October 29, 2015
Patients have many choices when it comes to dialysis treatment, and making a decision of where to receive care can be confusing. A recently updated tool from the federal government simplifies that process, making it easier for patients, their families and caregivers to compare the quality of kidney care providers.
July 30, 2014
Every year, DaVita Kidney Care strives to improve clinical outcomes for our patients by evaluating the way nephrologists and dialysis caregivers approach patient care. Since 2000, we have succeeded in improving outcomes in specific areas relating to infection control, improved catheter rates, increased use of fistulas, better dialysis adequacy and year-over-year decreased mortality rates.[1] The end result of these improvements in care is increased overall quality of life for our patients. Read more…
July 2, 2014
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.
April 25, 2014
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.
March 19, 2014
When 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:
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!
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