Table 2.

Adverse consequences of the current Centers for Medicare and Medicaid Services policy prohibiting ESRD facilities from being reimbursed by Medicare for acute dialysis in patients with AKI

Perspective	Consequences of Current Policy
Hospitals and health care systems	Increased costs associated with either paying for outpatient dialysis at an ESRD facility or providing resources to support outpatient dialysis in a hospital-based unit
Health care providers	Increased pressure to certify patients with AKI requiring dialysis as having ESRD, thereby facilitating placement at outpatient ESRD facilities; knowingly providing ESRD certification when recovery of renal function is reasonably expected may constitute federal fraud
Patients	More limited outpatient dialysis placement options, which may lead to delays in hospital discharge
	Placement in a hospital-based facility may result in prohibitive travel requirements for patients and their families
	Premature certification of ESRD status may significantly decrease likelihood of recovery of renal function