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Reducing Catheter Rates

The Dialysis Vascular Access Coalition (DVAC) is fighting to protect the ability for dialysis patients to have the right vascular access.  In the early 2000s, most dialysis patients were not getting the right vascular access – with fistula rates well below 40% – and concerns were so pronounced that CMS launched a nationwide Fistula First Breakthrough Initiative (FFBI). By 2017, fistula rates had reached almost 66%, which was the goal set by the original FFBI. 1

Unfortunately, central venous catheter (CVC) rates remain very high in the United States in patients initiating hemodialysis, nearly exceeding 80%. 2 What is worse, recent data shows that there is a general shift away from fistulas with more patients backsliding into the use of a catheter.  Data from Vasc-Alert shows that the number of patients on a catheter instead of an arteriovenous access (fistula or graft) has increased 44% since the huge 39% cuts to dialysis vascular centers shut down 20% of office-based vascular access centers. 

Graph showing the percent of ESRD patients using a central cenous catheter

CMS in the 2022 ESRD PPS Final Rule also noted that data indicate that long-term catheter use rates increased significantly during the COVID–19 PHE.  

These trends not only contribute to higher infection rates, but also cost Medicare more money. Compared to fistulas, the average annual total cost of treating patients with catheters is significantly higher ($90,000 for catheters vs. $64,000 for fistulas).  Vascular access centers need Medicare payment stability to help reverse these troublesome trends in catheter rates. 

 

1.)  Lee T. (2017). Fistula First Initiative: Historical Impact on Vascular Access Practice Patterns and Influence on Future Vascular Access Care. Cardiovascular engineering and technology, 8(3), 244–254. https://doi.org/10.1007/s13239-017-0319-9
2.)  Ibid