Chief Medical Officer and Executive Vice President for Clinical and Scientific Affairs
Fresenius Medical Care North America
Dr. Franklin Maddux is Chief Medical Officer and Executive Vice President for Clinical and Scientific Affairs for Fresenius Medical Care North America, overseeing the delivery of high quality, value based care for the largest integrated renal care network on the continent. Dr. Maddux earned his M.D. degree from the School of Medicine at the University of North Carolina Chapel Hill, where he holds a faculty appointment as Clinical Associate Professor.
Q: How important to patients is this shift to value based care for treating kidney failure?
Dr. Maddux: One of the reasons why the evolution of healthcare for patients with advanced kidney disease is so exciting right now is that we have the opportunity to advance the degree of influence we have over—not only the dialysis treatment itself—but also other aspects of a patient’s healthcare needs that affect their total life and ability to have a better quality of life. We are improving their care and integrating their regular life into those things that create good health behaviors and outcomes. For those reasons, these value based care models shift away from an individual dialysis treatment to this larger picture of what we can do to help an individual be more successful living with this difficult disease.
Q: How will taking responsibility for the total costs of care improve outcomes for our patients?
Dr. Maddux: When we become fully responsible for patients’ total cost of care, our focused lens shifts from the dialysis treatment, which is lifesaving for all of these patients, to their overall healthcare, which includes the opportunity to be very focused on other needs they might have. This may include palliative care needs, whether they have access to transportation, access to transplantation of kidneys, and the opportunity to look at the adjacent diseases that affect their outcomes. These include cardiac diseases, vascular diseases, diabetes and other healthcare issues, but also aspects of their daily life that might have a great impact on their healthcare outcomes. These social determinants of healthcare outcomes become part of the focus and responsibility of the provider who has taken on this mature, full, total cost of care responsibility.
The Dialysis PATIENTS Demonstration Act will create more efficient delivery of care and provide the opportunity to reduce hospitalizations, optimize the use of medications and their most efficient uses and look at things outside of individual medical treatments. This combination offers the opportunity to have patients who are healthier, more engaged in their care and looking for ways to avoid many of the things that drive up healthcare costs, like hospitalizations.
Q: Will the Dialysis PATIENTS Demonstration Act still offer patients choice in how their care is managed?
Dr. Maddux: The Dialysis PATIENTS Demonstration Act is one of the vehicles that gives patients more options on how they receive their care and who they get their care from. Patients get the opportunity to select the dialysis facility they want to dialyze in prior to their attribution into any of the PATIENTS Act—related facilities, allowing patients to have the choice to participate or not participate through the selection of their facility. They also have the option after two and a half months to test the system, and, as they do so, they can decide if they want to opt out. This degree of choice becomes a really important feature that doesn’t exist in any of the other programs available today.
Metropolitan Nephrology Associates
Fresenius Health Partners
Dr. Andy Howard is a nephrologist based in Clinton, Md., who works closely with Fresenius Kidney Care Surrats clinic located across the street from his office. As part of an end stage renal disease (ESRD) seamless care organization program, or ESCO, Dr. Howard has seen first-hand the benefits of this new innovative model of healthcare.
Q: How would you describe value based care?
Dr. Howard: Value based care has many names. It’s referred to as integrated care, care coordination, paying for value rather than volume, but we’re really talking about the same thing – getting the best outcomes, being judged by different quality metrics for these outcomes and at the same time spending less money.
Q: Why must we change the way we deliver care?
Dr. Howard: Our current healthcare expenditures in the United States are just not sustainable. Few physicians and others involved in healthcare would disagree that we need to reward providers for their outcomes, not simply the number of patient procedures they perform.
Q: Why should coordinated care come from a specialist, such as a nephrologist, rather than a primary care physician?
Dr. Howard: Nephrologists have a unique relationship with these ESRD patients who receive dialysis at a center, where we typically see them each week. We have 52 touches a year. These patients look upon us as their primary care provider, and we’re perfectly situated to try and take care of as much of their care as we can because of the frequency of visits.
We have also developed what is critical for an integrated care and team-based approach. In addition to the nephrologist, physician assistants and nurse practitioners, dialysis nurses and home dialysis nurses work with us. We have full-time social workers to assist patients with life, behavioral and environmental issues and renal dietitians to support patients’ nutrition.
Q: Describe the impact you have seen from a value based approach?
Dr. Howard: We’ve had the opportunity to participate in a value based care model that is specific to ESRD. It allows us to interface with our patients and the care team to maximize our patients’ quality of life, and keep them at home instead of in the hospital. We not only maintain quality, but have the opportunity to improve and enhance quality. The patients, and America, win by reducing costs. We’ve not only seen the potential for this, but we’ve seen what actually happens.
Q: Why do you support the Dialysis PATIENTS Demonstration Act?
Dr. Howard: The Dialysis PATIENTS Demonstration Act is a very exciting pathway to allow more nephrologists to participate in value based care on behalf of their patients. We need to change the fee-for-service model, which is part of the reason for the current, unsustainable healthcare costs. We’ve taken the first steps, but now we need to increase opportunities for physicians and patients to participate in value based models.
The Act also heightens our focus on kidney transplant. Ultimately, kidney transplant is the desired goal for all patients with ESRD. In comparison to current programs, this value based model allows more patients and nephrologists to participate in efforts designed to get patients to transplant.