NN&I - August 2010

National 8 Nephrology News & Issues August 2010Subscribe to our free eNewsletter at www.nephronline.com Congress approves six-month delay in physician pay cutNephrologists got a 2.2% pay increase last month and Congressional mem -bers gave themselves until Nov. 30 to come up with a way to permanently fix the stimulus growth rate, or SGR, that threatens Medicare-funded physician pay each year. The House of Representatives voted 417 to 1 to pass a bill to delay a 21% cut in Medicare pay for physicians and to give doctors the raise retroactive to June 1. The Senate passed a similar bill a week earlier. President Obama signed Variations in the quality of treatment across the country for dialysis patients have been previously identified in comparisons of ESRD network data. Researchers took a closer look at these variations in the July 14 issue of the Journal of the American Medical Association. The regional differences in treatment practices for older adults with kidney failure, including decisions about starting or stopping dialysis, don't seem to be explained by differences in patient characteristics, according to Manjula Kurella Tamura, MD, senior author of the study and assistant professor of nephrology at the Stanford University School of Medicine. Kurella Tamura and colleagues used a registry to identify patients aged 65 or older who started dialysis between 2005 and 2006. They then grouped the patients into geographic regions based on the average level of health care spending in that region at the end of life. In regions with high-intensity end-of-life care, the study found a higher density of nephrologists and higher rates of kidney failure treated with chronic dialysis, especially among the very elderly. Despite a higher density of nephrologists in high-intensity regions, patients with kidney failure were less like-ly to have seen a nephrologist before starting dialysis. "People who live in these high-spending areas don't tend to fare any better than the low-spending areas," said Kurella Tamura. Among patients who died, they also found that patients who lived in high-intensity regions were more likely to die in the hospital and less likely to have used hospice care. The study was not designed to identify the reasons for these variations, but the researchers say the patterns are consistent with previous studies examining geo-graphic variations in treatment practices for other conditions. "The findings seem to suggest that higher-spending regions have a more inter -ventional, aggressive style of practice at the end of life," Kurella Tamura said. "We need to make sure all patients are getting care that matches their preferences and values rather than care that is simply a reflection of where they live." the bill on June 25. The pay increase and delay in the pay cuts will cost taxpayers $6.4 billion. The SGR formula links physician reimbursement rates to increases in the gross domestic product. Because spending on physician services has outpaced increases in the GDP, the for -mula has called for cuts in reimburse- ments each year over most of the past decade. If Congress doesn't implement permanent changes, the SGR will take effect agian in November. JAMA study looks at regional variations in the quality of kidney careNews BriefsThe Centers for Medicare & \037 Medicaid Services sent the ESRD payment bundle rule to the Office of Management and Budget on June 30 for final approval. Industry sources indicated that CMS had set a July 9 release date for the final rule, but at press time the document had yet to be made public. On June 23, CMS announced \037 that CROWNWeb phase 3 will begin in January and will include at least 360 dialysis facilities (both indepen-dent and corporate dialysis facilities). Once CMS approves phase 3 it will then target the full national release of CROWNWeb by late Spring 2011. Harvard professor and pediatrician \037 Donald Berwick was sworn in on July 12 in Boston to be the next chief of Medicare and Medicaid. His first assignment: how to encourage more physicians to adopt systems for elec-tronic medical records. "He will be getting to work right away,'' said CMS spokesperson Peter Ashkenaz. DaVita Inc. announced it has cho- \037 sen a site in downtown Denver for its new national headquarters. The company said construction will begin in early 2011 and DaVita expects to begin occupying the building in the second half of 2012. Space will total more than 270,000 square feet. The company acquired the land at a cost of about $11 million and the estimated construction costs will be $90 million. Former Renal Physicians Association \037 president Jimmy Roberts, a communi-ty-based nephrologist who led the RPA in the 1990s in defining the bundle of services under the monthly capitated payment, died March 13 after a battle with lung cancer. Roberts, who had a solo practice in Chico, Calif., was Compiled by Mark Neumann National_08_10[5].indd 8 7/15/10 6:05:37 PM