From Nephrology News
Kidney Care Partners expresses concern about proposed rule for ESRD payments
Kidney Care Partners said they are concerned that a combination of flat payments and increased regulatory pressures proposed by the Centers for Medicare & Medicaid Services may negatively impact stability and affect quality of care in Medicare's end-stage renal disease program. KCP is a coalition of kidney patient advocates, clinicians, care professionals, dialysis providers, researchers, and manufacturers.
CMS released a proposed rule July 2 that would increase payments to dialysis facilities by 0.3% to 0.5%, while rural facilities will receive a decrease of 0.5%. CMS projects that ESRD facilities in Puerto Rico and the Virgin Islands will receive a 3.6% decrease in estimated payments, based on the proposed rule.
"On initial review, KCP appreciates the agency's interpretation of the kidney provisions contained in the Protecting Access to Medicare Act of 2014 (PAMA) to stabilize rates through 2015, though we remain concerned that despite these actions, Medicare reimbursement for dialysis care is not keeping pace with the rising costs of delivering quality health care to individuals with kidney disease," said Dr. Edward R. Jones, Chair of KCP. "While the proposed rule implemented Congressional intent by modifying deep cuts planned for 2015, many dialysis facilities continue to face economic hardship."
In recent years, the Medicare ESRD benefit has not received an inflation adjustment from CMS, which when coupled with sequestration cuts and other reductions by CMS, has resulted in Medicare reimbursement that is below the cost of care for most patients, according to KCP. "Without adequate Medicare funding, providers and physicians are forced to make difficult choices regarding staffing, quality improvement interventions, and ultimately whether to keep a center's doors open to patients," KCP said in a statement.
"KCP supports efforts to ensure that payments reflect the actual cost of providing care so that our community can continue delivering high quality dialysis care and sustained quality improvements," said Jones. "We will continue our diligent work with the broader kidney care community to submit detailed comments to the proposed rule during the public comment period."
Jones said that KCP will devote significant time and attention to the portion of the proposed rule pertaining to quality. "The Quality Incentive Program has tremendous implications for care quality and economic stability. We look forward to working with CMS to ensure that the final rule contains policies that continue to elevate the quality of patient care," Jones said.
From Medical Research.com
MedicalResearch.com Interview with:
Victoria A. Kumar, M.D.
Internal Medicine/Nephrology
Division of Nephrology
Department of Internal Medicine
Southern California Permanente Medical Group
Los Angeles, California, USA
Medical Research: What are the main findings of the study?
Dr. Kumar: There was over a 2 fold increase in patient survival in incident peritoneal dialysis patients in the first year on dialysis compared to propensity matched incident hemodialysis patients. We excluded any patients who utilized a central dialysis catheter at any point during the first 90 days on hemodialysis in an effort to reduce the mortality bias associated with hemodialysis patients who start with a catheter. All hemodialysis patients had pre-dialysis care by a nephrologist prior to starting dialysis.
The 2+ fold increase in survival among peritoneal dialysis patients resulted in a 2-3 year cumulative survival advantage for peritoneal dialysis patients, using both intent to treat and as-treated analyses.
Medical Research: Were any of the findings unexpected?
Dr. Kumar: Given that a couple of recent reports had attributed the initial 1-2 year survival advantage seen in PD patients in several large studies to the early use of central venous catheters among matched hemodialysis patients, our findings were surprising. Other authors have attributed the initial 1-2 year survival advantage seen in other studies to lack of pre-dialysis care, but all of our study patients were managed by a nephrologist prior to starting PD/HD.
Medical Research: What should clinicians and patients take away from your report?
Dr. Kumar: The survival advantage afforded by peritoneal dialysis in the first couple years on dialysis should be emphasized when patients are in the process of choosing a dialysis modality.
Using an expensive agent to prevent blood clots in kidney failure patients' dialysis catheters may turn out to be less costly overall due to its ability to reduce medical complications, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).
Recombinant tissue plasminogen activator (rt-PA) is a medication used to break up blood clots that occur in the vessels of patients having a heart attack. A recent clinical trial revealed that using rt-PA once per week plus the anticlotting agent heparin twice per week was better than using heparin alone 3 times per week for preventing blood clots and infections in dialysis catheters. Its significant expense has limited its use in many dialysis programs, however.
Braden Manns, MD, MSc (University of Calgary, in Alberta, Canada) and his colleagues collected detailed costs within this trial to determine how the use of rt-PA affected overall health care costs over time. The researchers found that the increased cost of rt-PA was partially offset by lower costs for managing complications. Overall, the difference in unadjusted average cost for managing patients with rt-PA/heparin versus heparin alone was $323 Canadian dollars. When the costs were extrapolated over a 1-year time horizon, assuming ongoing rt-PA effectiveness, the overall costs of the strategies in the trial were similar.
"Our study suggests that for patients at high risk of dialysis line blockage, a higher expense rt-PA may provide reasonable value for the money," said Dr. Manns.
PKD Research
From 7th Space
Characterization of the SAM domain of the PKD-related protein ANKS6 and its interaction with ANKS3
Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic disorder leading to end-stage renal failure in humans. In the PKD/Mhm(cy/+) rat model of ADPKD, the point mutation R823W in the sterile alpha motif (SAM) domain of the protein ANKS6 is responsible for disease.
SAM domains are known protein-protein interaction domains, capable of binding each other to form polymers and heterodimers. Despite its physiological importance, little is known about the function of ANKS6 and how the R823W point mutation leads to PKD.
Recent work has revealed that ANKS6 interacts with a related protein called ANKS3. Both ANKS6 and ANKS3 have a similar domain structure, with ankyrin repeats at the N-terminus and a SAM domain at the C-terminus.
Results: The SAM domain of ANKS3 is identified as a direct binding partner of the ANKS6 SAM domain.
We find that ANKS3-SAM polymerizes and ANKS6-SAM can bind to one end of the polymer. We present crystal structures of both the ANKS3-SAM polymer and the ANKS3-SAM/ANKS6-SAM complex, revealing the molecular details of their association.
We also learn how the R823W mutation disrupts ANKS6 function by dramatically destabilizing the SAM domain such that the interaction with ANKS3-SAM is lost.
Conclusions: ANKS3 is a direct interacting partner of ANKS6. By structurally and biochemically characterizing the interaction between the ANKS3 and ANKS6 SAM domains, our work provides a basis for future investigation of how the interaction between these proteins mediates kidney function.
Author: Catherine N LeettolaMary Jane KnightDuilio CascioSigrid HoffmanJames U Bowie
Credits/Source: BMC Structural Biology 2014, 14:17
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