"Fistula First" as a CMS breakthrough initiative: improving vascular access through collaboration

Area of Science:

• Nephrology
• Vascular Surgery
• Healthcare Policy

Background:

• The arteriovenous fistula is recognized as the optimal vascular access method for patients with end-stage renal disease (ESRD).
• Following the success of national ESRD Network initiatives, the Centers for Medicare & Medicaid Services (CMS) formally adopted the "Fistula First" policy.
• This initiative signifies a major focus on improving vascular access outcomes in ESRD care.

Purpose of the Study:

• To highlight the significance of the "Fistula First" initiative in ESRD vascular access.
• To describe the formation of a stakeholder coalition addressing fistula placement.
• To outline the ongoing efforts of task forces focused on improving the healthcare system for arteriovenous fistula placement.

Main Methods:

• Formation of a formal coalition comprising members of the renal stakeholder community.
• Establishment of five distinct task force groups.
• These groups are actively investigating and addressing systemic issues related to arteriovenous fistula placement.

Main Results:

• The "Fistula First" initiative has been formally adopted by CMS, underscoring its importance.
• A collaborative coalition of renal stakeholders has been successfully established.
• Multiple task forces are actively engaged in optimizing the process of arteriovenous fistula placement.

Conclusions:

• The "Fistula First" initiative represents a significant policy shift towards prioritizing arteriovenous fistulas for ESRD vascular access.
• Collaborative efforts among stakeholders are crucial for addressing the complexities of successful fistula implementation.
• Ongoing work by task forces aims to enhance the overall healthcare system supporting arteriovenous fistula placement in ESRD patients.