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Caroline Jennette

Often compared to the health maintenance organizations (HMOs) of the past, accountable care organizations (ACOs) have taken the spotlight as a new model of health care delivery and payment under the Affordable Care Act. Mark McClellan, MD, PhD, former administrator of the Centers for Medicare & Medicaid Services and current director of the Engelberg Center for Health Care Reform, spoke about ACOs at the 2011 Kidney Week Christopher R. Blagg Endowed Lectureship in Renal Disease and Public Policy.

The main tenet of ACOs is to provide high quality (and low cost), coordinated care with payments based on the value of

Caroline Jennette

While the nation awaits a ruling this month from the Supreme Court on the constitutionality of the Affordable Care Act (ACA), activities working toward implementation—or lack thereof—continue to be a complicated issue for states, especially those wrestling with differing views on health reform among state policymakers, governors, insurance commissioners, and attorneys general. Many states continue to move forward with implementation even as their governors decline or return federal funding to assist in development (Table 1).

Health exchanges

With a deadline to have a basic proposal in place by January 2013, creation of health care exchanges has been at

Caroline Jennette
Clinical Performance Measures

The growing tide of new metrics for evaluating delivery of care for chronic kidney disease (CKD) and other outpatient services warrants a healthy look at their efficacy, according to speakers at the policy sessions at Renal Week. Even as physicians and other care providers gear up to meet the new requirements, they must also take part in evaluating how well the measures work, speakers said.

Historically, there has been a lack of quality measures for CKD, but as some care services move away from hospitals and toward ambulatory care providers, a plethora of new measures for CKD

Caroline Jennette

Did you know that you may be listed as a urologist or an internist when you bill for Medicaid? Looking at Medicaid provider enrollment applications in 48 states (two do not have accessible applications), only 20 states have unique specialty codes for nephrology. Among these, only six have unique provider codes for pediatric nephrology.

Why is this important? According to the Center on Budget and Policy Priorities, 44 states face budget shortfalls in fiscal years 2009 and 2010 totaling more than $350 billion. Medicaid expenditures, shared by both state and federal governments, add a significant burden to state budgets. This

Caroline Jennette

Although the year is only half over, as of July, 41 states will have ended their legislative sessions for the year. Of this group, 17 states will carry over bills to the 2010 session if they have already passed both the House and the Senate. Dealing with budget shortfalls and a crumbling economy continues to take up a large chunk of political time, but policy initiatives related to kidney disease and nephrology were still introduced, and some were successful in their passage.

Figure 1 provides a snapshot of the number of bills introduced during the 2009 session related to

Caroline Jennette

The 2009 Renal Week Public Policy Sessions got off to a provocative start with a forum on conflicts of interest in medicine.

Allen Detsky, MD, PhD, an economist and general internist at Mount Sinai Hospital in Toronto, Canada, argued that physicians sitting on clinical practice guideline (CPG) committees may be influenced—both consciously and subconsciously—by relationships they have with pharmaceutical companies.

In a survey of 100 physicians who served on CPG committees, Detsky and his colleagues found that the majority (87 percent) had relationships with pharmaceutical companies and that the average number of companies physicians had relationships with was 10. While

Caroline Jennette

Kidney Disease Education (KDE) classes are now reimbursed by Medicare. Patient education services were mandated by the Medicare Improvements for Patients & Providers Act of 2008 and became effective January 1, 2010.

Who is allowed to administer KDE classes?

KDE services may be delivered by a physician, physician assistant, nurse practitioner, clinical nurse specialist, or if in a rural area (defined by Metropolitan Statistical Area), KDE services may be provided by a hospital, critical access hospital, skilled nursing facility, outpatient rehabilitation facility, home health provider, or hospice. Under no circumstances can a dialysis unit provide or bill for Medicare KDE

Caroline Jennette

Speakers at a “Controversies in Organ Transplant Policy” session at Renal Week 2010 described a range of issues affecting both kidney donors and recipients.

Gabriel Danovitch, MD, director of the Kidney Transplant Program at UCLA, described the steps taken this year by the Declaration of Istanbul Custodian Group (DICG) to create a framework of “muscles and tendons” across the “skeleton” of the Declaration. The Declaration of Istanbul was created in 2008 by representatives of scientific and medical bodies from around the world to protect the poor and vulnerable from the negative effects of transplant tourism and organ trafficking.

Although the

Caroline Jennette

Although the biggest health reform changes are not slated to become effective until 2014, several provisions going into effect this year will affect state Medicaid programs. The new political climate in Washington and courtroom battles may bring about significant changes to the Affordable Care Act (ACA), but states continue to move forward in implementation.

Changes to Medicaid in 2011

States continue to buckle under budgetary restraints, spending on average 16 percent of their general fund budgets on Medicaid. Several ACA provisions that become effective this year may help state Medicaid programs implement new service delivery systems, streamlining care and reducing

Caroline Jennette and Scott Sanoff

The National Kidney Foundation’s “End the Wait” campaign, launched earlier this year, is an ambitious agenda aimed at improving access to kidney transplants. The campaign reflects an increasing recognition nationally that kidney transplantation is the treatment of choice for most individuals with end stage renal disease (ESRD) and a growing awareness of the imbalance between available organs and the number of patients on the waiting list.

The campaign has four overarching goals: 1) improve the outcomes of first transplants, reducing the need for re-transplantation; 2) increase deceased organ donation; 3) increase the number of living donors; and 4) improve the