Kidney Care Partners-a coalition of renal providers, patients, renal pharmaceutical companies, and dialysis equipment manufacturers-launched the Performance Excellence and Accountability in Kidney Care (PEAK) project on June 3 in Washington, with the hopes of reducing the death rate among dialysis patients in their first year of treatment by 20% before the end of 2012. If successful, PEAK could extend the lives of 10,000 dialysis patients, KCP said.

KCP has contracted with Brown University in Rhode Island, and that state's quality improvement organization, Quality Partners of Rhode Island, to manage the project. Scientists from Brown University's Gerontology Center will work with nephrologists in the school's Department of Medicine to develop project goals and track progress.

The impetus for PEAK began about six months ago, said Kent Thiry, chairman of KCP and CEO of DaVita Inc., the second largest dialysis provider in the United States. When KCP members looked at launching a new project, "we wanted something that would have a clear quality improvement goal...something that would really move the dial," he said. At 30% per year, first year mortality was a persistent problem, and outcomes hadn't improved in over a decade. "We didn't want to use the excuse any more [of high mortality] about having older and sicker patients on dialysis. We're looking at this problem as a way to see how we can think differently, share [information] differently, and live up to our goals" of KCP, he said.

While the agenda and approach to the problem is still being formulated, PEAK project directors believe one of the keys to reducing the mortality rate is in improving preventive care, addressing clinical issues in patients as their kidney disease progresses. The success of the project will rely on a "community-wide process of identifying and sharing 'breakthrough' practices that will improve survival rates," according to the PEAK Web site. Project coordinators will look at anemia management, catheter use, dialysis adequacy, and nutrition as starting points, and explore the value of case management.

Thiry said he hopes the Centers for Medicare & Medicaid Services takes an interest in PEAK, particularly since reducing mortality will also reduce expensive hospitalizations for dialysis patients. "In order to significantly reduce first year mortality, we need to significantly improve quality of care. If you improve quality of care, you will reduce hospitalizations."

For more information on PEAK, visit the Web site at www.kidneycarequality.org


RPA makes recommendations to CMS on the ESRD bundle

The Renal Physicians Association released a paper on May 18 detailing the Association's views on the forthcoming bundled payment system for dialysis services. The full paper is available at www.renalmd.org. Here is a summary of the RPA recommendations taken from the paper:

1.    Reimbursement for nephrologists' services must be outside the expanded composite rate bundle.

2.    Reimbursement for services and procedures related to maintaining a patients' vascular access must be outside the payment bundle.

3.    The route of drug administration should be immaterial in developing the bundled  payment, and this principle should apply to both oral and injectable drugs, and to subcutaneous administration of drugs, that have been proven to be clinically equivalent.

4.    The payment bundle must appropriately account for case-mix variability, and allow for ongoing review and analysis of environmental changes affecting case-mix.

5.    The revised composite rate bundle should promote patient choice of all dialysis modalities.

6.    In developing outlier payment policies, CMS should address frequently occurring circumstances such as those patients with chronic fluid overload, as well as less common situations such as chronically obese patients or pregnant patients. CMS should also consider creating a waiver or exception process to provide appropriate additional reimbursement to account for the higher cost of treating these patients.

7.    The revised composite rate formula should address the needs of pediatric patients, and specifically include the current pediatric dialysis unit exemptions and the current case-mix adjustments that account for the increased costs associated with dialyzing children, adolescents and young adults.

8.    The revised composite rate formula must not only cover the services included in the bundle but also be sufficient to promote the use of electronic medical records, integration of emerging technologies, and other innovations in medical practice, as well as the increased expense of compliance with the revised Conditions for Coverage for ESRD facilities.

9.    A mechanism for predetermined, periodic review of the bundle must be included when the bundle is revised.


 In Brief: CMS's Judith Kari receives award from NKF

Judith Kari, MSW, received the Robert W. Whitlock Lifetime Achievement Award from the National Kidney Foundation. Kari has been a professional member of the nephrology community for four decades. She began as a clinician working with dialysis and transplant patients in the Veterans Administration system. She worked as Executive Director of one of the original ESRD Networks for 10 years and as a workgroup member of one of the original Dialysis Outcomes Quality Improvement committees, setting standards for dialysis adequacy. She has served on the Board of Directors of the National Kidney Foundation and as the Deputy Director of the American Kidney Fund. She was elected the first president of the Council of Nephrology Social Workers.

Currently, Kari is the National Technical Director of the ESRD Survey and Certification Program for the Centers for Medicare and Medicaid Services. "I love my work, and I always have. I have been very fortunate to be working in the changing world of nephrology," she said.




In Memoriam

Barbara Prowant, MS,RN,CNN
The University of Missouri and the organizers of the Annual Dialysis Conference have established The Barbara Prowant Lectureship for the 2010 conference as well as a scholarship fund to promote nephrology nursing education and research. Prowant, who has helped to direct the conference's program since 1981, died just hours before the start of this year's 29th annual meeting, held in Houston March 8-11, after a battle with cancer. She was 55.

Prowant was certified as a nephrology nurse in 1988 and as a peritoneal dialysis nurse in 1989. She joined the Nephrology Division at the University of Missouri Health Sciences Center in 1977 as the Coordinator of the CAPD program and starting in 1979 she served as a Research Associate for the division.

For more information on the Barbara Prowant Lectureship and the Prowant Scholarship Fund, contact Elaine Rogers at 573.882.9973 or e-mail rogerse@health.missouri.edu.

William B. Schwartz, MD
William B. Schwartz, MD, a prominent nephrologist  and researcher who later focused on health care policy, has died. He was 86.

During his early decades as the head of the division of nephrology at what is now Tufts Medical Center in Boston, he helped to develop the field of nephrology and led landmark studies.

Schwartz's 1984 book "The Painful Prescription: Rationing Hospital Care," co-written with economist Henry J. Aaron, ignited a national debate on medical expenses. In a 1998 interview with The New York Times, Schwartz said "Americans have a hard choice between two options, and that hard choice has not been openly faced by the government, by employers, or by the general public... If we want all of these open-ended advances in medical care to be made available to virtually everyone who might benefit from them, costs will inevitably continue their upward surge, and we will devote an ever larger portion of our national resources to health care."