Fall 2011 Member e–Newsletter

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REMINDER: May 9-13, 2012

Quick News…

  • 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.
  • Wouldn't it be nice if we could predict how fast patients would progress through the stages of kidney disease from CKD to ESRD? The answer is not here yet but is closer. A recent article in JAMA reported on a predictive model which incorporated demographic, clinical and laboratory data which accurately predicted progression for patients in Stages 3 to 5 CKD, and includes a downloadable Excel spreadsheet: Tangri N, Stevens LA, Griffith J, et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011, 303(15):1953-1559.
  • In the November Nephrology News and Issues, CAP members Deb Hain and Amma Seewah-Bonsu reported on the predictive shortage of nephrologists and how Advanced Practitioners can help meet the needs of the population. This issue is also addressed in the following: Sargen M, Hooker RS, Cooper RA. Gaps in the supply of physicians, advance practice nurses, and physician assistants. J Am Coll Surg. 2011, 212(6): 991-999.
  • We all know a picture speaks a thousand words. The FDA's Nutrition Facts Label Programs and Materials site provides ideal teaching tools.

CMS, the Bundle and US

Lynn Poole, FNP-BC, CNN
CAP Legislative Chair

In the world of CKD/ESRD, 2011 will rank as one of the most interesting and pivotal years for the ESRD program and 2012 is shaping up to be more of the same. Like most people, Advanced Practitioners (APs) want clear and concise answers to questions that such changes bring. In the world of the Center for Medicaid and Medicare Services (CMS) and payers who adopt CMS policies, uncertainty seems to be the rule of the day.

During 2011, APs discussed a variety of topics and sometimes came away with answers and solutions. At other times, we were frustrated that the answers are not so clear cut or they seemed to be a work-in-progress. To further complicate matters, APs are providing services in varied work settings and under differing state laws and regulations with the result being that solutions may never be clear-cut or applicable to all settings.

The number one issue which had a significant impact on practice was the Prospective Payment System (PPS) for ESRD (aka "the bundle"). AP discussions included: laboratory testing, use of antibiotics, when/how to use the modifiers for acute conditions, use and payment for EMLA cream, recommendations for use of ESAs and hemoglobin ranges, proposed changes/additions to the PPS Quality Improvement Program, who can sign the 2728 attesting to the presence of ESRD, and the Medicare Kidney Education Program, to name a few.

What can we expect for 2012? We are awaiting the publication of the final rules for the next iteration of the PPS Quality Improvement Program (QIP) measures. We should expect to see a higher level of interest on the QIP since clinics have a financial risk if they don't meet the established QIP thresholds. If they meet the outcome thresholds, they will recoup the two percent withheld from their total Medicare revenue. If not, they stand to lose the entire two percent or some portion of it. Given that CMS has a full year of claims, we should expect them to review those to assess intended or unintended consequences of the PPS. And don't forget that CMS has every claim paid for fee-for-service Medicare beneficiaries.

Finally, remember that the PPS is a payment system, not a clinical management system. Each of us should continue to advocate for the best treatment for our patients and whenever possible, utilizing evidence based guidelines and best practices. We should have a high level of confidence that in 2012, APs will shine as advocates for their patients. Our collective wisdom is superior to each of us acting alone.

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Chair’s Corner

Kim Zuber, PA–C, MSPS

"We in America do not have government by the majority. We have government by the majority who participate." - Thomas Jefferson

Jefferson's quote is just as true today as it was 200 years ago. Without groups such as the National Kidney Foundation, individuals such as Lynn Poole and Jane Davis and professional allies such as the NKF social workers, CAP members would be left out of state and federal legislation, have no input into rule-making nor have an advisory voice in renal issues nationwide.

Recently, I received an email from the NKF social work group (Council of Nephrology Social Workers, or CNSW) which informed me that the proposed guidelines of evaluation of a potential kidney donor by UNOS leave off PAs…while including APNs and CNSs. Without friends looking out for us, this could have passed by without any comment from CAP.

Dolph Chianchiano, NKF's legislative guru extraordinaire, has reached out to CAP asking for our input on medication regulations, PQRI projects, bundling, prospective payment systems and assorted other governmental and legislative items. He is there to protect our patients, protect us and to make sure a voice for reason is always at the table. With his recent retirement from NKF, a lifetime of goodwill and institutional knowledge leaves with him. I am glad to know that he leaves his protégé, Troy Zimmerman, in his stead while he continues to mentor us part-time.

When I first joined CAP, we wanted to set up an AP Advisory Board (like the physicians have!) at Fresenius and DaVita. The Committee wrote letters to the Chief Medical Officers (Dr. Mike Lazarus and Dr. Allan Nissensen) and lobbied them at every renal meeting. They were both charming and helpful, and agreed it was a wonderful idea. However, the concept never moved past the 'theory' stage. With the advent of the new FMC Chief Medical Officer (Dr. Raymond Hakim), an Advisory Board at Fresenius has been created. However, after years of letter-writing and lobbying, we had 48 hours to put the full proposal together. Without Lynn Poole's experience in what to ask for, expertise in writing proposals and good sense to know what was a 'politically correct' way to word a legal document, I would have been up the creek. Jane Davis (as usual!) edited the proposal in an hour and we had it to the lawyers at FMC by the deadline.

As we celebrate Thanksgiving and the upcoming holidays, we need to remember how thankful we should be for the friends we have both in and outside of the renal community. The next time you feel that it seems like we are not getting anywhere, just remember:
Winners never quit and quitters never win. - Vince Lombardi

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NKF- CAP Elects New Officers

Thanks to all who voted. NKF-CAP would like to announce the following new officers, who will take their post at the 2012 NKF Spring Clinical Meetings in May and serve through 2014.

Chair-Elect: Tricia Howard, MHS, PA‑C
Secretary: Catherine Wells, ACNP, CNN‑NP

Congratulations Tricia and Catherine!

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2011 CAP Salary Survey Results Presented at ASN

Barb & Kim with the posterCAP EC members Barb Weis and Kim Zuber stand with the poster "Analysis of Advanced Practitioner Salary and Benefits," authored by Marty Bergman, MS, RD, PA-C, Kim Zuber, PA-C, MSPS and Garrett Smith, PA and presented at the 2011 ASN conference. The Salary Survey will be repeated in 2012.

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The 2012 NKF Spring Clinical Meeting is approaching!

At the close of each NKF Spring Clinical Meetings, we look at our CAP CE Chairpersons and wonder how they can repeat a stellar performance. And every year, without fail, they outdo themselves with an AP track which is even better than the one before. This year is no exception.

The 2012 NKF Spring Clinical Meetings at the Gaylord National in Washington, DC, kicks off May 8 with the preconference program Nephrology 201. This always popular session is a great introduction for the new nephrology practitioner, in addition to serving as a terrific refresher for the seasoned one.

APs are involved in every aspect of nephrology, from the hospital to the clinic to interventional suites. In order to meet the expanding scope of our practices, Nephrology 201, for the first time, will offer two choices for afternoon sessions. One will be for the practitioner in the acute setting and the other for the practitioner in the chronic setting. It will be tough to choose between them but either one is a winner!

Session topics include old favorites with a new twist. One example is the all time favorite topic of interpreting the laboratory results, paired with nutritional implications and approaches to those results.

SCM12 will also offer:

  • What to do about the patient whose snoring shakes the rafters? We've got you covered.
  • Does the person at the health food store advise your patient on supplements and herbals? RX for the AP addresses Herbals, OTC meds and more.
  • All work and no play makes for a very dull AP. There are also fun activities planned where we can relax, network and have a good time.

For more details and to register, visit the SCM12 website. We hope to see you there!

Travel Grants

Hot off the press: NKF Council Educational Stipends are now available!! You can now apply for stipends of up to $500 to assist in attending the NKF 2012 Spring Clinical Meetings. Priority will be given to first time attendees and poster presenters; however, all should apply. As a requirement of receiving a stipend, awardees should attend the entire meeting and submit a session summary to the CAP newsletter by May 31, 2012. Visit the SCM12 website to apply.

Deadline for application is Monday, January 9th.

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