Allen R Nissenson UCLA Med Ctr, Los Angeles, CA, William Mattern, UNC, Chapel Hill, NC, Tom Parker RMS-LL, McGaw Park, IL, Perry Arnold RMS-LL, Timonium, MD, Jerry Walker Jackson RMS Lifeline, Birmingham AL, Rick E. Mishler, AZ Kidney Disease & Hypertension Ctr, Phoenix, AZ, Donald A. Schon AZ Kidney Disease & Hypertension Ctr, Phoenix, AZ, and Terry Litchfield RMS Lifeline, McGaw Park, IL for Medical Advisory Board of RMS-LL

Vascular access remains the most significant source of morbidity and cost for chronic hemodialysis patients. Outpatient vascular access centers, with a dedicated team of nephrologists, interventional radiologists, and vascular surgeons should lead to placement of the most appropriate access initially; enhance identification of an access likely to fail; prospectively repair an access with impending failure; improve the quality of access repairs; minimize the need for hospitalization; and assure fewer missed outpatient dialysis treatments. There are three Lifeline centers now under operation, in Baltimore, MD, Birmingham, AL, and Phoenix, AZ. These centers have performed over 5000 vascular access procedures to date.

In addition, a detailed review of hospital utilization indicates significant reductions in bed days and admits.

Dedicated, outpatient vascular access centers offer a rare opportunity in medicine- clinical outcomes improve for patients, providers are able to organize and control the delivery of care, and the payer (Medicare or other insurers) is able to save considerable money.