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ESRD: State of the Art and Charting the Challenges for the Future

ESRD: State of the Art and Charting the Challenges for the Future. Beth Israel Deaconess and Harvard Medical School April 23 – 26, 2009. A teaching hospital of Harvard Medical School. William M. Bennett, MD Allan J. Collins, MD Richard J. Cronin, MD Francis L. Delmonico, MD

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ESRD: State of the Art and Charting the Challenges for the Future

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  1. ESRD: State of the Art and Charting the Challenges for the Future Beth Israel Deaconess and Harvard Medical School April 23 – 26, 2009 A teaching hospital of Harvard Medical School

  2. A teaching hospital of Harvard Medical School

  3. William M. Bennett, MD Allan J. Collins, MD Richard J. Cronin, MD Francis L. Delmonico, MD Raymond Hakim, MD William L. Henrich, MD Alan Hull, MD: Honorary Chairman Prof. Norbert Lameire J. Michael Lazarus, MD Edmund Lowrie, MD Andrew S. Narva, MD Allen R. Nissenson, MD Eberhard Ritz, MD Steering CommitteeChairmen: Tom F. Parker and Theodore I. Steinman A teaching hospital of Harvard Medical School

  4. Sponsorswith appreciation • Platinum Level • Amgen • Genzyme A teaching hospital of Harvard Medical School

  5. Sponsorswith appreciation • Gold Level • Abbott Laboratories • American Renal Associates, LLC • Dallas Nephrology Associates, PA • Renal Ventures Management • Watson Pharmaceuticals A teaching hospital of Harvard Medical School

  6. Sponsorswith appreciation • Silver Level • AMAG Pharmaceuticals, Inc • NxStage • U. S. Renal • Fresenius Medical Care, NA • Contributors • B. Braun Medical, Inc. • DaVita A teaching hospital of Harvard Medical School

  7. Program Endorsements • American Society of Nephrology • National Kidney Foundation • Renal Physicians Association • International Society of Nephrology • European Dialysis and Transplant Association/European Renal Association A teaching hospital of Harvard Medical School

  8. Immediate Legacy • Publication in CJASN • Talks before • ISN • ASN • (NKF) • (RPA) • Letters to KCP and CMS A teaching hospital of Harvard Medical School

  9. Immediate Legacy • Response by Steering Committee to Notice of Proposed Rules for Bundling • Marc Neumann NNI Editorial • Gary Peterson RenalWeb • D and T A teaching hospital of Harvard Medical School

  10. The Setting • Our Milieu • 20% of facility patients die each year • A program that costs $34,000,000,000/year • $20,000 per patient per year in hospitalizations • Less than 20% rehabilitation • Survival results worse than colon ca. A teaching hospital of Harvard Medical School

  11. A different world than 20 years ago in Dallas • More complex reimbursement • Misalignment of various stakeholders • Providers • Nephrologists • Payors • Regulators • An understanding of the spectrum of disease from early CKD to RRT • The complexity of the science A teaching hospital of Harvard Medical School

  12. A different world than 20 years ago in Dallas • How to apply what we have learned in the emerging environment we face: • Bundling in 2011 • Capitation to soon follow • Overall change in healthcare policy • Science should drive reimbursement and delivery, but is this true in ESRD? A teaching hospital of Harvard Medical School

  13. Because things are the way the are, we cannot stay the way we are. So what do we do? With what we have learned? A teaching hospital of Harvard Medical School

  14. What are the critical lessons • Cardiovascular Disease • Infection A teaching hospital of Harvard Medical School

  15. But, first the overall problem A teaching hospital of Harvard Medical School

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  25. What are the critical scientific elements • Cardiovascular Disease • Infection A teaching hospital of Harvard Medical School

  26. ASCVD is apparently not the leading cause of CV death A teaching hospital of Harvard Medical School

  27. A teaching hospital of Harvard Medical School

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  34. Can we now say that sodium modeling is detrimental to outcomes? A teaching hospital of Harvard Medical School

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  40. A teaching hospital of Harvard Medical School

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  42. A teaching hospital of Harvard Medical School

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  44. A teaching hospital of Harvard Medical School

  45. A teaching hospital of Harvard Medical School

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  50. A teaching hospital of Harvard Medical School

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