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Interpreting changes to the ESRD quality incentive program

Fishbane, Steven; Miller, Ilene; Masani, Naveed N; Danko, Helen; Bruno, Lenore
PMID: 23252078
ISSN: 0896-1263
CID: 3535372

Changes to the end-stage renal disease quality incentive program

Fishbane, Steven; Miller, Ilene; Wagner, John D; Masani, Naveed N
Monitoring the quality of dialysis care has long been a component of the Medicare ESRD program. As part of the 2008 Medicare Improvements for Patients and Providers Act (MIPPA), Congress mandated the Quality Incentive Program (QIP), which linked measures of care quality to payments. The legislation embraced the idea that this linkage of federal money to performance would encourage the purchase of greater 'value.' The first 2 program years for the QIP use a simple scoring methodology and a limited scope of quality metrics. For payment year 2014 (performance period calendar year 2012), the program changes substantially, with an expanded number of quality measures and a more complex scoring methodology. In this article, we describe the program structure, quality measures, scoring system, and financial impact.
PMID: 22534963
ISSN: 1523-1755
CID: 3535362

The QIP: will it improve dialysis care? An overview

Fishbane, Steven; Miller, Ilene; Danko, Helen; Masani, Naveed
The Centers for Medicare & Medicaid Services End-Stage Renal Disease Quality Incentive Program is a pay-for-performance initiative that imposes dialysis payment reductions of up to 2% for suboptimal quality. In payment years 2012 and 2013 the methodology is simple, a point system based on performance in dialysis adequacy and anemia. In payment year 2014 (performance period begins Jan. 1, 2012) the QIP changes substantially, with a methodology that more closely resembles the Medicare Hospital Inpatient Value-Based Purchasing Program. Succeeding with the QIP will require both providing high quality care for a wider variety of measures, and a clear and complete understanding of the program structure and the new scoring methodology. In this review we discuss the QIP, with a comprehensive explanation of measures and scoring procedure.
PMID: 22359961
ISSN: 0896-1263
CID: 3535352

Membranous glomerulonephritis with ANCA-associated necrotizing and crescentic glomerulonephritis

Nasr, Samih H; Said, Samar M; Valeri, Anthony M; Stokes, Michael B; Masani, Naveed N; D'Agati, Vivette D; Markowitz, Glen S
BACKGROUND AND OBJECTIVES: Only rare cases of concurrent membranous glomerulonephritis (MGN) and antineutrophil cytoplasmic antibody (ANCA)-associated necrotizing and crescentic glomerulonephritis (NCGN) have been reported. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The authors report the clinical and pathologic findings in 14 patients with MGN and ANCA-associated NCGN. RESULTS: The cohort consisted of eight men and six women with a mean age of 58.7 yr. ANCA positivity was documented by indirect immunofluorescence or ELISA in all patients. Indirect immunofluorescence was positive in 13 patients (seven P-ANCA, five C-ANCA, one atypical ANCA). ELISA was positive in nine of 10 patients (five MPO-ANCA, three PR3-ANCA, one MPO- and PR3-ANCA). Clinical presentation included heavy proteinuria (mean 24-hr urine protein 6.5 g/d), hematuria, and acute renal failure (mean creatinine 4.4 mg/dl). Pathologic evaluation revealed MGN and NCGN, with crescents involving a mean of 32% of glomeruli. On ultrastructural evaluation, the majority of cases showed stage I or II membranous changes. Follow-up was available for 13 patients, 12 of whom were treated with steroids and cyclophosphamide. At a mean follow-up of 24.3 mo, five patients progressed to ESRD, seven had stabilization or improvement in renal function, and one had worsening renal function. Five patients, including three with ESRD, died during the follow-up period. The only independent predictor of progression to ESRD was serum creatinine at biopsy. CONCLUSIONS: MGN with ANCA-associated NCGN is a rare dual glomerulopathy seen in patients with heavy proteinuria, acute renal failure, and active urine sediment. Prognosis is variable, with 50% of patients reaching endpoints of ESRD or death.
PMCID:2637583
PMID: 19158367
ISSN: 1555-905X
CID: 2349192

Hyponatremia in community-acquired pneumonia

Nair, Vinay; Niederman, Michael S; Masani, Naveed; Fishbane, Steven
BACKGROUND/AIM/OBJECTIVE:Community-acquired pneumonia (CAP) is a frequent cause for hospitalization and may result in a number of different renal and electrolyte complications. The purpose of this study was to describe the incidence of hyponatremia in CAP and to analyze risk factors for its occurrence. METHODS:Records were reviewed for all 342 subjects who participated in the Community-Acquired Pneumonia Standardized Order Set study, a 2-year trial of supplemental treatment tools in hospital pneumonia treatment. RESULTS:Hyponatremia (serum sodium concentration <136 mg/dl) was present at hospital admission in 27.9% of patients. The magnitude was generally mild, only 4.1% of patients had serum sodium <130 mEq/l. Patients with hyponatremia had greater initial heart rate (100.2 vs. 93.2 beats/min, p = 0.03), white blood cell count (15,100 vs. 12,100/mul, p < 0.0001) and pneumonia severity index class 4 or 5 (35.7 vs. 25.1% of patients, p = 0.05). Hyponatremia at admission was associated with greater risk for death and increased length of hospital stay. Hyponatremia developed during the hospitalization in 10.5% of subjects, with most cases being mild, only 2.6% of all patients having serum sodium decrease to <130 mEq/l. Patients developing hyponatremia were more likely to have end-stage renal disease and to have had initial intravenous fluids other than isotonic saline, but had similar severity of illness on admission to those without acquired hyponatremia. CONCLUSION/CONCLUSIONS:Hyponatremia is a common complication present at the time of admission for CAP. It is associated with more severe illness, increased mortality risk and extended hospital stays. Hyponatremia develops less frequently during the hospitalization and is unrelated to severity of illness on admission, but is an iatrogenic complication and thus initial treatment with isotonic saline may reduce the risk of this complication.
PMID: 17356253
ISSN: 1421-9670
CID: 3535342

A patient with an uncommon etiology of intradialytic hypotension [Case Report]

Masani, Naveed N; Miyawaki, Nobuyuki; Maesaka, John K
Hemodialysis is associated with various complications, the most common being intradialytic hypotension (IDH). In the majority of cases, IDH is easily corrected and does not represent a life-threatening condition. We present a patient in whom IDH was unresponsive to various corrective strategies. A new mitral valve regurgitant lesion was diagnosed that eventually led to the patient's demise. Unusual etiologies of IDH need to be considered, particularly in instances where routine therapeutic measures are ineffective.
PMID: 16191186
ISSN: 0894-0959
CID: 3464672

SLE and rapidly progressive glomerulonephritis [Case Report]

Masani, Naveed N; Imbriano, Louis J; D'Agati, Vivette D; Markowitz, Glen S
PMID: 15861363
ISSN: 1523-6838
CID: 3535332

Hepatic iron in hemodialysis patients [Letter]

Fishbane, Steven; Miyawaki, Nobuyuki; Masani, Naveed
PMID: 15458478
ISSN: 0085-2538
CID: 3534922