ASN President's Column July 2016

By Raymond C. Harris, MD, FASN

We are all aware that the landscape for the practice of medicine in the United States is rapidly changing. For Nephrology in particular, how we practice currently will be very different from practice patterns in 20, 10 or even 5 years from now. Three recent developments may have significant effects upon the practice of Nephrology:

1. MACRA. MACRA (legislation approved in 2015) repealed the Medicare SGR physician payment system and replaced it with two tracks for Medicare physician payments, MIPS (Merit-based Incentive Payment System) and APMs (Alternative Payment Models).           

The SGR model was unsustainable, and ASN joined the rest of organized medicine to support its repeal.  ASN also supports the goals of the new payment system: to reward better care rather than more care, and to consolidate the existing quality reporting programs into a single program.  In this regard, the society has provided thoughtful comments to CMS about modifications to MACRA that will make the system more reflective of high-quality clinical practice and fully supportive of the latitude clinicians require to deliver the best care to individual patients. ASN’s letter to CMS represents hard work by members of the Public Policy Board, led by John Sedor, and by the Quality Metrics Task Force, led by Dan Weiner, and especially through the efforts of ASN staff, Rachel Meyer and David White.

While the legislation is specific to Medicare payments, these changes will impact commercial health plans as well. ASN will help educate its members about these changes in practice, the timelines that will affect each of us, and how the Final Rule differs from the Proposed Rule.

2. Changes to AKI coverage. The 2017 ESRD Prospective Payment System provides changes to coverage of patients with AKI in outpatient ESRD facilities. This change represents a potential benefit to our patients with AKI, who will no longer be required to remain hospitalized or return to acute dialysis facilities for treatment. At the same time, these changes require careful attention by physicians and dialysis facilities to tailor the dialysis prescription and provide close follow-up so that patients will be provided an optimal chance for recovery from AKIASN has met with CMS to share preliminary observations and will work with CMS and others to achieve these goals.

3. The White House Organ Summit. As I noted briefly in my June column, this Summit provided a unique opportunity to highlight the importance of kidney transplantation for our patients. Specific to practice, the Summit addressed the need for increasing the rate of transplantation, including discarding fewer organs, increasing organ donation after circulatory death, increasing the ability of all transplant centers to provide the best outcomes, being open to new payment plans through ESCOs and using social media as a means to increase organ donations. In addition, at the Summit the Department of Defense announced a plan to partner with industry to provide up to $160 million for innovative biomanufacturing and regenerative medicine approaches that transform care. ASN’s pledge to provide the initial $7 million to fund an XPRIZE for development of novel alternative approaches to existing methods of dialysis will further this push to innovate care of kidney patients.

As clinicians, we pride ourselves on our ability to balance a wide range of complex health issues to improve quality of life for people with kidney diseases.  I am excited about the growing number of initiatives that will prove catalysts to incorporating transformative change into kidney care.

 

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Raymond C. Harris, MD, FASN
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We are all aware that the landscape for the practice of medicine in the United States is rapidly changing. For Nephrology in particular, how we practice currently will be very different from practice patterns in 20, 10 or even 5 years from now. Three recent developments may have significant effects upon the practice of Nephrology:

1. MACRA. MACRA (legislation approved in 2015) repealed the Medicare SGR physician payment system and replaced it with two tracks for Medicare physician payments, MIPS (Merit-based Incentive Payment System) and APMs (Alternative Payment Models).           

The SGR model was unsustainable, and ASN joined the rest of organized medicine to support its repeal.  ASN also supports the goals of the new payment system: to reward better care rather than more care, and to consolidate the existing quality reporting programs into a single program.  In this regard, the society has provided thoughtful comments to CMS about modifications to MACRA that will make the system more reflective of high-quality clinical practice and fully supportive of the latitude clinicians require to deliver the best care to individual patients. ASN’s letter to CMS represents hard work by members of the Public Policy Board, led by John Sedor, and by the Quality Metrics Task Force, led by Dan Weiner, and especially through the efforts of ASN staff, Rachel Meyer and David White.

While the legislation is specific to Medicare payments, these changes will impact commercial health plans as well. ASN will help educate its members about these changes in practice, the timelines that will affect each of us, and how the Final Rule differs from the Proposed Rule.

2. Changes to AKI coverage. The 2017 ESRD Prospective Payment System provides changes to coverage of patients with AKI in outpatient ESRD facilities. This change represents a potential benefit to our patients with AKI, who will no longer be required to remain hospitalized or return to acute dialysis facilities for treatment. At the same time, these changes require careful attention by physicians and dialysis facilities to tailor the dialysis prescription and provide close follow-up so that patients will be provided an optimal chance for recovery from AKIASN has met with CMS to share preliminary observations and will work with CMS and others to achieve these goals.

3. The White House Organ Summit. As I noted briefly in my June column, this Summit provided a unique opportunity to highlight the importance of kidney transplantation for our patients. Specific to practice, the Summit addressed the need for increasing the rate of transplantation, including discarding fewer organs, increasing organ donation after circulatory death, increasing the ability of all transplant centers to provide the best outcomes, being open to new payment plans through ESCOs and using social media as a means to increase organ donations. In addition, at the Summit the Department of Defense announced a plan to partner with industry to provide up to $160 million for innovative biomanufacturing and regenerative medicine approaches that transform care. ASN’s pledge to provide the initial $7 million to fund an XPRIZE for development of novel alternative approaches to existing methods of dialysis will further this push to innovate care of kidney patients.

As clinicians, we pride ourselves on our ability to balance a wide range of complex health issues to improve quality of life for people with kidney diseases.  I am excited about the growing number of initiatives that will prove catalysts to incorporating transformative change into kidney care.