Nephrologist

Bernard Jaar, MD, from Johns Hopkins University and the Nephrology Center of Maryland, will be honored with the Garabed Eknoyan Award from the National Kidney Foundation, according to a press release.

Physician assistants and nurse practitioners, collectively known as advanced practitioners or APs, provide an increasing portion of primary care in the United States and will be the dominant clinicians recognizing and referring patients with chronic kidney disease in the 21st century. In 2016, there were 104,000 APs practicing in primary care, almost half of the number of the 223,000 PCPs.1 The PCP population is declining and aging with greater than 25% of the workforce older than 60 years. In contrast, the AP population is younger; for example, the mean age for a PA is 37 years.1

SAN DIEGO — Rheumatologists treating patients with lupus nephritis should make a concerted effort to reduce or avoid use of NSAIDs and other nephrotoxic drugs in order to improve long-term outcomes, according to a presentation at the 2019 Congress of Clinical Rheumatology West.

Health care is entering a new era where the advent of “big data” brings tremendous opportunities to revolutionize the profession. In order to be purposeful, data must be analyzed, interpreted and used to improve patient care. Exploring the associations among different pieces of information derived from large and diverse datasets to enable intelligent and informed decisions is now possible with the emergence of artificial intelligence (AI).

When speaking at a press conference just hours before President Trump unveiled the Advancing American Kidney Health initiative, HHS Secretary Alex M. Azar II called the package of new regulations and financial incentives “the most significant initiative undertaken on kidney disease by any President, and the single biggest change to how we treat this disease since Medicare began covering end-stage renal disease patients in 1973.”1

The government took a bold step in payment reform in July with the announcement of five new Centers for Medicare and Medicaid Innovation-designed payment models for physicians and dialysis providers. Ultimately, this movement away from fee-for-service payment toward value-based reimbursement is a fundamental step in the process of aligning health care providers around the holistic care for patients, especially upstream in chronic kidney disease.

Editor’s note: HHS has set a goal of having 80% of the incident dialysis patient population treated by home dialysis or have a functioning transplant by 2025. Nephrology News & Issues asked Brent W. Miller, MD, the Michael A. Kraus Professor of Medicine and clinical chief of nephrology at Indiana University School of Medicine, as well as a Nephrology News & Issues Editorial Advisory Board Member, whether the plan can be successful.

At first glance, it is hard to say how the Advancing American Kidney Health initiative payment models will affect the operations or the finances of kidney transplant centers. While increasing the total number of kidney transplants performed is heavily incented in both the mandatory ESRD Treatment Choices and voluntary payment models, the financial carrots and sticks in this regard are directed only at general nephrologists and dialysis providers.

The growing consensus in the kidney community is greater home dialysis use is essential to achieving clinical, patient quality-of-life and public policy objectives. Providers acknowledge the need to reframe how we think about delivering dialysis care to patients. As Adam Boehler, director of the Center for Medicare & Medicaid Innovation (CMMI), notes, treatment for patients with kidney failure should be “transplant wherever possible; if not, [treatment at] home wherever possible; and it should be a last resort that people go to a dialysis center.”

Editor’s Note: The number of patients on PD in the United States has historically outnumbered those patients choosing home hemodialysis. In Nephrology News & Issues’ 2019 dialysis provider survey, for example, growth in the PD population among the 10 largest providers was quadruple that of home hemodialysis, representing 28% of new patients who started dialysis among these providers from 2018 to 2019 (see page 30 of this issue for the complete survey results).