be associated with better outcomes.
In a paper in JASN earlier this month, Slinin et al presented an observational analysis using the USRDS database. Their research question was: do the number of provider visits to dialysis patients each month associate with patient outcomes? Their answer was "yes" for first-time hospitalization (adjusted HR=0.96; 95% CI=0.95–0.97), but not for all-cause mortality (adjusted HR=0.98; 95% CI=0.96–1.01).
Of course, the problems with such an analysis are many, including the use of an administrative data-base with its inherent issues with accuracy of information and classification bias and the effect of residual, to name a few. As well, some outcomes that are very important, like patient quality of life are not measured and even easily measurable. However, the article is interesting and does reinforce the idea that frequency of visits to a dialysis patients might matter. Seeing patients on dialysis - at least every week and often times even at every dialysis treatment - is practiced in many countries around the world. However, in the US a vista at each dialysis treatment is easier said than done - partly because of the size of the US dialysis patient population, but also because distances also sometimes considerable especially in rural areas, and the number of nephrologists in some areas is quite constrained. Nevertheless, the article adds to the evidence that seeing patients at least 4 times a month may be associated with better outcomes.
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