HHS says MA plan options, benefits, and enrollment are expected in increase in the coming year.
With Medicare's open enrollment period looming on October 15, the Centers for Medicare & Medicaid Services announced this week that Medicare Advantage premiums for 2020 will drop by an average of 23% when compared with premiums in 2018.
Since 2017, the average monthly Medicare Advantage premium has fallen by 27.9%, and the 2020 estimates represent the lowest average monthly premium for a Medicare Advantage plan has been since 2007, CMS said.
In addition, Health and Human Services Secretary Alex Azar said the 24 million people who are projected to enroll in Medicare advantage will have more plans and benefits to choose from.
"That is what CMS has been delivering with its improvements to Medicare Advantage: lower costs, more options, and benefits tailored to patients' needs," Azar said in a media release.
"This proven record of success—decreasing premiums in both Medicare Advantage and Medicare Part D—contrasts with proposals for a total government takeover of healthcare, which would destroy options such as Medicare Advantage that seniors increasingly choose," he said.
Medicare Advantage enrollment has increased by more than 30% since 2017. CMS projects that Medicare Advantage enrollment, currently at 22.2 million, will increase to 24.4 million in 2020, representing about one third of the 60 million people in the Medicare program.
CMS Administrator Seema Verma used the announcement to take a swipe at Medicare For All proposals touted by some Democratic presidential candidates.
"On the contrast, proposals for more government through Medicare for All or a public option, would only harm the progress we have made to protect and strengthen the Medicare program for future generations," Verma said.
Along with a previously announced 13.5% declinein the average monthly basic Part D premium, Verma said beneficiaries have saved about $2.65 billion in Medicare Advantage and Part D premium costs since 2017.
Critics of MA say it actually costs the federal government more money because MA enrollees generally are healthier, use fewer healthcare services, and would accrue lower costs for the program if they were enrolled in traditional Medicare.'
Katherine Holt, associate director of the Center for Medicare Advocacy, says that MA plans have been able to lower premiums by narrowing provider networks, and "aggressively managing care through difficult prior authorization requirements."
Holt says the Trump administration is "engaged in a concerted effort to steer beneficiaries to Medicare Advantage, whether or not a private plan is the right choice for their coverage needs."
"More choices are not necessarily better choices," Holt says. "Beneficiaries should carefully weigh the value of Medicare Advantage plan extra benefits against the need for significant access to medical services as available in Original Medicare."
The projected average monthly basic Part D premium of $30 in 2020 is the lowest the Part D basic premium has been since 2013.
According to CMS:
MA average monthly premiums are expected to drop 14% to $23 in 2020, down from $26.87 in 2019.
Beneficiaries will have about 1,200 new MA plans operating in 2020 than in 2018.
The average number of MA plan choices per county will increase from about 33 plans in 2019 to 39 plans in 2020. This represents an increase of 49% since 2017.
The continued decline in Medicare Advantage and Part D premiums over the past three years is estimated to save taxpayers nearly $6 billion in the form of lower Medicare premium subsidies.
America's Health Insurance Plans said beneficiaries are flocking to MA "because it delivers better services, better care and better value than traditional Medicare."
"Medicare Advantage continues to outperform and offer better coverage and care than traditional Medicare, even though the average payment to MA plans is equivalent to costs for traditional Medicare, AHIP said.
Children with two subtypes of cardiomyopathy — hypertrophic or restrictive — are now dying on the waitlist at a rate 4-6 times higher than before the new criteria went into effect in 2016.
Recent attempts to improve waiting times and lower mortality rates for children needing heart transplants may have made the problem worse, new research suggests.
In fact, mortality increased for some types of heart disease.
"Changes were made to prioritize sicker children with fewer treatment options — for instance, kids with congenital heart defects — but the reality we’re showing is that since the criteria change, transplant centers are using more listing status exceptions, essentially short-circuiting the intended benefit," said senior author Brian Feingold, MD, medical director of pediatric heart failure and heart transplantation at UPMC Children’s Hospital of Pittsburgh, in comments accompanying the study.
The new policy de-prioritizes children with cardiomyopathies. Because of that, the UPMC researchers found, clinicians are getting more exceptions to the policy for their cardiomyopathy patients, especially a subtype called dilated cardiomyopathy, so that patients will retain the highest listing status.
Since the revamped criteria was established, exceptions for dilated cardiomyopathy rose by more than 13-fold, yet the study shows high priority status makes no difference in the survival rates of these patients, the researchers found.
However, children with two other subtypes of cardiomyopathy — hypertrophic or restrictive — without an exception, are now dying on the waitlist at a rate 4-6 times higher than before the new criteria went into effect, the researchers found.
"We can't prove causality here, but it would seem that restrictive and hypertrophic cardiomyopathy patients have been disadvantaged by the criteria change," Feingold said.
"They're prioritized downward under the umbrella of cardiomyopathy, likely inadvertently, while children with congenital heart defects have not been able to benefit due to increased exception use," he said.
Feingold said the reason why patients with different subtypes of cardiomyopathy are faring so differently under the new guidelines is that children with dilated cardiomyopathy tend to be better candidates for implanted blood pumps called ventricular assist devices (VADs).
Considered a type of life support, VADs place patients higher on the waitlist. They also allow patients to rehabilitate, even leave the hospital, while waiting for a transplant.
Feingold said he hopes the findings will prompt discussions about improving waitlist criteria for children awaiting heart transplants.
"The chronic shortage of organ donors means that we must strive to optimize organ allocation as much as possible," he said. "It's very difficult to know all of the downstream effects of policy decisions like these, so we should continue to tweak and observe until we get it right."
Starsky Bomer, 46, the former CFO/COO at Atrium Medical Center Pristine Healthcare, was also ordered to pay more than $6.2 million in restitution.
A Houston-area hospital executive has been sentenced to 10 years in prison for his role in a $16 million Medicare fraud scheme involving partial hospitalization programs, the Department of Justice said.
Starsky Bomer, 46, the former chief financial officer and chief operating officer at Atrium Medical Center in Stafford, Texas, and Pristine Healthcare in Pasadena, Texas received the sentence this month, 11 months after a jury convicted him of one count of conspiracy to receive healthcare kickbacks, two counts of violating the Anti-Kickback Statute, and one count of conspiracy to commit healthcare fraud.
At trial, prosecutors showed that from 2011 until February 2013, Bomer and his co-conspirtors submitted to Medicare about $16 million in false claims for partial hospitalization program services.
Bomer ran a scheme that paid bribes and kickbacks to group home owners and patient recruiters in exchange for sending Medicare patients to Atrium and Pristine's PHPs, and disguised the bribes and kickbacks as salaries and transportation payments to group home owners, DOJ said.
Bomer knew that many of the patients admitted to Atrium and Pristine's PHPs did not qualify for and were never provided legitimate partial hospital servicea.
A federal judge this month also ordered Bomer to pay $6.2 million in restitution and to forfeit another $158,260 in money generated by the scheme.
Healthcare-related professions were the top four earners on Glassdoor's annual highest-paying jobs list.
For the third straight year, physicians sit atop Glassdoor's 25 Highest Paying Jobs in America, with a median base salary of $193,415.
Healthcare-related professions own the top four spots on the annual list, put out by the online job listing and recruiting site, including: pharmacy manager, with a median base salary of $144,768; dentist, $142,478; and pharmacist, $126,438. Physician assistant is No. 8, at $113,855, and nurse practitioner is No. 11, at $109,481.
Glassdoor's estimate for physician compensation is more than three-and-a-half times higher than the median U.S. base salary of $53,950.
In 2018and 2017, physicians also topped Glassdoor's list, with median base salaries of $195,842, and $187,876, respectively. No explanation was given for why the median base salary for physicians dropped by $2,427 over the past year.
The relatively high salaries in the healthcare sector could be attributed to demand. Glassdoor reported that there 3,729 job openings on its site for physicians on its site as of late August. Physician assistants and nurse practitioners also were in high demand, with 11,008, and 17,572 job openings, respectively.
To make Glassdoor's Top 25 list, job titles must get at least 100 salary reports shared by U.S.-based employees over the past year. Glassdoor also uses a proprietary statistical algorithm to estimate annual median base pay, which controls for location, seniority and other factors.
The number of job openings per job title represents active job listings on Glassdoor. The report takes groups similar job titles, and C-suite jobs are excluded.
For example, an American Medical Group Association survey in August identified the top mean compensation among physician specialists, led by orthopedic surgeons, $591,245; gastroenterologists, $527,998; general cardiologist, $519,964; diagnostic radiologists (MD non-interventional) $482,599; and urologist, $469,755.
The five lowest-paying specialties for AMGA's mean compensation were urgent care, $283,787; internal medicine hospitalists, $293,252; neurology, $310,518; general obstetrics/gynecology, $340,388; and emergency medicine, $363,201.
State officials say TennCare could collect as much as $1 billion in savings under the proposal.
Tennessee this week made public its $7.9 billion block grant proposal for its Medicaid program, which would be the first of its kind if it passes muster with federal regulators.
The proposal, four months in the making, is expected to be submitted to the Centers for Medicare & Medicaid Services in November.
Republicans have since the 1980s attempted to transition state Medicaid funding into block grants, which they say would allow for more flexibility and cost savings. Those attempts have been rebuffed at the federal level.
The federal government pays for about $7.9 billion of TennCare's $12.1 billion overall budget, which is roughly 65% of the cost.
Tennessee officials say TennCare, the state's Medicaid plan for 1.4 million Tennesseans, could collect as much as $1 billion in savings under the proposal, even as Medicaid services are expanded. The state based that estimate on claims that the program's spending has come in under CMS projections in recent years, saving the federal government billions of dollars.
Tennessee Gov. Bill Lee told reporters that the state deserves to be rewarded for its good stewardship of federal dollars.
"Over the last 10 years, we've saved the federal government a significant amount of money because of the efficiencies that we've operated our plan under, which is why they're looking to us as potentially being the first state," Tennessee Gov. Bill Lee told reporters this week, according to The Tennessean.
TennCare Director Gabe Roberts told the Associated Press that the plan was a "hybrid" approach to block grants because the state has designed its proposal to allow Tennessee to keep 50% of any unspent block grant funds.
State officials have also stressed that the proposal will undergo what is expected to be vigorous negitions with CMS in the coming months.
Reaction to the proposal was mixed.
Craig Becker, president and CEO of the Tennessee Hospital Association, said he was "encouraged that the Medicaid block grant proposal for the TennCare program will not reduce benefits, remove individuals from the rolls and has the potential for shared savings."
"THA is working now to understand the potential impact of the proposal on TennCare members, hospitals and the state," he said. "Ensuring adequate funding for the program in the future is critical to continuing to care for some of Tennessee’s most vulnerable residents and is a strength of the proposal."
"The potential for shared savings in recognition of TennCare's historic fiscal responsibility also presents a great new opportunity for enhanced coverage for TennCare enrollees, Becker said, adding that THA will review the proposal and submit formal comments in the coming weeks.
Michele Johnson, executive director of the Tennessee Justice Center, an advocacy group for TennCare enrollees, said the state wants to make children in the program "guinea pigs in a risky experiment that no other state has been reckless enough to try."
"Half of Tennessee children, including those who are most vulnerable, rely on TennCare for essential healthcare. We were just in the news for cutting off over 200,000 kids, and the state still doesn’t know whether they were eligible or not," Johnson said.
"What is most distressing is that this proposal is all about the state using kids' healthcare as a piggy bank. State officials should listen to the many respected national patient advocacy groups that warn that such proposals put patients' health and safety at risk," she said.
Providers raise concerns that the mandatory CMMI payment models will create unnecessary burdens and challenges.
The American Hospital Association and other key stakeholders are raising concerns about a proposed mandatory alternative payment model for radiation oncology that is scheduled to take effect in less than four months.
The Centers for Medicare & Medicaid Services announced in July that the five-year model would make prospective payments to cover radiotherapy services, in 90-day episodes, for patients diagnosed with 17 types of cancer.
The model would link payment to quality metrics and would require participation from physician group practices, hospital outpatient departments and freestanding radiation therapy centers in randomly selected geographic areas. It would also qualify as an Advanced Alternative Payment Model (APM) and Merit-based Incentive Payment System (MIPS) APM under the Quality Payment Program (QPP), CMS said.
A CMS fact sheet issued with the proposed rule said that the model would test whether episodic payments in a prospective and site-neutral fashion would reduce the amount Medicare spends on radiation services while maintaining or even improving quality.
In written comments, AHA called on CMS to a delay of the Jan. 1, 2020 starting date for the model, make the model voluntary, and "balance the risk versus reward equation much more appropriately."
"Our members support moving toward the provision of more accountable, streamlined care and are redesigning delivery systems to increase value and better serve patients," AHA wrote.
However, AHA added that hospitals and health systems "should not be required to participate in such a complicated program ... if they do not believe it will benefit the patients they serve. Moreover, other providers that may have the systems in place to excel under this new model could be excluded based on geographic location."
AHA said the proposed rule's requirement that model participants take on 100% risk immediately, without any stop-loss protections or adjustment for actual versus historical case mix "places too much risk and burden on providers with little opportunity for reward in the form of shared savings, especially in light of the significant investments required."
Those concerns were echoed by the Community Oncology Alliance. The nonprofit association said it supports efforts to transition away from fee-for-service to value-based payment models. However, COA said it "absolutely does not support mandatory CMMI models."
"CMMI should be working closely with COA and other organizations to develop a radiation oncology model that will first test and then implement the model on a broader scale," COA said in its formal comments. "We strongly believe that no provider, nor their patients, should be forced into any transformative model."
American Society for Radiation Oncology Board Chair Paul Harari, MD, acknowledged "some positive elements" in the model but raised concerns that it "falls short" of three key goals advocated by ASTRO; Rewarding radiation oncologists for quality initiatives that improve the value of healthcare; ensuring fair payment in both hospital and freestanding clinics to protect patient access; and incentivizing the appropriate use of cancer treatments.
"An ASTRO analysis estimates that the RO Model would cut payments to required participants by approximately $320 million during the 5-year period—an excessive amount that would undermine this unique opportunity," Harari said.
For the model to be successful, ASTRO recommended launch the model on a voluntary basis and trasition to mandatory on a limited basis, including opt-outs for low-volume practices and hardship cases.
ASTRO also identified what it called "serious flaws in the calculation approach for the national case rates," which it said would result in significant payment penalty for participants.
"We are concerned that the methodology fails to appropriately account for a range of complex clinical scenarios and average treatment costs for many clinics," Harari said.
To solve that, ASTRO recommended that CMS "include some physician fee schedule costs, properly attribute palliative care cases, and ensure adequate payments for patients receiving standard-of-care multi-modality treatments, such as combination therapy for gynecological cancer."
Harari said the payment adjustments proposed in the model could result in significant cuts to all participants and unfairly disadvantage "efficient" practices.
ASTRO recommended that CMS adjust the efficiency factor to avoid penalizing efficient practices and scale back the discount factors, and that CMS should pay for new technology at fee-for-service rates and adopt a rate review mechanism for new service lines and upgrades.
"The proposed RO Model would heap additional administrative tasks and costly requirements on already burdened radiation oncology practices that are required to participate in the model," Harari said.
ASTRO recommended that CMS delay many of these requirements and rely input from the radiation oncology community "to ensure that only information that is most meaningful and least burdensome is collected."
Philip Esformes of Miami Beach ran the largest healthcare fraud scheme ever charged by DOJ.
The Miami-based owner of a chain of skilled nursing and assisted living facilities has been sentenced to 20 years in federal prison for his lead role in a decades-long scam that the Department of Justice has called the largest healthcare fraud scheme it ever prosecuted.
Philip Esformes, 50, of Miami Beach, was also sentenced to three years supervised release.
During an eight-week jury trial in April, federal prosecutors accused Esformes of billing Medicare for more than $1.3 billion in fraudulent charges. The jury found Esformes guilty of more than 20 felony fraud counts, including accepting kickbacks, money laundering, fraud, and obstruction of justice.
A Nov. 21 hearing will determine restitution and forfeiture, DOJ said.
"Philip Esformes is a man driven by almost unbounded greed," Deputy Special Agent in Charge Denise M. Stemen of the FBI’s Miami Field Office said in a media release.
"The illicit road Esformes took to satisfy his greediness led to millions in fraudulent health care claims, the largest amount ever charged by the Department of Justice. Along that road, Esformes cycled patients through his facilities in poor condition where they received inadequate or unnecessary treatment, then improperly billed Medicare and Medicaid," Stemen said.
Evidence presented at trial showed that, between 1998 and 2016, Esformes led an extensive healthcare fraud conspiracy involving a network of assisted living facilities and skilled nursing facilities he owned, DOJ said.
Esformes bribed physicians to admit patients into his facilities. Then, he cycled the patients through his facilities where they often failed to receive appropriate medical services or received medically unnecessary services billed to Medicare and Medicaid. Several witnesses testified to the poor conditions in the facilities and the inadequate care patients receive.
Evidence showed Esformes used his stolen money for extravagant gifts, including luxury automobiles and a $360,000 watch. He also used the stolen money to bribe the basketball coach at the University of Pennsylvania to gain admission for his son.
Altogether, Esformes personally pocketed about $37 million from the scheme, DOJ said.
Esformes’s coconspirator, physician’s assistant Arnaldo Carmouze, previously pleaded guilty to fraud charges and was sentenced in April to more than 6 years in prison and ordered to pay $12.5 million in restitution.
Co-conspirator Odette Barcha also pleaded guilty to a kickback charge and was sentenced in April to 15 months in prison and three years of supervised release and was ordered to pay $704,500 in restitution.
Physicians say prior authorization creates undue time burden and administrative costs.
A House committee on Wednesday heard complaints from four physicians about the hassles of prior authorization and its ill-effects on patients.
"While there may be a limited number of justifiable cases where prior authorization is appropriate, it is clear that health plans more often require prior authorization as a cost-containment strategy by limiting and restricting access to specific services," John Cullen, MD, president of the American Academy of Family Physicians, told the House Committee on Small Business.
"In submitting prior authorizations, family physicians and their staff spend countless hours reviewing documents, processing paperwork, checking boxes, and waiting on hold to talk to health plans to meet their often arbitrary and not evidence-based requirements so that our patients can get the care they need," he said.
Cullen's testimony was echoed by his physician colleagues before the committee.
"In one year, my practice dedicated over $80,000 in resources for prior authorizations," said Dave Walega, MD, Chief, Division of Pain Management at Northwestern University Feinberg School of Medicine in Chicago.
"If the same costs and circumstances were incurred in a small group medical practice, it could be financially devastating to have overhead costs rise so high," he said.
Paul Harari, MD, chairman of the American Society of Radiation Oncology, said "prior authorization is intended to minimize health care costs, but this is often done at the expense of a patient’s well-being."
"Nationwide, physicians and their patients are bearing the brunt of excessive prior authorization practices," he said.
"Physician practices are on the frontline – and complying with management utilization has driven up the cost of running a medical practice," said Howard Rogers, MD, a Connecticut-based dermatologist, speaking on behalf of the American Academy of Dermatology Association. "On average, dermatologists dedicate eight hours per week solely to administrative activity; precious time they could be otherwise dedicating to patient care."
"Prior authorization is one of the most unbalanced approaches to utilization management in terms of increasing practice costs while providing no increase in quality of care and regularly delaying patient treatment," Rogers said.
The physicians got a receptive ear from subcommittee Chairwoman Nydia M. Velázquez (D-NY).
"When doctors spend hours dealing with paperwork or can't treat a patient because a health insurance company won't approve a treatment, the result is patients suffering," she said in opening remarks. "And that is why we are here today–to discuss a barrier preventing family physicians and specialists from providing critical care to their patients."
Velázquez said that while prior authorization is a vital tool used to reduce care costs and advance evidence-based medicine, "it's also putting an undue burden on physicians, their staff, and patients. It is not uncommon that patients now face delays of two weeks and sometimes over a month before getting treatment."
America's Health Insurance Plans and the Blue Cross Blue Shield Association submitted a joint statementto the committee, citing statistics that "65% of physicians reporting that at least 15-30% of care is unnecessary."
"Needless medical tests harm patients and waste billions of dollars every year; $200-$800 billion is wasted annually on excessive testing and treatment," the payers said. "Medical management ensures patients have access to safe and clinically-effective health care services and addresses this type of waste in our health care system."
The payers said that prior authorization is a valuable tool in the fight against healthcare fraud. They also said they were working with providers and the federal government to reduce the paperwork and procedural burdens for physicians.
Using the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System and its own in-house analysis, TFAH issues a biannual snapshot of obesity rates nationwide.
"These latest data shout that our national obesity crisis is getting worse," TFAH CEO and President John Auerbach said in comments accompanying the study.
"They tell us that almost 50 years into the upward curve of obesity rates we haven't yet found the right mix of programs to stop the epidemic," he said. "Isolated programs and calls for life-style changes aren't enough. Instead, our report highlights the fundamental changes that are needed in the social and economic conditions that make it challenging for people to eat healthy foods and get sufficient exercise."
The consequences of soaring obesity rates include increased risk for type 2 diabetes, high blood pressure, stroke and cancers, with an annual cost of about $149 million, half of which is paid for by Medicare and Medicaid, TFAH said.
Nine states had adult obesity rates at or above 35% in 2018, up from seven states at that level in 2017, an historic level of obesity. The nine states are: Alabama, Arkansas, Iowa, Kentucky, Louisiana, Mississippi, Missouri, North Dakota and West Virginia.
Mississippi and West Virginia have the highest level of adult obesity in the nation at 39.5%, while Colorado has the lowest rate at 23%, TFAH said.
The pace of obesity appears to be accelerating. As recently as 2012, TFAH notes, no state had an adult obesity rate over 35% and from 2013 through 2018 33 states had statistically significant increases in their rates of adult obesity, TFAH said.
A second data source used in the report, the National Health and Nutrition Examination Survey, also shows all-time high levels of obesity. In 2015-2016, the most recent available data, the national adult obesity rate was 39.6% and the national child obesity rate was 18.5%.
Nationwide, obesity has increased by 70% over the last 30 years for adults and by 85% for children.
As with other studies, the TFAH report shows the close link between obesity and socio-economic conditions. Lower-income people, and people of color, who are more likely to live in "food deserts" and neighborhoods that discourage physical activity, and who are the target of junk food marketers, are also at elevated risk.
As of 2015-2016, 47% of Latino adults, 46.8% of Black adults were obese. White and Asian adults were 38% and 12.7% respectively. Childhood obesity was highest amongst Latino children at 25.8%, while 22% of Black children, 14% of White children, and 11% of Asian children were obese.
The report cites a number of initiatives that could help bend the obesity curve, including:
Expand access to WIC (Special Supplemental Nutrition Program for Women, Infants and Children) food packages.
Increase the price of sugary drinks through excise taxes and use the revenue to address health and socioeconomic disparities.
Make it more difficult to market junk food to children by ending federal tax loopholes and business costs deductions related to the advertising of such foods to young audiences.
Strengthen and expand school nutrition programs beyond federal standards to include universal meals, flexible breakfasts and eliminate all junk food marketing to students.
Enforce existing laws that direct most health insurers to cover obesity-related preventive services at no-cost sharing to patients.
Cover pediatric weight management programs and services in Medicaid.
Primary care physicians complain about a lack of access to CKD clinical information systems, insufficient patient education materials.
The federal government's efforts to reduce by 25% the number of people developing end-stage kidney disease in the next decade may be hobbled the lack of knowledge and support tools made available to primary care physicians.
That's according to a new study in PloS ONE, which suggests that more resources will be needed to achieve the goals set in July by the Department of Health and Human Services.
"If we hope to reduce the personal and financial toll of chronic kidney disease and end-stage kidney failure, primary care physicians must be key players, said John Sperati, MD, associate professor of medicine at the Johns Hopkins University School of Medicine and director of the school's Nephrology Fellowship Training Program.
"And we as kidney specialists need to form better partnerships with PCPs, and need to offer more training and resources to them," he said.
Sperati and colleagues at Johns Hopkins heard from four focus groups comprised of more than 30 primary care physicians across the nation, and found that many of them don't have the knowledge or the tools to identify and manage patients with chronic kidney disease, especially in the early stages of the disease.
An estimated 37 million people, about 15% of the nation's adult population, are believed to be affected by CKD, with high blood pressure and diabetes being major contributors to the disease.
Medicare costs for CKD in 2016 were $79 billion, and another $35 billion for end-stage renal disease, According to the U.S. Renal Data System. HHS hopes that by identifying those at risk of CKD in its early stages, lifestyle adjustments, medications, and disease management can delay expensive, invasive countermeasures, such as dialysis and transplants.
To reach that goal, primary care physicians will be a key player, Sperati said, because there is a nationwide shortage of nephrologists, with only about one kidney specialist for every 2,000 patients with CKD. Those specialists, he notes, focus on the 8% of CKD patients in advanced stages with multiple complications or end-stage kidney failure.
That means that PCPs will have to provide the care for CKD in its early stages. Despite how prevalent this disease is, Sperati believes that, if managed early on by PCPs, some patients can avoid advanced stages.
Almost 85% of the PCPs in the researchers' focus groups said they felt comfortable managing patients with early-stage CKD, but not comfortable managing specific complications such as anemia (44%), bone disorders (72%) and excess metabolic acid in the body that damages the kidneys (69%), the researchers found.
Most of the docs complained that they lacked access to clinical information systems and insufficient patient education material about CKD. They also complained about the lack of time they had to spend with patients, along with system-level barriers such as poor reimbursements for delivering care to complex CKD patients.
The PCPs identified patient barriers to management, such as limited understandings of the implications of CKD and the costs associated with meds, tests and other costs.
To improve early diagnosis of CKD, the focus group physicians called for: more access to automatic estimated glomerular filtration rate (eGFR) reports to screen for low levels of GFR clear; guidelines for treatment; better education; and improved insurance coverage and physician reimbursement for services and care.
"This is very helpful information in identifying what primary care physicians see as barriers but also as potential solutions," Sperati said.
This study was funded by the National Kidney Foundation and no author declared any conflict of interest.
