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Archive for Nephrology

July 9, 2014

DaVita Kidney Care Welcomes New Vice President of Clinical Affairs for Home Dialysis

DaVita Kidney Care’s mission is to be the Provider and Partner of Choice. To achieve this mission, we are continually recruiting top clinical leaders in nephrology research and clinical practice to join the DaVita Village. I am proud to announce that we have the honor of welcoming Martin Schreiber, M.D. to our physician leadership team as the vice president of clinical affairs for DaVita home dialysis and a member of the Office of the Chief Medical Officer. I have personally known Marty for more than 20 years and have seen how his commitment to clinical excellence has been a driving force throughout his nephrology career. He has devoted his life to improving the quality of care and quality of life for patients with chronic kidney disease, and is an internationally recognized clinician, researcher and advocate for home dialysis.

I am delighted to welcome Marty to the DaVita Village. My colleagues and I are excited to see such an exceptional physician have the opportunity to help lead the charge in delivering patient-centric care, enhancing patient choice and moving up the DaVita Patient-Focused Quality Pyramid.

July 2, 2014

Standing on the Shoulders of Giants: We Need More Giants in Nephrology

Standing on the shoulders of giants

In October 1978, after a year on the faculty at UCLA, I was invited to participate in a panel discussion on peritoneal dialysis (PD) at the Western Dialysis and Transplant Society’s (WDTS) Ninth Annual Meeting at the Hilton Hawaiian Village in Honolulu. During my training in nephrology at Northwestern University in Chicago (and my internship and residency at Michael Reese Hospital in that same city) I had become a strong advocate for PD. At that time I was placing Tenckhoff catheters at the bedside and prescribing either manual PD using bottled dialysate, or PD using the Baxter Physio-Control system, a proportioning device. I learned at the side of one of the great unsung leaders in dialysis therapy (then working at Lakeside VA Hospital), Dr. Peter Ivanovich—he had a deep passion for the care of patients but also understood the value in clinicians and clinical researchers collaborating with industry to guide research and development. Peter instilled in me many of the values that I have held throughout my career, and I remain grateful to him for that and am thrilled that he is still at it, now at Northwestern, helping drive innovation for kidney patients.

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April 25, 2014

April is Donate Life Month

DonateLifeMonth

April is National Donate Life Month (NDLM), a time dedicated to encouraging Americans to register as organ, eye and tissue donors and to celebrating those who have given life by donating. As physicians, we see patients from across the kidney disease spectrum, from early stage to end stage kidney failure to transplant eligibility. Dialysis is an effective way of treating end stage renal disease, but most patients do not see it as their only long-term choice. The greatest gift we can give our patients is to encourage them to consider transplantation and to help them navigate the sometimes-turbulent waters of transplant evaluation.

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April 11, 2014

DaVita’s Patient-Focused Quality of Life Pyramid: Looking Beyond the Traditional Model of Care

The end stage renal disease program has a 40-year legacy of providing life-sustaining care to countless vulnerable patients with otherwise fatal kidney disease. There has been an intense focus on aspects of care delivered in the dialysis center, including anemia management, renal bone disease treatment, nutrition planning and the transition to vascular access. These critically important aspects of care must be provided at the highest level of quality.
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March 19, 2014

The Renal Physicians Association: Happy 40th Birthday!

Happy 40th, RPAWhen I was a young faculty member at UCLA, I had heard about the Renal Physicians Association (RPA) but did not think there would be any reason to join. After all, this was a group that focused on payment issues for nephrologists, and how could that possibly be relevant to someone who was a salaried doctor, and at an academic health center? As I delved into my responsibilities at UCLA, however, and became responsible for overseeing the care of patients in a large dialysis program almost entirely dependent on Medicare for reimbursement, it started to become clear to me how critical it was to have a strong advocacy organization that could work with Medicare and Congress to craft the most appropriate, effective and fair public policy for the end stage renal disease (ESRD) program. In addition, as clinical nephrology practice was becoming more complex with the new appreciation for the scope of the chronic kidney disease (CKD) epidemic, the need for tools to assist nephrologists in delivering the highest-quality care increased dramatically. I saw the light, and the rest is history. I joined RPA, worked on committees, served on the board of directors (1993-2006) and eventually served as president (1999-2001).

The nephrologists who originally formed RPA were ahead of their time. They began to build important relationships with the Health Care Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services. This collaboration served all nephrologists and kidney patients well in the subsequent four decades, with key regulatory and legislative achievements focused on improving the lives of patients while ensuring that nephrologists’ interest were represented as well. As the organization matured it began to focus intently on driving quality in ESRD care, and in 1993 it developed the first clinical practice guideline in our discipline—addressing adequacy of dialysis—several years before the Disease Outcomes Quality Initiative was begun. The most recent guideline on appropriate initiation and withdrawal of dialysis has become a seminal resource for nephrologists, patients and families to assist in decision-making at the difficult time of transition to dialysis. Myriad tools to assist nephrologists in optimizing care for CKD and ESRD patients have also been developed and disseminated.

I am particularly proud of RPA’s accomplishments during my two-year tenure as president. The following are some of the highlights:

  • RPA initiates Renal Fellows Workshop prior to annual meeting
  • First nephrology practice benchmarking survey conducted and presented
  • RPA launches corporate patrons program to engage in dialogue with industry supporters
  • RPA publishes first edition of the Renal Physicians Guide to Nephrology Practice
  • RPA convenes summit on chronic renal disease (with American Society of Pediatric Nephrology, American Society of Nephrology, and National Kidney Foundation)
  • HCFA responds to RPA’s request for community input on a method to measure and report on quality of renal dialysis services with establishment of the ESRD stakeholders council
  • RPA surveys randomly selected nephrology practices on expenses associated with the inpatient dialysis codes and the monthly capitation payment
  • RPA offers mortgage-financing assistance to members for home purchases
  • RPA publishes second clinical practice guideline on appropriate initiation and withdrawal of dialysis
  • RPA launches third guideline on appropriate patient preparation for renal replacement therapy
  • RPA publishes Capitation Models for ESRD: Methodology and Results—culmination of a two-year data-collection and -analysis effort supported by member contributions; risk-adjusted capitation rates and total spending for ESRD patient care
  • Past RPA president Dr. Derrick Latos becomes chair of the Practicing Physicians Advisory Council (established by Congress in 1990 to advise the Health and Human Services secretary on regulations and carrier manual instructions that relate to MD services under Medicare/Medicaid)
  • RPA launches patient safety initiative; convenes multistakeholder workshop
  • RPA launches website; creates www.renalmd.org
  • RPA testifies at Senate Special Committee on Aging in the ESRD program

I am very proud of what the organization accomplished during those years and subsequently, but now it’s time to focus on the future. The discipline of nephrology faces many challenges now and in the years to come: trainees’ waning interest in becoming nephrologists; continued downward pressure on reimbursement for nephrology procedures/activities; an increase in the number of employed physicians throughout healthcare; the rise of Accountable Care Organizations and other risk-taking, risk-sharing organizations; the increasing emphasis on value rather than volume in healthcare; federal budget constraints and pressure to restructure Medicare; a growing elderly, frail population with multiple chronic illnesses; etc., etc.

Some nephrologists are already throwing up their hands in despair, but my advice—which comes from years of watching the ESRD program grow and mature and from working with RPA—is to be a champion for our patients and our discipline. Helping strengthen RPA and being an active participant in the advocacy, public policy, and quality-of-care efforts is the best way to truly be a champion in nephrology.

As Muhammad Ali said,
Champions are made from something they have deep inside them—a desire, a dream, a vision.

HAPPY BIRTHDAY, RPA!

March 13, 2014

World Kidney Day Google+ Hangout On Air

Today is World Kidney Day, which is an important reminder of why kidney disease education and awareness are needed worldwide.

Roughly 1.4 million people across the globe are on dialysis and that number continues to grow each year. Kidney disease is a worldwide health concern. Today I participated in a Google+ Hangout On Air with Dr. Topoti Mukherjee, a nephrologist from India; Angela Lattimore, a dialysis patient from South Carolina; and Sara Hendren, a representative from the nonprofit program Bridge of Life – DaVita Medical Missions.

In case you missed it, here is the recording of the broadcast.

Read more…

February 26, 2014

5 things to look forward to at DaVita’s Physician Leadership Meeting

This year’s DaVita Physician Leadership Meeting (PLM) will be held Feb. 27 and 28 in San Diego, Calif. PLM is a gathering of DaVita medical directors and business leaders. This will be the ninth and largest PLM, with more than 1,000 attendees from 46 states across the country, including 700-plus medical directors.

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January 28, 2014

15 Million Americans Could Face Reduced Healthcare Options and Higher Costs

Fellow physicians,

I’m writing this post today to encourage you to join me and show your support in helping stop proposed Medicare Advantage cuts.

As early as February, Congress is expected to craft a longer-term solution for a Medicare payment system based more on quality and value than on the current fee-for-service system. Medicare Advantage (MA), one of the programs undergoing increased scrutiny, has allowed physicians to provide far better overall care to patients. Currently, almost 15 million seniors and people with disabilities rely on the care and benefits provided by MA plans. Over the next 10 years, Washington plans to cut $200 billion from these plans, which may lead to higher out-of-pocket costs, limited choice in physicians, fewer plans for managing chronic conditions and increased hospital readmission rates. While this cut does not directly affect dialysis patients, it has the potential to impact patients on a Medicare Advantage plan who are currently in earlier stages of chronic kidney disease.

 

“If implemented, the proposed funding cuts could affect millions of Americans.”

 

When we learn of legislative proposals that could affect vulnerable patients, we want to make sure that members of the physician community are aware of them and have the opportunity to voice concerns.

How can you help?

Tell Congress to stop cuts to MA. It takes only one minute to help protect patients across the nation.

  • Go to ProtectYourMA.com
  • Provide your zip code
  • Use the message template to contact your legislator

 

Show your support now >>

Thank you for your continued commitment to ensuring quality healthcare options for all.

 

Sincerely,

Allen R. Nissenson, MD, FACP
Chief Medical Officer

January 17, 2014

Kidney Care Trends That Will Shape 2014

It’s the beginning of a new year, and that means medical professionals are setting goals to further improve health outcomes for their patients. This is particularly important for patients who suffer from complex, chronic illnesses.

I’ve compiled a list of trends that I predict will play a large part in shaping kidney care during 2014, with a focus on patients with end stage renal disease (ESRD).

Working Instagraphic2Working patients. This was a hot topic closing out 2013 and will continue to gain attention throughout 2014. Admittedly, for some patients there are medical reasons that prevent them from  working when on dialysis; however, I foresee the kidney care community turning its focus toward the education of patients, employers and the public about the benefits of continuing to work despite being on dialysis. A key part of this educational effort will be an emphasis on treatment options for patients who can continue working. For such patients, the use of home dialysis modalities is particularly helpful. Read more…

December 9, 2013

Maintaining Employment: A Key Component of Health-Related Quality of Life for Dialysis Patients

Working Instagraphic1I was speaking to a group of end stage renal disease (ESRD) patients at a symposium recently and met a 50-year-old man with polycystic kidney disease who had just started on in-center hemodialysis. He had been followed by a nephrologist for a number of years prior to progressing to ESRD, and had been well prepared by conventional standards to start dialysis while being placed on the cadaver transplant list. He had an arteriovenous fistula, and began dialysis uneventfully as an outpatient. He said that physically he was adapting well to dialysis, but was concerned and depressed because he quit his job when he knew dialysis was imminent. His doctor had not had a conversation about this issue with him and he didn’t know what to do or how he was going to continue to take care of his family. He asked me why dialysis patients had to stop working and he was surprised to hear me say that he could continue working, and that his doctor and dialysis facility should be helping him work through this issue and get back to work. This story is only too common. Read more…

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