Pay-for-performance requirements for microalbuminuria are out of touch with the latest science.
Many want you to screen diabetes patients for proteinuria every year...and then TREAT microalbuminuria with an ACE inhibitor or ARB even if the patient doesn't have hypertension.
The idea is to slow the progression of kidney disease.
But now we know that microalbuminuria is NOT a good marker for kidney disease...and adding an ACEI or ARB at this stage does NOT reduce risk.
It's a different story for diabetes patients with MACROalbuminuria.
In these cases, starting an ACEI or ARB does slow the progression of kidney disease.
I frequently get letters from insurance companies claiming that they know the best way to treat patients. The above statements are excerpted from a letter that we sent to FREEDOM MEDICARE INSURANCE explaining why we do not do this test. It is hard enough practicing medicine in today’s political and economic climate and having an insurance company or the government dictating policy is not going to make it easier.
