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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…

November 27, 2013

CMS Issued a Final Ruling on 2014 Dialysis Payment Rates

As many of you may know, on Nov. 22, the Centers for Medicare & Medicaid Services (CMS) issued its final rule on 2014 payment rates for dialysis facilities paid under the End Stage Renal Disease Prospective Payment System (ESRD PPS) as well as updates to the Quality Incentive Program (QIP). CMS first announced a proposed cut of 12 percent(1) from Medicare’s ESRD program in July, potentially threatening access to dialysis care for thousands of patients with kidney disease across the country.

Thanks to the support from our physician partners, patients, teammates and other members of the kidney care community over the last few months, we were able to generate more than 124,000 contacts to Congress asking them to help stop the cuts. Our combined efforts were a success, resulting in flat rates over the next two years and continued access to dialysis care for our patients. But we still have some work to do to help mitigate future cuts. Read more…

October 31, 2013

ASN 2013: The Global Kidney Care Community Meets in Atlanta

The American Society of Nephrology’s (ASN’s) Kidney Week, the world’s premier nephrology conference, is upon us again. This year more than 13,000 kidney professionals from across the globe will descend on Atlanta, Ga., for a week of sharing knowledge, learning the latest scientific and medical advances and engaging in provocative discussions that will help usher in a better tomorrow in kidney care.

ASN Kidney Week 2013ASN is changing the focus of Kidney Week in 2013 to innovation and individualization. In a preview video, ASN executive director Tod Ibrahim spoke with ASN president Bruce Molitoris, MD, FASN, about what’s new. After watching it, I am excited to know that attendees will be gaining more real-world information to carry home and use directly for patient care. Additionally, attendees will enjoy expanded early programs, more basic science sessions and a new and enhanced Kidney Week 2013 app. Read more…

October 10, 2013

Dialysis and Depression on World Mental Health Day

While looking at my calendar recently, I noticed World Mental Health Day was near. I began to think about the many dialysis patients we, as renal caregivers, see and how depression is such a prevalent issue among them. The lifestyle changes to be made during dialysis often bring up feelings of despair and loneliness for patients. They need a support team to help them get over this hurdle.

For today’s post, I asked Duane Dunn, MSW, national director of social work for DaVita, to give us a little insight into the issue of depression in dialysis patients, depression-treatment options and the teams that support this fragile population. Read more…

September 25, 2013

6 Twitter Accounts to Follow for Kidney Patient Resources

Twitter has become one of my favorite ways to consume news about the kidney care community. Tweets abound daily with proclamations advocating for patient rights, kidney-friendly diet tips, kidney disease education resources and more. In an ever-increasing world of digital media, social networks and the like, Twitter serves as a tool for me to tune into conversations that are relevant to the topics important to me. If you’re not on Twitter and would like to become part of the larger digital kidney care community that lives there, here are a few must-follow accounts to get you started. Read more…

August 22, 2013

Did you miss “Voices of Dialysis: Protecting Access to Care?”

On Aug. 13, I joined other members of the kidney care community for Voices of Dialysis: Protecting Access to Care—a Google+ Hangout discussing the government’s proposed funding cut for dialysis care. In this interactive video chat, the other speakers and I shared our concerns about the Centers for Medicare & Medicaid Services (CMS) plans to cut dialysis funding by 9.4 percent and elaborated on the potential impact for hundreds of thousands of Americans who rely on dialysis for life-saving treatments.

In case you missed the live Google+ Hangout, watch the complete 45-minute recap of Voices of Dialysis: Protecting Access to Care.

Speakers:
Eric Edwards, Dialysis Patient,
Dialysis Patient Citizens Board President

Allen R. Nissenson, MD, Chief Medical Officer,
DaVita

Robert J. Kossmann, MD, President,
Renal Physicians Association (RPA)

Diane Wish, President and CEO,
Centers for Dialysis Care

August 12, 2013

Voices of Dialysis: Protecting Access to Care

Join representatives from the kidney care community myself on Tuesday, Aug. 13, at 4 p.m. PT/ 7 p.m. ET for Voices of Dialysis: Protecting Access to Care—an important Google+ Hangout discussing the government’s proposed funding cut for dialysis care.

What’s a Google+ Hangout?
It’s a 45-minute interactive video chat that’s free to join and open to anyone. Participants will watch as a panel of speakers discuss a particular topic. All you need to participate is internet access.

Speakers to include:

Eric Edwards, Dialysis Patient,
Dialysis Patient Citizens Board President

Allen R. Nissenson, MD, Chief Medical Officer,
DaVita

Robert J. Kossmann, MD, President,
Renal Physicians Association (RPA)

Diane Wish, President and CEO,
Centers for Dialysis Care

August 1, 2013

Medicare and Dialysis: A History Lesson Unheeded

“July and August will be critical months to take our message to Washington: no more cuts for dialysis patients and their providers.”

 

The recent proposal from the Centers for Medicare & Medicaid Services (CMS) to cut reimbursement for dialysis treatments by 9.4 percent has made me think hard about where dialysis has been, where it is now and where it might be headed. When I began my internship and residency at Michael Reese Hospital in Chicago (now gone, unfortunately), the Medicare entitlement for dialysis had not yet been enacted. Michael Reese had a long connection with pioneers in dialysis dating back to the 1920s. During my internship I rotated on the nephrology service. We had converted a hospital room to a dialysis ward and built Kiil dialyzers each time we wanted to do hemodialysis. We created Scribner shunts for blood access, and each treatment was an exciting challenge to get through without hypotension, clotting or other misadventures. We also had more than 40 patients on intermittent peritoneal dialysis (IPD). They would be admitted to the hospital each week, have a peritoneal catheter inserted and receive 48 hours of IPD. As the intern on the service, I admitted each patient, drew blood and then ran a set of electrolytes in a dedicated lab on the ward. I prescribed the peritoneal dialysis regimen for the 48 hours based on the physical examination and laboratory values. The Medicare entitlement for dialysis was enacted in the first year of my residency, 1972, and implemented in 1973. It changed everything.

Read more…

July 15, 2013

Stop Medicare Cuts Before They Happen

Centers for Medicare & Medicaid Services (CMS) recently took another step in a series of funding cuts for some of the most vulnerable patients in the U.S. healthcare system. These cuts threaten a system of care that has provided significant, systematic improvements in clinical outcomes and survival rates for patients with kidney failure.

Read more…

June 14, 2013

Breaking the Chains of Clinical Practice Guidelines: Could SCAMPs Be the Answer?

I have written extensively about the challenges in driving better outcomes in our patients with advanced CKD and ESRD. Not the least of these is the continued reliance of clinicians, payers and regulators on clinical practice guidelines (CPGs) to determine what domains are worthy of focus for public reporting and for payment to dialysis facilities. Unfortunately, however, the CPGs in nephrology are small in number and, despite excellent performance across the ESRD population on overall, we have not moved the needle on the really important primary outcomes that will ultimately result in better lives for our patients: lower mortality, fewer hospitalizations and an improved experience of care.

A nephrologist with a happy patient and caregiver.A recent article in Health Affairs described a different approach to achieving the goals for which we all strive—the use of standardized clinical assessment and management plans (SCAMPs), “a clinician-designed approach to promoting care standardization that accommodates patients’ individual differences, respects providers’ clinical acumen, and keeps pace with the rapid growth of medical knowledge.”(1) This approach was developed and has been applied largely by pediatricians as an outgrowth of their frustration with CPGs. Nearly 50 SCAMPs have been developed, and more than 12,000 patients currently are enrolled in SCAMP programs. Read more…

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