Winter 2012 Member e–Newsletter

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REMINDER:

May 9-13, 2012

Take the 2012 CAP Salary and Benefits Survey

Click here! Your input will help us all better understand the multiple roles of the Advanced Practitioner in nephrology and how we are being compensated within the profession.

CALENDAR

March is National Kidney Month!
March 8: World Kidney Day

March 15-18
Renal Physicians Association Annual Meeting
Marriott Wardman Park Hotel
Washington, D.C.

April 29-May 2
American Nephrology Nurses' Association
Walt Disney World
Orlando, FL

Quick News…

  • By the numbers: According to the 2010 CAP survey of renal advanced practitioners, the majority of us are age 30-59. Most of us have been in our present position for less than 5 years (59%).
  • Have you seen the latest USRDS data? The 2011 U.S. Renal Data System (USRDS) report is now available. Check out the summary slide show by here (by Renal Business Today) or access the entire report here.

Table of Contents

Dialysis Essentials Arrives

Dialysis EssentialsFirst, we had Nephrology Essentials, an online tool and CAP membership benefit that serves as a primer for the practitioner who is new to nephrology. Now Dialysis Essentials is available on the CAP website. Use your membership number to access this new tool for practitioners. It is divided into three sections: hemodialysis, peritoneal dialysis and management of issues, which includes anemia, bone mineral disease and nutrition. Written by CAP members for CAP members, it is sure to be an essential, go-to source. Many thanks to all the people who contributed, and especially to Lisa Farris, who so masterfully put this together.

Dialysis Essentials contributors: Gladys Benavente, MSN, ANP-c, CNN-NP; Marty Bergman, MS, RD, PA-C; Jane S. Davis, DNP, CRNP; Beth Evans, CRNP; Lisa L. Farris, DNP, CRNP; Tricia Howard, MHS, PA-C; Becky Keating, RN, CNN, Annette Needham, MSN, ARNP, NP-C, CCTC; Lynn Poole, CRNP, Amma Sewaah-Bonsu, DNP, CRNP; Kim Zuber, PA-C

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Chair's Corner

Kim Zuber, PA–C, MSPS

As I prepare to write my last column, I am reminded of how far advanced practitioners have come in the last four years…and how far we still have to go. Once we were considered an afterthought but now our opinion is valued and solicited by the medical community in general and NKF in particular. We are the face of nephrology for many of the patients, we are courted by the drug companies and we are acknowledged as the educators for kidney disease. Our Council has grown from a mere five members to 300+ in the space of three years. Among our accomplishments:

  • We have had the highest membership growth rate of any of the NKF Councils.
  • We have an AP member who sits on the NKF Board of Directors and continually reminds them to use the neutral word ‘practitioners’ or ‘clinicians’ when referring to the professional who care for kidney patients.
  • We have a research letter in AJKD outlining the impact of APs in the Kidney Disease Education (KDE) classes.
  • We have a bimonthly column in Clinician Reviews for outreach to our colleagues to educate them about our patients. Our article, “Renal Dosing of Medications,” is rated the 2nd-highest read article, proving our colleagues need and want our expertise.
  • We have a quarterly column in Nephrology News and Issues which updates the renal community about APs and what they can (and do) do for their practices.
  • We have articles in Clinical Advisor, PA Professional, JAAPA, and ANNA.
  • We have an annual meeting, sponsored by the Renal Physician Association (RPA), which includes AP speakers and APs on the planning committee.
  • We have APs on the planning committee for the RPA’s annual physician meeting.

And yet, we still are fighting many of the same battles:

  • We are not always acknowledged in newsletters and publications when patients are told to “ask your doctor.”
  • We are ignored by the same drug companies who are courting us to run their research protocols when they advertise “only your doctor can…”
  • We are omitted from new regulations for UNOS to decide who can evaluate a donor and/or recipient (thanks to NKF-CNSW for letting us know about this!).
  • We have to fight to have AP speakers included in some of our own meetings.

As I said in my last column, “Laws are made by those who show up.” As I turn the reins of CAP over to 2012-13 Chair Barb Weis, NP extraordinaire, I ask (actually beg) all of you to stay involved, to give back to your community and your profession and to make sure that APs are included in all the laws and regulations, advertising, and articles to come. I know I can count on all of you. CAP has been an incredible organization that is still young. Look at all we have accomplished already...can you imagine what we can do in the next four years?

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2012 CAP Awards

NKF-CAP honors Dolph Chianchiano, JD, MPRAand Marty Bergman, MS, RD, PA-C, for their work in the nephrology community. NKF-CAP awards will be presented at the 2012 NKF Spring Clinical Meetings in Washington, DC, in May.

DolphDolph Chianchiano, JD, MPRA, is the third recipient of the CAP Nostradamus Award. The annual award is given to a person or institution which has made a contribution to nephrology and, specifically, advanced practitioners. For more than 30 years, Dolph has been actively involved in public policy both at a national and state level. He has been a true patient advocate who has always promoted the renal community. Among his many accomplishments are influencing the extension of Medicare coverage for immunosuppressants for transplant recipients and launching the American Journal of Kidney Diseases (AJKD).

It was Dolph's work which helped bring about the Medicare Improvements for Patients and Providers Act (MIPPA) and the educational benefit for six hours of education for Medicare recipients. This act has been particularly beneficial to advanced practitioners, as we are the ones generally teaching the classes.  Although he has officially retired, Dolph still maintains a presence at the NKF and will remain a valuable resource and friend to us.

Marty BergmanDietitian-turned-nephrology-practitioner, a quilter who once raised ducks, Marty Bergman, MS, RD, PA-C, is the 2012 recipient of the CAP Tim Poole Award. Marty was CAP's first Member-at-Large, a position which covers a range of projects. She was a driving force behind the first NKF-CAP Salary and Benefits Survey, and has helped develop the 2012 survey. Marty created a poster with the results which was exhibited at the 2011 ASN meeting. Dialysis Essentials, the new online training program for nephrology APs, would not have been possible without her hard work. When Sydney, the CAP traveling stuffed kidney mascot, began showing wear and tear, Marty arranged for a new and improved Sydney. In short, she has done a little bit of everything and all of CAP is indebted to her.

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Bundling and Hemoglobins: A Look Back

Lynn Poole, FNP-BC, CNN
CAP Legislative Chair

As we embark on a new year, it is a good time to review some of the happenings of 2011. The most talked-about change in the care of patients with ESRD was the implementation of the Prospective Payment System (PPS) for ESRD (bundled payment). As 2011 came to a close, the results of the Quality Improvement Program (QIP) were published and, in general, showed good results. Bear in mind that the data submitted for the first QIP measurement was for 2010 and any payment reductions will apply in 2012. In November 2011, CMS issued final rules for QIP. The provisions in the final rule will be effective for payments to dialysis facilities furnished on or after Jan. 1, 2012; the new requirements for the ESRD QIP described in the final rule will affect the payment rates in payment years 2013 and 2014.

The 12/15/2011 edition of Renal Business Today reported on the QIP performance scores for 2011. Included is a statement from Patrick Conway, MD, Chief Medical Officer and Director of the CMS Office of Clinical Standards and Quality.

“For the payment year (PY) 2012 ESRD QIP, 4,939 facilities were assessed and received a Total Performance Score, which determines if the facility met the requirements under the program and can avoid receiving a payment reduction. Of these facilities, over two-thirds (69.1 percent) will receive no payment reduction as a result of achieving a high enough Total Performance Score, which for 2012 is 26 out of 30 points.

The payment reductions for the remaining facilities are as follows:

  • 16.6 percent will receive a 0.5 percent reduction
  • 6.0 percent will receive a 1.0 percent reduction
  • 7.7 percent will receive a 1.5 percent reduction
  • 0.6 percent will receive a 2.0 percent reduction

An additional 625 facilities (11.2 percent of all facilities) did not receive a Total Performance Score due to insufficient data. These facilities will not receive a payment reduction.

The ESRD QIP program’s overarching goal is the continual improvement of dialysis care provided to Medicare beneficiaries nationwide to drive better outcomes. The ESRD QIP will evolve over time to include additional measures that promote high quality of care and outcomes for Medicare beneficiaries."

The Dialysis Outcomes Practice Patterns (DOPPS) Practice Monitor (DPM)

DOPPS reported that from August 2010 to April 2011:

  • average hemoglobin levels fell slightly (0.10 g/dL)
  • the percentage of patients with hemoglobin >12 g/dL declined from 31.4 percent to 28 percent
  • the percentage with hemoglobin <10 g/dL rose from 8.5 percent to 10 percent
  • the percentage with hemoglobin <9 g/dL was stable at approximately 2.7 percent

In addition, there was a drop in prescribed doses of ESA especially at the higher dosages. No conclusions were drawn as to whether there is a causal relationship to the PPS but these findings suggest there have been changes in practice patterns during the months prior to and subsequent to its implementation.

As 2012 progresses, we can expect to see additional results/outcomes of the PPS as it moves forward to full implementation. So stay tuned and be sure to let us know what is happening in your area.

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Welcome to New NKF-CAP Executive Committee Member Catherine Wells, DNP, ACNP-BC, CNN-NP

CAP members are familiar with Catherine Wells' name. She is a frequent contributor to listserv discussions and is one of our volunteer authors. Catherine was recently elected Secretary of CAP, to follow in Lisa Farris' footsteps. Catherine lives in Jackson, MS, where she has the impressive title of Director of Nephrology and Dialysis Services. In this capacity, she is responsible for all dialysis programs for the University of Mississippi Healthcare – including outpatient dialysis, inpatient dialysis, and a large home training program. In addition to her administrative duties, Catherine also directs the annual Nephrology Update and Renal Update, a one-day seminar for dialysis nurses. She has worked with dialysis patients since 2003, first as a nurse in a rural area and then as an advanced practitioner at the University of Mississippi.

In 2010, she received her Doctorate of Nursing Practice from the University of South Alabama. Her capstone project involved clinical research as well as continuous quality improvement (CQI). Catherine is passionate about using CQI in the pursuit for the best medical care, as patients deserve nothing less. When she is not working, she enjoys her family and during soccer season, is frequently at the field watching her daughter play. We welcome Catherine to the Executive Committee.

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