NURSING HOME DIALYSIS: Rapidly Growing and Complicated

This article is published on Kidney News Online. View the article in full here: https://www.kidneynews.org/kidney-news/features/nursing-home-dialysis-rapidly-growing-and-complicated

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Suresh Samson, MD, FASN, is the Chief Medical Officer for Concerto Renal Services (Concerto), a Chicago-based dialysis provider and one of the nation’s largest providers of nursing home dialysis. In 2018, Concerto provided nursing home dialysis to nearly 1800 patients in Illinois, Indiana, and Wisconsin, and is currently working to implement its model in multiple other states by the close of 2019.

On August 10, 2018, the Centers for Medicare & Medicaid Services (CMS) published updated regulations for dialysis facilities (1). The CMS guidance encompasses several modalities, with a focus on the locations where dialysis services are provided.

The new guidance reaffirmed CMS’ recognition of dialysis in a nursing home setting, making revisions to the State Operations Manual (Chapter 2, ESRD Facilities), adding section 2271A, titled “Dialysis in Nursing Homes.” This action affirmed that Medicare-approved ESRD facilities may provide dialysis services to skilled nursing facility (SNF) residents in the nursing home within an approved home training and support modality. These new requirements include operational, logistical, physical, and staffing guidelines for nursing home dialysis. What follows is a summary of the nursing home dialysis model.