Rhode Island Kidney Care Connection
Furthering Kidney Health for Patients
With Diabetes
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Clinical Labs Report Additional Data to Aid in Detecting Kidney Disease
Washington, DC -- Early identification of individuals with chronic kidney disease (CKD) can delay the onset of end stage renal disease (ESRD) and the need for chronic dialysis treatments.
The incidence of CKD continues to grow, and early identification and intervention are critical to manage this costly disease.
Reporting of a patient's estimated glomerular filtration rate (eGFR) is widely accepted as a more accurate indicator of kidney function than a serum creatinine test alone. The calculation of eGFR factors-in a patient's age, height, weight, and gender, along with the results from a serum creatinine test. The creatinine test itself measures how well the patient's kidneys process a waste product released by muscles when they burn energy. The eGFR calculation provides a more complete picture of how well the patient's kidneys are performing.
A number of subspecialty societies and organizations have emphasized that automatic eGFR reporting is the most desirable method of identification of patients with CKD. In fact, it has been asserted that the only reason to measure serum creatinine is to assess eGFR. At present, at least six states mandate that clinical laboratories in their state report eGFR when creatinine is ordered (Louisiana, Michigan, Connecticut, Pennsylvania, New Jersey, Tennessee) and several additional states have similar legislation pending. Although there is some opposition to legislative mandates of clinical practice, the early detection of CKD is important enough that states are likely to continue to require clinical laboratories to provide this information in the absence of general agreement by laboratories to provide this calculation on a voluntary basis.
In May, the American Clinical Laboratory Association (ACLA), which represents approximately 70% of independent laboratory services throughout the U.S., made a recommendation to its members that they voluntarily calculate an eGFR and report this additional information when doctors order a serum creatinine. ACLA's Board of Directors and general membership unanimously agreed to voluntarily and routinely report eGFR with physician test orders for serum creatinine.
Because not all doctors request an eGFR when they order the underlying serum creatinine tests, the lab industry decided recently to urge its members to voluntary report eGFR results regardless of whether it is requested or not. Many physicians already ask for this data, but some do not said Alan Mertz, President of ACLA. As an industry, we think it is a good idea to provide it voluntarily. The action by ACLA members speaks to the importance of other clinical labs to voluntarily report eGFR to physicians to provide them with the additional data and context for the result.
Chronic kidney disease is a silent killer affecting some 26 million Americans. Symptoms are often hard to detect until the late stages of the disease. But by then, many patients are already facing serious complications, including cardiovascular disease, anemia, or kidney failure. Voluntary reporting of eGFR by the clinical laboratory members of the ACLA is a matter of good public policy as it allows the clinical laboratory to provide physicians with clinically useful information without a legislative mandate to do so.
Joseph Vassalotti, MD, Chief Medical Officer of the National Kidney Foundation, made the following statement in support of this initiative by the clinical laboratory industry: Chronic Kidney Disease (CKD) can be detected in patients at risk with diabetes, hypertension and cardiovascular disease by reporting estimated Glomerular Filtration Rate (eGFR) from a routine blood test for creatinine. The National Kidney Foundation commends ACLA for promoting voluntary reporting of eGFR by clinical laboratories
The Renal Physicians Association (RPA), which is comprised of nephrology practitioners around the country, endorses ACLAs initiative as well. RPA President Edward Jones, MD, congratulates the ACLA on their recommendation, noting, progressive and proactive efforts like that of the ACLA regarding voluntary reporting of eGFRs will substantially improve the kidney care community's ability to identify and treat the nation's growing CKD patient population.
ACLA's emphasis in this area will assist nephrologists as we work with primary care physicians to co-manage CKD patients.
For more information on ACLA, go to www.clinical-labs.org.
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Medicare Paid Over $92 Million in Incentives for 2008 Under the Physician Quality Reporting Initiative
More than 85,000 physicians and other eligible professionals who successfully reported quality-related data to Medicare under the 2008 Physician Quality Reporting Initiative (PQRI) received incentive payments totaling more than $92 million, the Centers for Medicare & Medicaid Services (CMS) announced on November 13, 2009, well above the $36 million paid in 2007.
The number of eligible professionals who earned an incentive payment increased by one-third from 2007, when 56,700 eligible professionals earned an incentive payment. In 2007, eligible professionals could only participate in the program during a 6-month reporting period. In 2008, the program expanded to allow reporting for either a 6-month or a 12-month period.
"We are very pleased with the results for 2008," said Charlene Frizerra, Acting CMS Administrator. "More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives.
Established in late 2006 by the Tax Relief and Health Care Act, PQRI is a voluntary program that allows physicians and other eligible healthcare professionals to receive incentive payments for reporting data on quality measures related to services furnished to Medicare beneficiaries. In the initial program years, physicians and other eligible professionals who satisfactorily submitted quality data for covered professional services furnished in the applicable reporting period were able to receive incentive payments of 1.5 percent of the total estimated allowed charges under Medicare Part B for covered professional services.
Physicians and other eligible professionals who satisfactorily reported PQRI quality measures data and thus qualified for an incentive payment for the 2008 PQRI received their payments this fall. The average incentive amount for individual professionals is over $1,000, with the largest payment to an eligible professional totaling over $98,000.
More than 153,600 professionals participated in the 2008 PQRI. Of those, over 85,000 physicians and other eligible professionals met statutory requirements for satisfactory reporting for the 2008 reporting period and are receiving incentive payments.
"We are not surprised that more eligible professionals participated and qualified for higher payments under the PQRI in 2008," said Barry M. Straube, M.D., CMS Chief Medical Officer and Director of the Agency's Office of Clinical Standards & Quality. "For the 2008 program year, CMS made a concerted effort to include as many provider types, and as many medical specialties, as possible in our menu of PQRI quality measures to assure that we were capturing the full spectrum of the health care services that Medicare beneficiaries receive. We also worked with national stakeholder groups to make improvements in the program from 2007 to 2008 and to promote education and outreach efforts to support eligible professionals in participation."
Eligible professionals from all U.S. states and territories participated in PQRI in 2008. Health practices with participating eligible professionals in Florida and Illinois received the highest incentive payments for the 2008 PQRI. In Florida, eligible professionals received a total of over $7.5 million, and in Illinois, they received over $6 million.
In 2008 Congress extended the PQRI under the Medicare Improvements for Patients and Providers Act (MIPPA) and authorized incentive payments through 2010. While the 2008 PQRI program included positive changes to ease the reporting of quality measures, the 2009 PQRI program provides enhancements that will make it even easier for physicians and other health care professionals to participate.
Beginning in 2009, Congress increased the incentive that eligible professionals could receive for satisfactorily reporting data from 1.5 percent to 2.0 percent of the estimate of the allowed charges under Medicare Part B for all such covered professional services furnished during the applicable reporting period for 2009 and 2010. CMS added 52 new quality measures for the 2009 PQRI year, raising the total number of measures to 153. These new measures cover all types of healthcare professionals who provide services to Medicare beneficiaries, and address areas such as osteoarthritis, back pain, coronary artery disease, and HIV/AIDS, as well as 18 measures that must be reported exclusively through PQRI-qualified registries.
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This material was prepared by Quality Partners of Rhode
Island, the Quality Improvement Organization for Rhode Island, under
contract with the Centers for Medicare & Medicaid Services (CMS),
an agency of the U.S. Department of Health and Human Services.
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CKD - Treatment & Medication
The medical care of patients with chronic kidney disease should focus on the following:
- Delaying or halting the progression of chronic kidney disease
- Treating the pathologic manifestations of chronic kidney disease
- Timely planning for chronic renal replacement therapy
Click here to access the full WebMD article |
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Fistula First Breakthrough Initiative (FFBI) Launches Redesigned Web Site
"Everything you want to know about Fistula First is now easier to find on FistulaFirst.org," said Jay Wish, MD, FFBI Clinical Consultant.
"The redesign provides a fresh, user-friendly look and feel. The Web site is easy to navigate, attractive and accessible to all visitors, including people with visual or other physical disabilities." The redesign includes a new CKD page with resources for primary care providers, as well as an extensive bibliography of articles that will help increase AV fistula rates and an archives section that will help keep featured items current. The site also features a growing community of links to a number of related Web sites.
"I find great value in the Best-Demonstrated Practices section and hope that others will submit successes that they've experienced in reaching their AV fistula goals," said Lynda Ball, MSN, RN, CNN, Quality Improvement Director for Northwest Renal Network, who led the re-design. "This Web site is the perfect venue to share success stories."
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Featured Links
Continuing Education
Opportunities
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Provider Videos
To support and encourage conversations between health professionals and patients, the National Kidney Disease Education Program (NKDEP) has developed a series of short videos that show possible approaches health professionals can use to explain different aspects of CKD.
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Contact Us
For information or technical assistance on Quality Partners' Chronic Kidney Disease Project, please contact Lynn Pezzullo.
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