Times They Are a Changin

Evolving Relationships and Continual Leadership

ACO Healthcare changes

I recently attended the annual Renal Physicians Association meeting in Washington, DC. As many of you know, the RPA has led by representing the needs of practicing nephrologists to regulators and payers to see that we are appropriately reimbursed for high-quality services. In this they have excelled! Indeed, I have had the honor of serving as a Board of Directors member and president. The board has managed to maintain a healthy mix of practicing nephrologists, academics and business-savvy practitioners and has evolved to meet the changing environment in which we practice. The RPA has balanced patient service with quality oversight, promoted a safety focus before it was fashionable (thank you, Alan Kliger) and developed a robust public-policy arm. In my opinion they have served us very well, working quietly behind the scenes, lobbying, educating and advocating.

But I couldn’t help feeling at this year’s meeting that they/we may be inadequately prepared for the challenges ahead; namely, those of integrated care. On a positive note, the RPA has partnered with Fresenius and DaVita in discussions with the Center for Medicare and Medicaid Innovation (CMMI) and it does seem that there has been some headway made, but when the rubber meets the road will they remain the quintessential leaders we need?

In an integrated model of care, nephrologists’ partnership with their dialysis organizations will be essential. This certainly does not mean we will, or should, lose our independence or focus as patient advocates, but it does suggest that the current model of our relationship with dialysis providers will—or, more appropriately, must—evolve.
Nephrologists are essential in this model of care; indeed, it is what we have always advocated for and its time has arrived! But I was left with questions: Will the RPA continue to lead? How do they plan on shepherding nephrologists in this new world? How should we engage dialysis partners? Our hospitals? Our referring physicians? What is the value proposition? These questions are begging for answers or at least attention. Should the RPA be engaging in a more sustentative manner with dialysis providers representing the needs of their membership? I say yes, and the sooner the better.

All trade organizations must evolve or become irrelevant. Evolution can be painful, politically risky and open to harsh criticism by membership. It takes vision, leadership and . . . how can I put this . . . intestinal fortitude to accomplish.

I believe the time is now for the RPA to redefine who they are and why they are. I believe they are up to this challenge, as they have always been up to others. Importantly, we must support them in their efforts.

Always look forward, gaining strength from your past.

Robert Provenzano, MD
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Times They Are a Changin
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