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CMS-required visits adversely impact Seattle area hemodialysis program.

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    Quarterly in-center hemodialysis visits did not improve patient outcomes like dialysis adequacy or lab values. These visits negatively affected patient-nephrologist relationships and reduced nephrologist time for other patient care activities.

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    Area of Science:

    • Nephrology
    • Healthcare Quality Improvement

    Background:

    • The Northwest Kidney Center (NKC) in Seattle offers patient-centric chronic hemodialysis.
    • A 2009 regulation mandated quarterly in-center visits for hemodialysis patients.

    Purpose of the Study:

    • To evaluate the impact of mandated quarterly in-center hemodialysis visits on patient outcomes.
    • To assess the effect on patient-nephrologist relationships and nephrologist time.

    Main Methods:

    • Retrospective analysis of quality outcome indicators.
    • Comparison of data from 2008 and 2010 for patients at University of Washington Medical Center dialyzing at NKC.

    Main Results:

    • No significant improvement was observed in dialysis adequacy (eKt/V), phosphorus, albumin, or hemoglobin levels.
    • Quarterly visits were associated with adverse effects on patient-nephrologist relationships.
    • Nephrologists' time for other patient care activities was diverted.

    Conclusions:

    • Mandated quarterly in-center hemodialysis visits do not enhance key clinical outcomes.
    • The policy negatively impacts the therapeutic relationship between patients and nephrologists.
    • Resource allocation for nephrologists may be inefficiently utilized by these visits.