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June 16, 2015

Meaningful Use Stage 3: What does it mean for nephrologists?

This post is by Mark Kaplan, M.D., vice president of medical affairs for DaVita Kidney Care

For many in the throes of demonstrating for CMS’ Meaningful Use (MU) Stage 2 requirements, it may be too overwhelming to even consider what Stage 3 has in store. CMS released the Stage 3 Proposed Rules on March 20, and while 301 pages may seem long, it is sparse compared to previous rules.

There are eight objectives to meet for Stage 3, some which have multiple measures associated with them. For example, the CPOE objective requires meeting measures related to Lab Order Entry, Medication Order Entry, and Diagnostic Imaging Order Entry. Some objectives allow for meeting only two of the three measures, providing at least a semblance of flexibility.

At a glance: Stage 3 Objectives

  1. Protect Patient Health Information
  2. Electronic Prescribing (eRx)
  3. Clinical Decision Support (CDS)
  4. Computerized Provider Order Entry (CPOE)
  5. Patient Electronic Access to Health Information
  6. Coordination of Care through Patient Engagement
  7. Health Information Exchange (HIE)
  8. Public Health and Clinical Data Registry Reporting

Not surprisingly “payment adjustments,” (the CMS term for penalty), are still being enforced. Not attesting to MU in 2015 will cause 2017 to sting, as you’ll be receiving a 3% reduction in your Medicare Part B billings: 3% translates to roughly $7,000 for the average nephrologist.

Audits are another fact of life, with 5-10% of providers being subject to audit with failure rates are somewhere between 21-24%. Failing to pass an audit means giving CMS back any incentive dollars received.

As interpreting the objectives of, and meeting the requirements for, Meaningful Use become more important for the financial health of your practice, you need a vendor who understands this. It’s more important than ever to find a vendor who works with you like a partner.

Mark R. Kaplan, M.D., previously practiced nephrology in Nashville, Tennessee, where he launched and developed the practice’s clinical research program. He served as the vice president of clinical research at Renal Care Group and Fresenius Medical Care, and was chief medical officer at DSI Renal, Inc. before joining DaVita Kidney Care. Dr. Kaplan earned his medical degree at Vanderbilt University, and then completed a year as chief resident in internal medicine at the Nashville Veterans Affairs Medical Center, and a clinical and research fellowship in nephrology and hypertension at Harvard University Medical School’s Brigham and Women’s Hospital in Boston.

December 3, 2013

NEWS: School Bus Driver and PD Patient Gets Kidney Transplant

It’s no secret that dialysis patients who continue to work while on dialysis are two times more likely to get a kidney transplant(1), and the story of former DaVita patient Stephanie Carson is a great example. I’m happy to be able to share this coverage of Stephanie’s transplant with all of you and hope to see more news like it moving forward.

The Daytona Beach News-Journal
South Daytona mom thankful for health, daughter’s kidney donation

My FOX Orlando
Daughter gives mother a kidney
FOX 35 News Orlando

Our patients are a part of a fragile population and this kind of news plants seeds of hope and determination that many of them need in order to maintain their jobs and make it through the rehabilitation process of dealing with kidney disease. However, I’d be remiss not to mention the other side of this topic. Please keep in mind that there are many medical reasons why people do not work and those same reasons can keep these individuals off the transplant list.

Have you seen any stories lately that you’d like to share? Paste the link below and this blog post can serve as a wall of reminders about the benefits of staying employed during dialysis.

  1. Source: http://onlinelibrary.wiley.com/doi/10.1111/ctr.12177/abstract

March 7, 2013

End of Life Planning with Dialysis Patients

End of life discussions are always a sensitive and difficult subject to discuss with elderly dialysis patients. Today, I want to talk about why end of life planning should not be looked at as a broad decision based on chronological age, but rather a one-on-one opportunity to ensure the highest quality of life on a per patient basis.

How are you approaching end of life planning with your dialysis patients and what advice do you have for other physicians?

November 8, 2011

Is Failure an Option?

I read with interest an editorial by Kathleen Parker, writing for the Orlando Sentinel, which commented on Steve Jobs. Rather than focus on all of his successes, as many have done, she focused on his failures, concluding as many of us already know that “sometimes you have to fail to succeed.” Jobs himself recognized his failures in his now-famous 2005 commencement speech at Stanford University. Risk-taking is so ingrained in the psyche of Americans that it is viewed by many, myself included, as a major factor in differentiating us from other countries. In India, for example, risk-taking is frowned upon, which hampers small start-up companies from getting a foothold in a growing entrepreneurial environment.

So what does that have to do with accountable care organizations (ACOs)? In my many interactions with my colleagues, I often bring up a similar point as Parker about the fear of failure. Physicians are selected as success stories — the brightest person in grade school, high school, undergraduate and medical school. Failure was never an option. We didn’t get into medical school by collaborating with anybody. We got there by outperforming. My argument when discussing the business side of medicine is that if you have no failure, you’re not taking enough chances, and therefore someone who is willing to take those chances will succeed where you have not.
I think we all understand that risk-taking, rightfully, has no place in the clinical practice of medicine. Our conservatism serves us well in that arena. Outcome-driven data drive our practice of medicine. But as we embark in the reinvention of the relationship among care providers, healthcare payers and healthcare systems, I would urge caution. Failure in the ACO world is entirely possible. Physicians need to lead as the ultimate advocate for the patients who face the greatest risk from the failure of a system attempting to integrate historically distant parties.

I agree that failure is good. It often helps define who we are and leads to a better product or process; it has served the American business sector well. But we must maintain our diligence when it comes to applying this philosophy to the healthcare industry. Failure in that venue, particularly uncontrolled failure, would impact the outcomes of real people.

I look forward to your comments,
Robert Provenzano, MD

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