Thread by @Kidneys1st

@UCIkidney @kamkalantar hosted dinner discussion last night: #AdvancingAmericanKidneyHealth Executive Order
@MSchreiber_MD and @DrBobPro @DaVita | Mark Shapiro (Balboa Nephrology Medical Group)
Big changes happening and #nephrologists need to step up… #nephtwitter
1/x

Starting Jan 2020 half of #nephrology groups in the US will be assigned to the CMS Kidney Care First (KCF) accountable care model.
If you’re picked you HAVE TO participate, but can opt to switch to one of the other #KCC (Kidney Care Choices) models:
innovation.cms.gov/initiatives/ki…
2/x

The other payment models (Comprehensive Kidney Care Contracting #CKCC options) vary in amount of risk the neph practice is willing to take on for care of the #CKD patient.
This is at the level of the #nephrology practice NOT at the dialysis unit.
3/x

If you manage a large number of advanced CKD 4/5/ESRD pts (say 1,000) and took on 100% accountability for pt outcomes - you could be managing $$ millions revenue per year BUT costs add up (hospitalizations, transportation, cardiac procedures)...
4/x

If small patient base it would NOT make $ sense to voluntarily enroll in a #KidneyCareChoices model; @DrBobPro stated this emphatically.
5/x

Incentives will focus on transplantation rate, delaying ESRD, #HomeDialysis instead of in-center dialysis.
Reimbursement for #dialysis will drop 15%
Reimbursement for CKD 4/5 clinic visit will up 280% (!)
(apparently this comes out to a cost SAVINGS of 5% per pt for CMS…)
6/x

Applies only to #Medicare patients so if your practice is mostly #privateinsurance you can chill-ax for a bit (while still being a good nephrologist of course and doing timely transplant referral & modality education)…
Not sure how long before other payers will change too...
7/x

Since you’ll be compared against average performance metrics in their region - seems like there will inevitably be winners and losers. How to #PlaySmart to get the $ rewards?
8/x

- educate on #livingdonor transplant
- sell the idea of #HomeDialysis :: cue heated debate on balance of #PatientChoice vs physician paternalism /but hey they’re scared and they don’t know yet what’s best for them
- deploy dialysis educators at clinics and hospitals
9/x

- transition in-center HD to home
- more urgent-start PD for hospital ESRD “crash-landings”
- get your surgeons on board with embedded PD catheters and urgent-start PD
10/x

What about logistical / structural road-blocks at the dialysis units?
Most dialysis units OBSOLETE floor-plan; need to be redesigned so that 50% of the space is for #HomeDialysis
Estimated number of new #PD nurses required to meet expected PD growth: 2,000 !! 😳
11/x

In summary: “we all asked for this”
i.e., we pushed for better care & outcomes for CKD pts…
but the #KidneyCareChoices payment models that will kick in January 2020 (in 6 weeks!!) are flawed #WorkInProgress
(Dr. Shapiro quipped: hospitalist jobs aren’t looking so bad…)
12/fin