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 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…

We are seeing a continual increase in the number of US patients with CKD and ESRD. The epidemic of obesity, and resultant diabetes and hypertension, has not abated and will continue to swell the ranks of patients needing care from nephrologists. Add to this the incredible improvement in the survival rate of ESRD patients over the last decade and the extended availability of medical care to the uninsured thanks to the Affordable Care Act, and we are indeed on the brink of a tidal wave of kidney patients. These facts should be a wake-up call to health policy-makers, especially in light of the shocking statistics from the most recent Medical Specialties Matching Program (MSMP)(1). For appointment year 2013, MSMP indicates that nearly a quarter of nephrology fellowship programs had unfilled positions, the worst of all medical subspecialties. Only 25 percent of positions were filled by US graduates overall and only 21 percent of clinical nephrology positions are filled by US graduates—the lowest of any medical subspecialty. Read more…