New York QIO Promotes Better Management of Chronic Kidney Disease

To address the increasing prevalence of chronic kidney disease (CKD) in the US, IPRO and nine other Medicare Quality Improvement Organizations (QIOs) have been funded by the Centers for Medicare & Medicaid Services (CMS) to collaborate with healthcare providers in their respective states on a three-year quality improvement project. The goal is to encourage early identification and treatment of CKD; minimizing and/or preventing the progression of the disease; and improving overall care for Medicare beneficiaries. “Early identification of CKD allows more time for education and treatment interventions to improve CKD awareness and enhance patient outcomes,” according to Joseph Vassalotti, MD, National Kidney Foundation’s Chief Medical Officer and Associate Clinical Professor at Mount Sinai School of Medicine.

Quality Improvement Focus Areas
Incorporating evidence-based clinical standards, IPRO is working with primary care physicians, endocrinologists, nephrologists, vascular surgeons and other specialists providing care to Medicare beneficiaries with diabetes and/or CKD across New York State. Participating physicians are implementing the following system changes to improve the quality of CKD monitoring and care, with the ultimate goal of preserving kidney health and enhancing the quality of life for CKD patients.

• Improving early detection rates of CKD in patients with diabetes. Early manifestation of CKD in patients with diabetes is often undetected. IPRO is working with participating physicians to increase timely (i.e., annual) urinary microalbumin testing for Medicare beneficiaries with diabetes.

• Slowing the progression of kidney disease in patients who have diabetes and hypertension and/or CKD. IPRO is supporting primary care physicians in implementing system changes that will increase the frequency of ACE inhibitor and/or ARB agent treatments for patients who have diabetes and hypertension and/or earlystage CKD.

• Timely referral to nephrologists. IPRO is working with participating physicians to help ensure that patients are referred in a timely manner to nephrologists for counseling if renal placement therapy is necessary. When hemodialysis is the treatment choice for kidney failure, IPRO is supporting physicians by providing patient education materials to encourage early fistula access placement as a first choice for AV access where medically appropriate.

Free Support, Resources from IPRO
While the CKD Project is statewide, IPRO’s focus areas are the underserved communities in New York City and counties of Nassau, Suffolk, Westchester, Albany, Onondaga, Monroe and Erie. The National Institutes of Health National Kidney Disease Education Program (NKDEP) reports that minority populations are more likely to develop CKD than non-minority populations; and African American and Hispanic patients are more likely to develop kidney failure requiring dialysis or transplantation.

IPRO is supporting participating providers through promotion of timely and effective evidence-based clinical practices; dissemination of tools and resources for both providers and Medicare beneficiaries; and collaborations with key stakeholders to effect system change at the state and local levels.

“We urge healthcare providers in New York State to work on this important initiative both to improve patient care and reduce costly complications of CKD,” explains Clare B. Bradley, MD, MPH, Chief Medical Officer at IPRO. “We are confident that better care for these patients can lead to improved outcomes and better quality of life because it can result in less reliance on drugs, dialysis and hospitalizations,” according to Dr. Bradley.

If you are interested in learning more about how IPRO can provide you and your practice with free resources and assistance to improve early detection rates and slow the progression of CKD in New York’s Medicare population, contact Clare B. Bradley, MD, MPH, Chief Medical Officer, IPRO, Phone: 516-209-5563, E-mail

Approximately 26 million Americans have kidney disease.
Another 20 million Americans are at increased risk for developing kidney disease.
Nationally the incidence of CKD has increased over 3 1/2 times between 1995 and 2006.
The CDC has documented a 116% increase in New York State’s CKD rates over the past decade.
New York State has the fourth highest total Medicare expenditure for CKD of any state.
African Americans with CKD are four times more likely and Hispanics are three times more likely to progress to ESRD than are Caucasians.

This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 9SOW-NY-THM7.3-09-21