CMS-required visits adversely impact Seattle area hemodialysis program.

Chronic hemodialysis in Seattle developed with a highly patient-centric approach, providing patients the option of dialyzing in neighborhood units under the administration of a non-profit organization, the Northwest Kidney Center (NKC). This study examined the effects of a requirement in the 2009 Conditions for Coverage that in-center hemodialysis patients be visited quarterly during their treatment session. A retrospective analysis of quality outcome indicators for patients managed at the University of Washington Medical Center and dialyzing at NKC in 2008 and 2010 found that dialysis adequacy (eKt/V), phosphorus, albumin, and hemoglobin were not improved by quarterly dialysis visits. Instead, dialysis unit visits adversely impacted patient-nephrologist relationships and diverted nephrologists from other patient care activities.