6 the
ki ney citizen
Is This the Future of ESRD Care ?
A New Program Goes the Extra Mile for Dialysis Patients
By Jackson Williams
Government Affairs Director , Dialysis Patient Citizens
For more than a decade , officials in Washington , DC have been experimenting with ways to reorganize Medicare to deliver better care at lower costs . Several of these “ demonstration projects ” have involved ESRD patients . Now , the largest such program for dialysis patients has kicked off at 13 locations across the U . S . It ’ s called the ESRD Seamless Care Organization , or “ ESCO ,” model . This article describes what one of these projects , Philadelphia-Camden Integrated Kidney Care , is doing to improve care for its patients .
Philadelphia-Camden Integrated Kidney Care covers about 2,000 patients at DaVita clinics in the Philadelphia area . Patients do not enroll in an ESCO ; they are assigned to one by Medicare based on where they go to dialyze . Once the patient is assigned , the ESCO is responsible for the total cost of care for the patient — not just dialysis and other services associated with kidney care , but for emergency room visits and inpatient hospitalizations that make up the bulk of treatment costs for ESRD patients .
The ESCO agrees to actually lower its patients ’ costs relative to the national average . To do so , it must keep patients ’ health stable and avoid preventable complications that send patients to the hospital .
To accomplish this , Philadelphia-Camden Integrated Kidney Care deploys an additional staff of 20 clinicians and care coordinators . These teams aim to provide a “ total care package ,” says Bridget McCoy , a nurse practitioner who leads one of them . McCoy , who was previously assigned to regular duties in a dialysis facility , recalled that in that role , “ there were things I wanted to for my patients that I couldn ’ t do before ,” because clinics are organized to provide only the renal treatment specified by Medicare .
Under the regular system , accountability is fragmented ; dialysis clinics and nephrologists are responsible for kidney care , primary care physicians are responsible for other illnesses such as diabetes , and hospitals are responsible for the care provided within their walls . Under the ESCO system , the ESCO team commits to filling “ holes in care .” “ Most patients like it ,” says McCoy . “ It feels like a concierge .”
Like a concierge at a hotel , ESCO care managers use their special knowledge and contacts to provide a smooth , hassle-free experience to clients . But instead of securing dinner reservations or theatre tickets , the care manager is on the phone making doctor appointments , getting answers from pharmacists , or cutting through red tape with dentists or state assistance programs . And the stakes are higher , because a missed appointment or medication dosage can snowball into a trip to the hospital . “ The extra step makes the difference ,” says McCoy .
Among the key tasks that Philadelphia-Camden Integrated Kidney Care undertakes are :