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AS I SEE IT


staff, all of whom have specific exper- tise in kidney disease. Any delay in the creation of a func-


tional, mature fistula puts a patient at a greater risk of “crashing” into dialysis, which requires hospitalization and reli- ance on a catheter until a patient can undergo fistula creation and maturation. In addition to the benefits of improved scheduling and better communication to prevent these delays, we also have started using the less invasive endoAVF technology to preemptively create fistu- las in patients with stage 4 or 5 CKD, before they even need dialysis. This gives the access time to mature and sig- nificantly increases the likelihood that these patients will be able to initiate dialysis with their fistula and avoid the risks of a catheter altogether.


endoAVF technology to many patients across the region.


Dialysis Access Creation in ASCs Industry estimates suggest that approx- imately 50 percent of endoAVF proce- dures are performed in ASCs. In our experience,


shifting dialysis access


creation to an outpatient setting like an ASC enables NANI to provide our patients with better continuity of care, which ultimately results in a higher overall quality of care and improved quality of life for patients. An ASC can prioritize dialysis access creation in a way that hospitals simply cannot. With hospitals, lim- ited operating room (OR) or catheter lab time can cause delays in schedul- ing. The pandemic has reduced hospi- tal staff and resources, making OR time even harder to come by. Fistula creation is not often considered a priority, and thus, these procedures are likely to be bumped in the event of an emergency. In contrast, NANI can ensure a


patient’s access is placed in a timely manner, sometimes within a week or


10 ASC FOCUS MAY 2021 | ascfocus.org


two of their initial vessel mapping appointment. Our staff follows up directly with patients and can assist with any barriers that may prevent them from scheduling


their access


placement, whether those are transpor- tation issues or language barriers. We also can facilitate better com- munication among a patient’s health- care team. When a patient is referred to a hospital for access creation, our nephrologists often do not have access to those records, making two-way communication difficult. If a patient’s procedure is rescheduled, we might not even know until they tell us at a subsequent follow-up appointment. When our patients have their access


created and maintained by an interven- tional nephrologist within the NANI network, the nephrologist automati- cally has access to information about the status of the initial procedure, as well as the maturation process and when the fistula will be ready to use for dialysis. Patients also benefit from knowing their access is placed and maintained by the same physician and


EndoAVF Lowers Healthcare Costs Moving dialysis access procedures to ASCs with endoAVF technology can significantly reduce the cost associ- ated with treating ESRD. Considering that hemodialysis care costs an average of $90,000 per patient annually in the US ($28 billion total) according to the 2020 USRDS annual data report, reduc- ing cost while ensuring quality care is a high priority for the Centers for Medi- care & Medicaid Services (CMS). EndoAVF procedures cost less to


perform in an ASC—approximately $9,000 dollars, compared to approxi- mately $12,000 in a hospital. Beyond that, the technology enables us to meet many of the quality metrics that are being incentivized by new value-based care models.


In 2020, CMS launched the Kid- ney Care Choices Model (KCC) to encourage treatment options that improve overall health outcomes while saving healthcare dollars. NANI is currently participating in two CMS-driven value-based care models: ESRD Treatment


Choices


(ETC) and Comprehensive Kidney Care Contracting (CKCC).


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