Embracing the Future: RPA 2008 Annual Meeting
Embracing the Future: RPA 2008 Annual Meeting
The theme of the 2008 Renal Physicians Association (RPA) Annual Meeting, held in Austin, Texas, was "The Future is Your Business: Preparing for Changes in Nephrology Practice." Experts from around the country addressed topics to help nephrology practitioners be positioned for changes in nephrology practice and thrive in today's healthcare environment. Specifically, the meeting focused on payment issues and approaches to care delivery as essential elements of managing a nephrology practice. Highlights from the meeting are summarized below.
Program chair Dr. Keith Bellovich and RPA President Dr. Alan Kliger kicked off the meeting. Dr. Kliger highlighted RPA's work over the past year in his opening address. He emphasized RPA's successful advocacy efforts, including the Centers for Medicare and Medicaid Services' (CMS) removal of the safe-harbor language from Federal regulation, RPA's testimony to the House Ways and Means Subcommittee on reimbursement issues affecting nephrology, anemia management care for kidney patients, and testimony before the US Food and Drug Administration concerning use of erythropoiesis-stimulating agents (ESAs). The RPA and the American Society of Pediatric Nephrology (ASPN) delivered proposals to the Relative Value Update Committee (RUC) considering revaluation of monthly dialysis codes. RPA also took a lead role in the development of chronic kidney disease (CKD) and end-stage renal disease physician performance measures. RPA's Director of Public Policy Robert Blaser provided more details on RPA's regulatory and legislative agenda. Mr. Blaser highlighted RPA's priority advocacy issues for 2008: Medicare physician payment reform; kidney care quality and improvement; implementing health information technology to improve patient care; medical liability reform; expanded coverage for immunosuppressive drugs; and the use of daily dialysis to improve quality of life.
Karl Ulrich, MD, Clinic President of Marshfield Center (Marshfield, Wisconsin), presented the Brian Ling Memorial Lecture, "Pay for Performance is Here! Lessons of Success from the Medicare Physician Payment Demonstration Project". Dr. Ulrich focused on CMS's Physician Group Practice Demonstration Project as undertaken by Marshfield Clinic. He reviewed the rationale for taking part in the project, both from the perspective of Marshfield Clinic and the government. Dr. Ulrich provided an overview of operational initiatives undertaken by the clinic to effect positive outcomes and the results of the project's first year. Additionally, Dr. Ulrich discussed the effect that the project may have on the future delivery of healthcare, particularly as it relates to the rise in consumerism.
Federal policymaking affecting anemia management was addressed when UCLA's Allen R. Nissenson, MD, FACP, presented "ESA Payment Update: Where Knowledge Meets Politics." This presentation outlined the history of anemia therapy and the commentary and debate that have arisen from the CHOIR, CREATE, and Normal Hematocrit studies. Dr. Nissenson shared the evolution of clinical practice guidelines that the scientific community has developed to address anemia management and the factors that have resulted in various reimbursement protocols over the last decade.
West Virginia University's Rebecca Schmidt, DO, FACP, FASN, presented "Value and Courage in Politics: Nephrology Reaches Farther," sharing her experience working with West Virginia state legislators to get mandated CKD screening for at-risk individuals who are Medicaid beneficiaries. Dr. Schmidt provided an outline of how to build and sustain relationships with legislators and reminded participants that emphasizing CKD as being about the patients (patients = constituents) is key to getting your message heard, along with emphasizing the epidemic of CKD and providing legislators with information that they can share with their constituents.
Issues surrounding teamwork in physician practice were the focus of "Herding Cats," presented by Susan Diamond, MD, who practices internal medicine and nephrology in Dallas and San Antonio, and Lynn Stewart, Executive Director and Privacy Officer Representative of the San Antonio Kidney Disease Center Physicians Group, P.L.L.C. They stressed the importance of teamwork in a nephrology practice to improve the bottom line, physician morale, and "group" survival. The speakers emphasized that in order to succeed, nephrologists can no longer function as individuals but rather as leaders and members of high-performing, goal-oriented teams.
Another session examined how nephrologists' relationships with industry affect clinical research and practice, and also addressed appropriate ways for engaging with corporate entities. In "Into the Grey Zone: Exploring Relationships with the Pharmaceutical Industry," Drs. Nathan Levin and Jonathan Himmelfarb provided perspectives on the relationships between physicians and the pharmaceutical industry. Dr. Levin, Professor of Clinical Medicine at Albert Einstein School of Medicine (Bronx, New York) and Medical Director of the Renal Research Institute in New York City, noted that 94% of physicians have some contact with industry (including accepting samples, gifts, or some type of remuneration). Dr. Himmelfarb, Director of the Division of Nephrology and Transplantation at Maine Medical Center (Portland, Maine), explored conflicts of interest using examples of the studies done on Vioxx (rofecoxib) and Vytorin (ezetimibe/simvastatin) by physicians with financial ties to the manufacturers.
Mark L. Graber, MD, FACP, gave the Louis Diamond Lecture on "Decision Support and Nephrology." Dr. Graber, co-chair of the Veteran's Health Administration Decision Support Workgroup, created the nation's first voluntary, anonymous medical error reporting process. At the RPA meeting, he helped attendees analyze various software tools and addressed how they can be implemented in practice. Dr. Graber reviewed decision support informatics solutions that integrate medical knowledge with patient data to generate case-specific advice and tools that increase quality and decrease medical errors.
End-of-life concerns were the focal point of a presentation by James Tulsky, MD, of Duke University and Durham VA Medical Center. In his lecture, "Experiences in Teaching and Learning about End-of-Life Discussions," Dr. Tulsky provided an overview of his work with oncology patients, including guidance in having effective conversations with patients and family members. Drawing comparisons between patients with cancer and those with advanced kidney disease, Dr. Tulsky reiterated that the fundamentals are the same: Asking what the patient or family member knows or understands about the diagnosis/prognosis, listening carefully, acknowledging emotions and roles, and clarifying information are standards of good patient/physician communication and are essential to delivering quality care.
In regard to nephrology reimbursement, Robert J. Kossmann, MD, PC, FACP, FASN, who practices internal medicine and nephrology in Santa Fe, New Mexico, and is RPA representative to the American Medical Association (AMA) RUC, provided an overview of the RUC process, entitled "Revaluation of the G-Codes -- Update on the Physician Payment Survey." He summarized the methodology that the AMA Specialty Society RUC uses to revalue various Current Procedural Terminology (CPT) codes as well as RPA's role in the process of revaluing the outpatient series of dialysis G-codes. He noted that a parallel process was performed by leadership and staff of the ASPN for the series of pediatric monthly dialysis codes. The data received were compiled and developed into code-specific recommendations in the format required by the RUC and were submitted to the AMA in January 2008. The results of that process are embargoed until the release of the proposed rule on the 2009 Medicare Fee Schedule.
In "Creating Innovation out of Conformity: Implementing Clinical Guidelines," Richard S. Goldman, MD, from the University of New Mexico Health Sciences Center in Albuquerque, discussed the guidelines for advanced CKD and adherence to the guidelines among nephrologists, primary care providers, and others. He discussed the process of converting guidelines to performance measures and implementation tools, and noted that studies have shown that creation and dissemination of guidelines are not enough; implementation tools and strategies for adoption are also needed.
The meeting concluded with a panel discussion of "PQRI: The Decision Making Process." Representatives from practices in Maryland, Pennsylvania, and Arizona provided various perspectives on the CMS Physician Quality Reporting Initiative (PQRI) and the factors that went into their decision on whether to participate in PQRI, including the financial and personnel costs.
The meeting also featured interactive workshops on topics such as how to investigate and get involved in clinical research, how to negotiate practice mergers, how to create teamwork in nephrology practices, and how to code correctly for various CKD services.
The 2008 RPA Annual Meeting offered the more than 600 practitioners in attendance exciting new ideas and practical tools for success. RPA's focus is on the future -- the cutting edge of practice -- anticipating changes before they occur to best prepare nephrologists to develop strategies and approaches so that they may thrive as clinicians and managers.
Plans are under way for RPA's 2009 Annual Meeting, March 20-23 in Baltimore, Maryland. Details of the program and registration are available on the RPA Web site, www.renalmd.org.
Introduction
The theme of the 2008 Renal Physicians Association (RPA) Annual Meeting, held in Austin, Texas, was "The Future is Your Business: Preparing for Changes in Nephrology Practice." Experts from around the country addressed topics to help nephrology practitioners be positioned for changes in nephrology practice and thrive in today's healthcare environment. Specifically, the meeting focused on payment issues and approaches to care delivery as essential elements of managing a nephrology practice. Highlights from the meeting are summarized below.
RPA: Year in Review and Advocacy Agenda
Program chair Dr. Keith Bellovich and RPA President Dr. Alan Kliger kicked off the meeting. Dr. Kliger highlighted RPA's work over the past year in his opening address. He emphasized RPA's successful advocacy efforts, including the Centers for Medicare and Medicaid Services' (CMS) removal of the safe-harbor language from Federal regulation, RPA's testimony to the House Ways and Means Subcommittee on reimbursement issues affecting nephrology, anemia management care for kidney patients, and testimony before the US Food and Drug Administration concerning use of erythropoiesis-stimulating agents (ESAs). The RPA and the American Society of Pediatric Nephrology (ASPN) delivered proposals to the Relative Value Update Committee (RUC) considering revaluation of monthly dialysis codes. RPA also took a lead role in the development of chronic kidney disease (CKD) and end-stage renal disease physician performance measures. RPA's Director of Public Policy Robert Blaser provided more details on RPA's regulatory and legislative agenda. Mr. Blaser highlighted RPA's priority advocacy issues for 2008: Medicare physician payment reform; kidney care quality and improvement; implementing health information technology to improve patient care; medical liability reform; expanded coverage for immunosuppressive drugs; and the use of daily dialysis to improve quality of life.
General Sessions
Karl Ulrich, MD, Clinic President of Marshfield Center (Marshfield, Wisconsin), presented the Brian Ling Memorial Lecture, "Pay for Performance is Here! Lessons of Success from the Medicare Physician Payment Demonstration Project". Dr. Ulrich focused on CMS's Physician Group Practice Demonstration Project as undertaken by Marshfield Clinic. He reviewed the rationale for taking part in the project, both from the perspective of Marshfield Clinic and the government. Dr. Ulrich provided an overview of operational initiatives undertaken by the clinic to effect positive outcomes and the results of the project's first year. Additionally, Dr. Ulrich discussed the effect that the project may have on the future delivery of healthcare, particularly as it relates to the rise in consumerism.
Federal policymaking affecting anemia management was addressed when UCLA's Allen R. Nissenson, MD, FACP, presented "ESA Payment Update: Where Knowledge Meets Politics." This presentation outlined the history of anemia therapy and the commentary and debate that have arisen from the CHOIR, CREATE, and Normal Hematocrit studies. Dr. Nissenson shared the evolution of clinical practice guidelines that the scientific community has developed to address anemia management and the factors that have resulted in various reimbursement protocols over the last decade.
West Virginia University's Rebecca Schmidt, DO, FACP, FASN, presented "Value and Courage in Politics: Nephrology Reaches Farther," sharing her experience working with West Virginia state legislators to get mandated CKD screening for at-risk individuals who are Medicaid beneficiaries. Dr. Schmidt provided an outline of how to build and sustain relationships with legislators and reminded participants that emphasizing CKD as being about the patients (patients = constituents) is key to getting your message heard, along with emphasizing the epidemic of CKD and providing legislators with information that they can share with their constituents.
Issues surrounding teamwork in physician practice were the focus of "Herding Cats," presented by Susan Diamond, MD, who practices internal medicine and nephrology in Dallas and San Antonio, and Lynn Stewart, Executive Director and Privacy Officer Representative of the San Antonio Kidney Disease Center Physicians Group, P.L.L.C. They stressed the importance of teamwork in a nephrology practice to improve the bottom line, physician morale, and "group" survival. The speakers emphasized that in order to succeed, nephrologists can no longer function as individuals but rather as leaders and members of high-performing, goal-oriented teams.
Another session examined how nephrologists' relationships with industry affect clinical research and practice, and also addressed appropriate ways for engaging with corporate entities. In "Into the Grey Zone: Exploring Relationships with the Pharmaceutical Industry," Drs. Nathan Levin and Jonathan Himmelfarb provided perspectives on the relationships between physicians and the pharmaceutical industry. Dr. Levin, Professor of Clinical Medicine at Albert Einstein School of Medicine (Bronx, New York) and Medical Director of the Renal Research Institute in New York City, noted that 94% of physicians have some contact with industry (including accepting samples, gifts, or some type of remuneration). Dr. Himmelfarb, Director of the Division of Nephrology and Transplantation at Maine Medical Center (Portland, Maine), explored conflicts of interest using examples of the studies done on Vioxx (rofecoxib) and Vytorin (ezetimibe/simvastatin) by physicians with financial ties to the manufacturers.
Mark L. Graber, MD, FACP, gave the Louis Diamond Lecture on "Decision Support and Nephrology." Dr. Graber, co-chair of the Veteran's Health Administration Decision Support Workgroup, created the nation's first voluntary, anonymous medical error reporting process. At the RPA meeting, he helped attendees analyze various software tools and addressed how they can be implemented in practice. Dr. Graber reviewed decision support informatics solutions that integrate medical knowledge with patient data to generate case-specific advice and tools that increase quality and decrease medical errors.
End-of-life concerns were the focal point of a presentation by James Tulsky, MD, of Duke University and Durham VA Medical Center. In his lecture, "Experiences in Teaching and Learning about End-of-Life Discussions," Dr. Tulsky provided an overview of his work with oncology patients, including guidance in having effective conversations with patients and family members. Drawing comparisons between patients with cancer and those with advanced kidney disease, Dr. Tulsky reiterated that the fundamentals are the same: Asking what the patient or family member knows or understands about the diagnosis/prognosis, listening carefully, acknowledging emotions and roles, and clarifying information are standards of good patient/physician communication and are essential to delivering quality care.
In regard to nephrology reimbursement, Robert J. Kossmann, MD, PC, FACP, FASN, who practices internal medicine and nephrology in Santa Fe, New Mexico, and is RPA representative to the American Medical Association (AMA) RUC, provided an overview of the RUC process, entitled "Revaluation of the G-Codes -- Update on the Physician Payment Survey." He summarized the methodology that the AMA Specialty Society RUC uses to revalue various Current Procedural Terminology (CPT) codes as well as RPA's role in the process of revaluing the outpatient series of dialysis G-codes. He noted that a parallel process was performed by leadership and staff of the ASPN for the series of pediatric monthly dialysis codes. The data received were compiled and developed into code-specific recommendations in the format required by the RUC and were submitted to the AMA in January 2008. The results of that process are embargoed until the release of the proposed rule on the 2009 Medicare Fee Schedule.
In "Creating Innovation out of Conformity: Implementing Clinical Guidelines," Richard S. Goldman, MD, from the University of New Mexico Health Sciences Center in Albuquerque, discussed the guidelines for advanced CKD and adherence to the guidelines among nephrologists, primary care providers, and others. He discussed the process of converting guidelines to performance measures and implementation tools, and noted that studies have shown that creation and dissemination of guidelines are not enough; implementation tools and strategies for adoption are also needed.
The meeting concluded with a panel discussion of "PQRI: The Decision Making Process." Representatives from practices in Maryland, Pennsylvania, and Arizona provided various perspectives on the CMS Physician Quality Reporting Initiative (PQRI) and the factors that went into their decision on whether to participate in PQRI, including the financial and personnel costs.
The meeting also featured interactive workshops on topics such as how to investigate and get involved in clinical research, how to negotiate practice mergers, how to create teamwork in nephrology practices, and how to code correctly for various CKD services.
Concluding Remarks
The 2008 RPA Annual Meeting offered the more than 600 practitioners in attendance exciting new ideas and practical tools for success. RPA's focus is on the future -- the cutting edge of practice -- anticipating changes before they occur to best prepare nephrologists to develop strategies and approaches so that they may thrive as clinicians and managers.
Plans are under way for RPA's 2009 Annual Meeting, March 20-23 in Baltimore, Maryland. Details of the program and registration are available on the RPA Web site, www.renalmd.org.
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