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Archive for Nephrology

October 29, 2015

CMS Five-Star Quality Rating System Supports Patient Choice

SEALS(NEW)2016Patients 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.

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March 25, 2015

Keeping Patients Safe: A Fundamental Requirement to Move Up the Clinical Quality Pyramid

I was having a conversation with my mother-in-law, Doris, recently at her assisted-living facility. She had moved from her own apartment to the memory-care unit two years prior and had adjusted well to the smaller space and more institutional structure of the care she was receiving. At 92 years old she was fortunate to be physically frail but otherwise healthy—on only Synthroid for long-standing hypothyroidism. Slowly progressive dementia is apparent, but she is still able to carry out activities of daily living and recognize and enjoy visitors. I had recently completed Atul Gawande’s newest book, “Being Mortal: Medicine and What Matters in the End,” and decided to ask Doris what mattered most to her at this stage in her life. She wanted to be treated compassionately, with dignity, and she wanted to feel safe as her external environment contracted around her.

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July 30, 2014

Patient-Focused Quality Pyramid: FluidWise Edition

pouring water in a glass collection isolated

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 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


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 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.


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.

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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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