Editorial

Regulatory Issues 

The first article, written by Barry Straube, who is the chief medical officer for the Centers for Medicare and Medicaid Services, reviews the rationale behind the Centers for Medicare and Medicaid Services Quality Roadmap and the disconnect between access to care and quality of care in the United States' health care system, which is the costliest in the world. Dr Straube makes the argument that providers should be reimbursed for the quality of care they provide and advocates public reporting of provider outcomes. Drs Blaser and Kliger describe the intense congressional oversight of the end-stage renal disease component of the Medicare program, focusing on the quality of care provided and the use of erythropoiesis-stimulating agents for the treatment of anemia in patients with chronic kidney disease. They describe congressional concern regarding the quality of care delivered and the use of pay-for-performance/value-based purchasing to stimulate accountability of Medicare providers. They also discuss federal regulation of the use erythropoiesis-stimulating agents and efforts of cost containment. Dr Jones, chairman of a coalition of organizations called Kidney Care Partners, describes the organization's efforts to ensure equal access to chronic kidney disease care that is of the highest quality for all those persons with chronic kidney disease. He avers that the end-stage renal disease program is underfunded.

Practice Management 

Drs Rastogi, Linden, and Nissenson describe the currently disjointed care of patients with chronic kidney disease, which results in less than ideal clinical outcomes and associated quality of life and high monetary costs. They discuss the importance of structured disease-management programs with multidisciplinary collaboration in resolving these issues. Dr Spry also emphasizes the importance of the multidisciplinary approach to the patient with chronic kidney disease and describes the pros and cons of 3 models of chronic kidney disease clinics: an anemia-management chronic kidney disease clinic, a basic chronic kidney disease clinic, and a comprehensive chronic kidney disease clinic.

Information Technology 

Drs Rosenthal and Spiegel discuss the utility of computer templates as a tool to enhance the provider's ability to provide quality care to patients with chronic kidney disease. They note the importance of consultation between the developer and the end user in customizing templates that can ultimately decrease medical errors and increase quality and efficiency of delivery of care while enhancing user and patient satisfaction. Drs Soman and Yee describe the importance of clinical decision support systems in the reduction of medical errors and their use in 3 settings: a computerized anemia management system (CAMP, Henry Ford Health System, Detroit, MI), vascular access surveillance systems, and monthly capitation notes in the hemodialysis unit. Drs Wintz, Rosenthal, and Fadem report on the implementation of the Physician Quality Reporting Initiative in a nephrology practice, and, finally, Drs Maddux and Maddux write about nephrology-specific clinical information technology systems that are flexible and practice specific and assist in providing comprehensive and coordinated care to patients with chronic kidney disease. The final article in the series, “The Internet as a Tool for the Renal Community,” by Drs Buettner and Fadem describes its utility both for the health care professional and the patient and their family.

The issue concludes with a Wildcard article by Drs Moinuddin and Leehey that provides a comprehensive review of aerobic exercise and resistance training in patients with and without chronic kidney disease.