Delivery & Payment of CKD Care
This section describes delivery and payment of chronic kidney disease care provided by the Federal government.
Centers for Medicare & Medicaid Services (CMS)
CMS is conducting a demonstration project, entitled Care Management for High Cost Beneficiaries. One of the participating sites has designed its interventions based on beneficiaries with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The project focuses on the maintenance of patients with level 4 and level 5 CKD progressing to ESRD without a past acute in-patient episode. Disease management is directed by nephrologists in supplementary clinics to identify potential problems and avoid complications, coordination of early intervention plans, and prevention of acute hospitalizations stays.
Contact Information
Abe Hollander
Phone: 410-786-7874
Email: abraham.hollander@cms.hhs.gov
The Medicare End Stage Renal Disease Program is a national health insurance program for people with end stage renal disease (ESRD). Initially, ESRD Network areas were established to encourage self-care dialysis and kidney transplantation and to clarify reimbursement procedures in order to achieve more effective control of the costs of the renal disease program. Subsequently, the Social Security Act was amended to establish at least 17 ESRD Network areas and to revise the Network Organizations responsibilities.
Currently, 18 ESRD Network Organizations exist under contract to CMS and serve as liaisons between the federal government and the providers of ESRD services. The number and concentration of ESRD beneficiaries in each area define the Network Organizations geographically. Some Networks represent one state, and others represent multiple states. The ESRD Network Organizations' responsibilities include: the quality oversight of the care ESRD patients receive, the collection of data to administer the national Medicare ESRD program, and the provision of technical assistance to ESRD providers and patients in areas related to ESRD.
In addition, the ESRD Network Coordinating Center (NCC) provides centralized coordination and support for the ESRD Network Program. The NCC's primary responsibilities include collection, maintenance and distribution of ESRD information; coordination of national activities, including training initiatives; facilitation of special projects, and administrative support services, such as the planning of meetings and summary reports for ESRD Networks and CMS' ESRD Network Program.
Contact Information
Lynn Riley
Phone: 410-786-1286
Email: lynn.riley@cms.hhs.gov
Web: www.esrdncc.org
Back to Top
Health Resources and Services Administration (HRSA)
The primary goals of the OPTN are to increase the effectiveness and efficiency of organ sharing and equity in the national system of organ allocation by establishing and maintaining policies and procedures for the field of transplantation, and to increase the supply of donated organs available for transplantation.
The OPTN efforts related to delivery of care include:
- Facilitating the organ matching and placement process through the use of the computer system and a fully staffed Organ Center operating 24 hours a day;
- Developing consensus based policies and procedures for organ recovery, distribution (allocation), and transportation;
- And maintaining a secure Web-based computer system, which maintains the nation's organ transplant waiting list and recipient/donor organ characteristics.
As of February 2009, there were 100,816 candidates in the waitlist, of which 78,565 (77.9%) were waiting for a kidney transplant. Of these candidates, 60% have been on the waitlist between 30 days to two years, 16.6% between two to three years, 16.9% between three to five years, and 10.8% for five or more years.
Contact Information
Richard Durbin
Acting Director, Division of Transplantation
Phone: 301–443–6804
Email: RDurbin@hrsa.gov
Web: www.ask.hrsa.gov/Organ.cfm
Back to Top
Indian Health Service (IHS)
The IHS's Division of Diabetes Treatment and Prevention has published Indian Health Diabetes Best Practices: Chronic Kidney Disease and Diabetes, which outlines for IHS providers the best methods for identifying and evaluating patients with chronic kidney disease (CKD), managing and monitoring patients with CKD and diabetes, and evaluating the progression of CKD. IHS also has written best practices for health care organizations, essential elements of best practices for CKD programs, and guidance on evaluating and sustaining CKD programs.
Individuals living on reservations receive care for diabetes and hypertension, two leading causes of kidney failure, in IHS clinics across the United States. Those who progress to kidney failure are covered by the Medicare ESRD program and, if eligible, IHS contract health services.
Contact Information
Andrew S. Narva, MD, FACP
Chief Clinical Consultant for Nephrology
Phone: 301-594-8864
Email: narvaa@niddk.nih.gov
Web: www.ihs.gov/MedicalPrograms/Diabetes/
This information was reviewed by KICC agency representatives. It may not reflect new or future agency activities. For more information, please contact the listed representatives. |
