“It is one of the strengths and the appeals of our profession that we encompass so many aspects of medical science in our care of our patients and in our study of the mechanisms of kidney function and diseases.” Dr. Harris
Fifty years ago this year, a group of illustrious Nephrologists and prominent Internists met to form the American Society of Nephrology. Nephrology as a subspecialty had arisen both from studies of renal physiology and from studies and clinical activities related to metabolic and hemodynamic alterations related to kidney failure. As a field, it had clinical roots in cardiology. Indeed, the first renal society in the United States was the Renal Section of the Circulation Council of the American Heart Association. Although Nephrology was already an accepted subspecialty, the formation of the ASN signaled that in the United States, nephrology would no longer be considered only a branch or an offshoot of cardiology.
Nephrologists are leaders in medicine and science, but do we always define ourselves as such?
This “moment” in health care encompasses a huge amount of change, the kind of change nephrologists are incredibly well suited to lead. The skills that make us great nephrologists are the same skills that make us effectively pilot and implement new approaches to health care. Changes in government policies that focus on quality measures and team care, and the rollout of bundled payment mandates mean that clinicians must adjust their practice patterns. Nephrology is already a leader in these areas; we understand how to provide the highest quality care in a bundled payment environment, and we excel at leading medical teams that provide high-quality care for a complex patient population.
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 MACRA (legislation approved in 2015) repealed the Medicare SGR physician payment system and replaced it with two tracks for Medicare physician payments, MIPS (Merit-based Incentive Payment System) and APMs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).