We need to take a stand, for our patients, against the potential Medicare Advantage (MA) cuts that were recently proposed by the Centers for Medicare and Medicaid Services (CMS).
Read more…

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

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…

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

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

“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…

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…

A recent editorial in the New York Times described a move by the New York City public hospital system to “pay doctors based on how well they perform.” (1) Under this program, the more than 3,000 salaried doctors at the NYU School of Medicine, the Mount Sinai School of Medicine and the Physician Affiliate Group of New York will receive no cost-of-living increases for the next three years, but there will be annual bonuses tied to meeting quality-performance goals. In the same issue of the Times there is an important critique of the pay-for-performance (P4P) approach, describing what many policy experts have said for years: “If only it worked.” (2) Op-ed columnist Bill Keller points out that the real driver of costs in our healthcare system is not overutilization of services, but rather the high unit cost of each service. Others may debate this premise, but the reality is likely a bit of both—more units and higher cost for each. As Bill Clinton said during the 2012 Democratic National Convention, “it’s math, folks,” and P4P is unlikely to change these factors significantly. Read more…

My last blog used the infamous Rodney King episode in Los Angeles as the springboard for suggesting that integrating care—physicians, hospitals and patients working together—is essential to achieve the best clinical outcomes for the chronically ill while constraining the runaway costs of healthcare. A recent article in The New York Times (http://www.nytimes.com/2012/12/25/opinion/approaching-illness-as-a-team-at-the-cleveland-clinic.html?_r=0) makes it clear that this is not a theoretical concept. Physicians at one of the great healthcare organizations in the country, the Cleveland Clinic, have been forming focused teams that can mobilize to efficiently diagnose and treat a variety of illnesses, including neurological, cardiovascular, oncologic, urologic and nephrologic. Read more…

Allen R. Nissenson, MD, FACP, Chief Medical Officer, DaVita
Dr. Nissenson explains Accountable Care Organizations (ACOs) in more detail and the clinical care opportunities for the kidney community.