Controversial vascular access surveillance mandate

Research output: Contribution to journalComment/debate

22 Citations (Scopus)

Abstract

The Centers for Medicare and Medicaid Services (CMS) recently revised the requirements that end-stage renal disease (ESRD) dialysis facilities must meet to be certified under Medicare. The CMS ESRD Interpretive Guidance Update states that the dialysis facility must now have an ongoing program of hemodialysis vascular access surveillance. Surveillance usually refers to monthly access blood flow or static dialysis venous pressure measurements combined with preemptive correction of stenosis. However, surveillance as currently practiced does not accurately predict synthetic graft thrombosis or prolong graft life. There is limited evidence that monthly surveillance may reduce native arteriovenous fistula thrombosis without prolonging fistula life, but the effect on thrombosis awaits further confirmation. Thus, the CMS surveillance requirement is not evidence based. We recommend the following changes to the ESRD Interpretive Guidance Update: only monitoring (e.g., physical examination) is required, whereas the proper role of surveillance awaits the results of further research. Such changes would allow nephrologists to apply the clinical judgment and individualized care that is most beneficial to their patients. Published 2010. This article is a US Government work and is in the public domain in the USA.

Original languageEnglish (US)
Pages (from-to)92-94
Number of pages3
JournalSeminars in Dialysis
Volume23
Issue number1
DOIs
StatePublished - Jan 1 2010

Fingerprint

Centers for Medicare and Medicaid Services (U.S.)
Chronic Kidney Failure
Blood Vessels
Thrombosis
Renal Dialysis
Dialysis
Transplants
Venous Pressure
Public Sector
Arteriovenous Fistula
Medicare
Physical Examination
Fistula
Pathologic Constriction
Research

ASJC Scopus subject areas

  • Nephrology

Cite this

Controversial vascular access surveillance mandate. / Paulson, William D.; Work, Jack.

In: Seminars in Dialysis, Vol. 23, No. 1, 01.01.2010, p. 92-94.

Research output: Contribution to journalComment/debate

@article{bf774c2fef3b4d8b95b766eb545aae55,
title = "Controversial vascular access surveillance mandate",
abstract = "The Centers for Medicare and Medicaid Services (CMS) recently revised the requirements that end-stage renal disease (ESRD) dialysis facilities must meet to be certified under Medicare. The CMS ESRD Interpretive Guidance Update states that the dialysis facility must now have an ongoing program of hemodialysis vascular access surveillance. Surveillance usually refers to monthly access blood flow or static dialysis venous pressure measurements combined with preemptive correction of stenosis. However, surveillance as currently practiced does not accurately predict synthetic graft thrombosis or prolong graft life. There is limited evidence that monthly surveillance may reduce native arteriovenous fistula thrombosis without prolonging fistula life, but the effect on thrombosis awaits further confirmation. Thus, the CMS surveillance requirement is not evidence based. We recommend the following changes to the ESRD Interpretive Guidance Update: only monitoring (e.g., physical examination) is required, whereas the proper role of surveillance awaits the results of further research. Such changes would allow nephrologists to apply the clinical judgment and individualized care that is most beneficial to their patients. Published 2010. This article is a US Government work and is in the public domain in the USA.",
author = "Paulson, {William D.} and Jack Work",
year = "2010",
month = "1",
day = "1",
doi = "10.1111/j.1525-139X.2009.00682.x",
language = "English (US)",
volume = "23",
pages = "92--94",
journal = "Seminars in Dialysis",
issn = "0894-0959",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Controversial vascular access surveillance mandate

AU - Paulson, William D.

AU - Work, Jack

PY - 2010/1/1

Y1 - 2010/1/1

N2 - The Centers for Medicare and Medicaid Services (CMS) recently revised the requirements that end-stage renal disease (ESRD) dialysis facilities must meet to be certified under Medicare. The CMS ESRD Interpretive Guidance Update states that the dialysis facility must now have an ongoing program of hemodialysis vascular access surveillance. Surveillance usually refers to monthly access blood flow or static dialysis venous pressure measurements combined with preemptive correction of stenosis. However, surveillance as currently practiced does not accurately predict synthetic graft thrombosis or prolong graft life. There is limited evidence that monthly surveillance may reduce native arteriovenous fistula thrombosis without prolonging fistula life, but the effect on thrombosis awaits further confirmation. Thus, the CMS surveillance requirement is not evidence based. We recommend the following changes to the ESRD Interpretive Guidance Update: only monitoring (e.g., physical examination) is required, whereas the proper role of surveillance awaits the results of further research. Such changes would allow nephrologists to apply the clinical judgment and individualized care that is most beneficial to their patients. Published 2010. This article is a US Government work and is in the public domain in the USA.

AB - The Centers for Medicare and Medicaid Services (CMS) recently revised the requirements that end-stage renal disease (ESRD) dialysis facilities must meet to be certified under Medicare. The CMS ESRD Interpretive Guidance Update states that the dialysis facility must now have an ongoing program of hemodialysis vascular access surveillance. Surveillance usually refers to monthly access blood flow or static dialysis venous pressure measurements combined with preemptive correction of stenosis. However, surveillance as currently practiced does not accurately predict synthetic graft thrombosis or prolong graft life. There is limited evidence that monthly surveillance may reduce native arteriovenous fistula thrombosis without prolonging fistula life, but the effect on thrombosis awaits further confirmation. Thus, the CMS surveillance requirement is not evidence based. We recommend the following changes to the ESRD Interpretive Guidance Update: only monitoring (e.g., physical examination) is required, whereas the proper role of surveillance awaits the results of further research. Such changes would allow nephrologists to apply the clinical judgment and individualized care that is most beneficial to their patients. Published 2010. This article is a US Government work and is in the public domain in the USA.

UR - http://www.scopus.com/inward/record.url?scp=77950276916&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77950276916&partnerID=8YFLogxK

U2 - 10.1111/j.1525-139X.2009.00682.x

DO - 10.1111/j.1525-139X.2009.00682.x

M3 - Comment/debate

VL - 23

SP - 92

EP - 94

JO - Seminars in Dialysis

JF - Seminars in Dialysis

SN - 0894-0959

IS - 1

ER -