May 10, 2004 - On April 14, the Centers for Medicare & Medicaid Services (CMS) announced it is leading a national initiative to increase the use of fistulas in providing hemodialysis for Medicare beneficiaries with end-stage renal disease (ESRD). The "Fistula First" initiative aims at having fistulas placed in at least half of new dialysis patients with a long-range goal of maintaining fistulas in 40 percent of eligible patients who remain on dialysis. Currently, only about 30 percent of Medicare beneficiaries dialyze with a fistula. A fistula is a "connection" surgically created by joining a vein and an artery in the forearm that allows blood from the artery to flow into the vein and provide access for dialysis. (link is no longer available)

Medicare is trying to fundamentally change the standard of care for patients with ESRD, and it is reaching out to primary care physicians and specialists for help.

The motivation for the initiative is both to improve the quality of patient care and to save Medicare money. The effort could have an enormous impact. About 270,000 Medicare beneficiaries currently receive dialysis treatment, and the number is expected to double by 2010. Because ESRD patients automatically qualify for Medicare, the program bears the brunt of dialysis costs. Article from American Medical News.

Each of the eighteen ESRD Networks has set up a Fistula First information center on its web site:

#1 New England

#2 New York

#3 Trans-Atlantic

#4 Pennsylvania/Delaware

#5 Mid-Atlantic

#6 Southeastern

#7 Florida

#8 Alabama, Mississippi, Tennessee

#9/10 Illinois,Indiana, Ohio, Kentucky

#11 Upper Midwest

#12 Iowa, Kansas, Missouri, Nebraska

#13 Arkansas, Louisiana, Oklahoma

#14 Texas

#15 Intermountain

#16 Northwest

#17 TransPacific

#18 Southern California

The national web site for Fistula First can be found at the QualityHealthCare.org web site.

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