Year in review: Important developments in kidney care in 2017

Looking over the important events that shaped renal care in 2017 – clinical developments, policy changes, testing new payment models and natural disasters that challenged patients and providers – it becomes clear that few of these have been wrapped up in a neat, tidy bow. Many have already make tracks for 2018.

Governance. Since the departure of Tom Price, MD, former HHS secretary, the department is still looking for a new leader. While the office has continued to operate important programs, like CMS’ Innovation Center, the lack of a new secretary has meant limited launch of any new initiatives. The Renal Innovation Accelerator might be an exception (see an update in National News on page 10), with its focus on bringing public and private research dollars together to improve kidney care, but health care policy proposals have been scarce.

Physician payment. Like a chameleon, this effort by Congress to tie quality of health care to reimbursement for the nation’s near 1 million physicians seems to change every time the Federal Register gets printed. Nephrologist Terry Ketchersid, MD, helps us break down the details on the latest version of this model in this issue.

Integrated care. It’s no secret that CMS is conducting a 5-year demonstration to look at whether dialysis care can be delivered more efficiently within an end-stage renal disease seamless care organization (ESCO) run by nephrologists and dialysis providers. The results from the first year of the demonstration outshined all other accountable care organizations by delivering $72 million in savings in 2017. What remains hidden is how it is all getting done. Do not blame the renal provider community; CMS is putting a chokehold on participants from telling the story. Let us hope for a more open pathway for communication in 2018 when another round of results is due.

More information might help the renal community resolve conflicting views on how the use of integrated care should progress in the future. The Kidney Care Alliance (KCA), composed of not-for-profit dialysis companies, is opposing H.R. 4143, the Dialysis Patients Demonstration Act of 2017. The bill would allow dialysis companies to build their own integrated care networks similar to the ESCO demonstration.

“The legislation could further increase consolidation in a sector that is already highly consolidated,” KCA member Dialysis Clinic Inc. noted in a written statement. “Only large corporations could easily restructure themselves from a provider organization into an entity that could also administer an insurance plan, with complete risk of all of the patient cost …”

Natural disasters. Rare is the occasion in which dialysis care gets positive exposure in the general press, but the heroic search and rescue efforts by countless dialysis staff members to find patients trapped by flooding in Texas, Florida and Puerto Rico, and getting them desperately needed treatments put the renal community front and center in media circles. Industry also helped, with shipments of much needed supplies and donating money to the American Kidney Fund’s disaster relief efforts. Still, the damage from Hurricane Maria in Puerto Rico and its outlying islands leaves clinic operations an almost day-to-day challenge.

While we will continue to follow these events in 2018, certainly there were important developments that had a lasting affect this year.

Patients with acute kidney injury can now be treated in outpatient dialysis clinics.

While debate continues on allowing third-party payment to cover insurance premiums for dialysis patients, legislative activity from the pro-business Trump administration suggests dialysis providers may get a win over insurers this year.

On the clinical front, the drug tolvaptan used in patients with autosomal dominant polycystic kidney disease (PKD) during clinical trials showed a slower decline in estimated glomerular filtration rate compared to placebo. It’s a major breakthrough for patients with PKD.

Finally, I highlight an important step for the publication you are reading. Nephrology News & Issues begins its 32nd year as a SLACK Incorporated publication. Nephrology News & Issues joins the company’s extensive portfolio of specialty-focused health care titles in print and online at Healio.com. Turn to page 12 to read why we are excited to continue the success of Nephrology News & Issues in print and online.

There are plenty of good reasons to show that the kidney care field will have a busy 2018. -by Mark E. Neumann