Health care policy fellowship helps practitioners understand intricacies of ESRD program
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Being able to interpret the alphabet soup of health care policy related to kidney care is daunting for experienced clinicians.
But when trainees and early career fellows face the acronyms used to define agencies and demonstration projects, like CKCC, ACO, MA, SNP, PPS and ESCO, one can only imagine these physicians shaking their heads and wondering, “Where do I start?”
As a fellow beginning my nephrology career in 2015, one moment stands out to me. My mentor at Yale University School of Medicine, Ursula Brewster, MD, sat down during the first medicine rotation and showed us an article from the November 1962 issue of LIFE magazine entitled, “They decide who lives and who dies.”
Seven people sitting on a committee — their faces shadowed in anonymity — decided whether someone will be given the privilege to start dialysis. This LIFE article propelled kidney disease to the forefront of government policy and made end-stage renal disease a protected class of Medicare.
Public policy
As someone who was already excited about nephrology, this was the nail in the coffin: to see medicine and public policy united in purpose to create opportunities for all patients with ESRD. This crystallized my decision to become a nephrologist.
During my renal fellowship, I decided to revisit this topic of ESRD policy in my grand rounds, this time with a focus on kidney care finances. Aside from reading a few articles about policy and talking to a few attendings, it was challenging to develop a cogent and comprehensive understanding of how policy and the business of nephrology was evolving. I found the CMS website opaque and difficult to understand. Most nephrology podcasts covered clinical updates, but only some ventured into public policy and nephrology business practices.
At that time, we were also waiting for results from the ESRD Seamless Care Organizations demonstration, and CMS had just introduced the Kidney Care Choices model to the nephrology community. The landscape of ESRD was changing, and I realized that we needed to be at the forefront. We must be sitting at the table and be privy to these conversations.
Fellowship
The Early Career Policy fellowship, developed by the Renal Physicians Association, connects recent graduates to thought leaders, teaching about the challenges of the current policy climate and help envision a framework within the CMS models to best improve patient care. As public policy fellows, we get an inside look at how nephrologists advocate for themselves and patients both on and off Capitol Hill. We get to see “who makes the sausage and how it is made.”
At the recent RPA Physician Leadership and Advocacy meeting in June, Alex Liang, MD, the CEO for Dallas Nephrology Associates, reviewed the specifics of the Comprehensive Kidney Care Contracting model and the impact of the Medicare Advantage rate announcements for 2024. But he went beyond the typical CMS website information and described how his practice was rising to this challenge. Liang reviewed how they were structuring their population health services to help predict performance ahead of CMS and payer data and how they were focusing on programs that streamlined transition of care and patient education. It was practice management at its best, and what renal fellows need to hear.
As we enter this era of value-based care, we cannot do it by ourselves. I believe we will fare better learning from each other as a community than alone.
Acknowledgement: Thank you to Keith Bellovich, DO, for helping me prepare this article.
- For more information:
- Elizabeth Kurtz, MD, is a 2023 RPA Early Career Policy fellow and a nephrologist with TMA Associates in Pittsburgh. She can be reached at ekurtz@tma-wpma.com.
- For more information about the Early Career Policy fellowship, visit www.renalmd.org/PPFellowship.
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