Clinical practice management issues - Commentary

Americans' spending on health care is the highest in the world, yet it does not equate with the value expected. There are disparities in access to care and a wide variation in quality. It is imperative that the US health care payment and delivery system change. The Centers for Medicare and Medicaid Services (CMS) have defined and are implementing the CMS Quality Roadmap, which includes (1) working with stakeholder collaboratives; (2) reporting to the public; (3) reforming the reimbursement systems to reward quality; (4) promoting health information technology and evidence-based medicine; and (5) increasing availability of new treatments, technologies, innovations, and information. This will fit in the value-driven health care initiative of The Department of Health and Human Services. Strategies included (1) developing quality and efficiency metrics for kidney patients, (2) measuring quality at the individual dialysis facility and nephrologist level, (3) reporting outcomes including as consumer/payer choice incentives by the public, (4) reforming the reimbursement system, (5) promoting interoperable health information technology, (6) focusing on health disparities, (7) coordinating the system of care for patients, and (8) changing treatment-when indicated by new evidence. (c) 2008 by the National Kidney Foundation, Inc.