I attended Dr. Shari Ling’s presentation on CMS and the future incentive scheme for medicine, including CMS’ role in setting benchmarks for dialysis units. I think like most of the crowd, I came skeptical that 50,000 foot targets directed at dialysis units can be “aligned “– to use the terminology currently in vogue – with patient centered individualized treatment. We all know exceptions to the rules and we all take care of some patients for whom hemoglobin, phosphorus, calcium, and KT/V are not in alignment with their priorities. We struggle with patients who wish to choose dialysis with a catheter, despite being well educated about the risks. Coming in with this frame of mind, I was quite impressed with Dr. Ling’s thoughtful responses to the audience. It is on our shoulders in the nephrology community to find measurable outcomes that we believe are important and that reflect the complexity of the decisions made in hemodialysis. When we make something too “patient centered” we run the risk of simply contributing to harm – see the recent Annals of Internal Medicine article on patient satisfaction and mortality if you want to contemplate how patient centeredness might not be clinically appropriate – and if we are too “target centered” we run the risk of disconnecting what we do from what the human beings we take care of want to achieve. Not an easy equation to balance.
Post written by Dr. Dena Rifkin, Feature Editor for AJKD’s In a Few Words.
Check out more AJKD blog coverage of the NKF’s 2015 Spring Clinical Meetings!