#NephJC Transcript
Healthcare social media transcript of the #NephJC hashtag.
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See #NephJC Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | Graham Abra, MD @GrahamAbra RT @kidney_boy: The San Francisco Chronicle also recommended a no vote on Prop 8. #NephJC https://t.co/QWwQg0Wn7d H/T @gratefull080504 (I Think) |
 | Michael Shapiro, MD @mdsmd1 As did the San Diego Union Tribune. #nephjc |
 | Robert Blaser @RobertBlaser1 Rob Blaser from RPA on, thanks for the invite. #nephjc |
| Graham Abra, MD @GrahamAbra Graham Abra, private citizen, care for dialysis patients, home dialysis clinic Medical Director, work at a non-profit dialysis, opposed to Prop 8 #NephJC |
 | Nephrology Journal Club @NephJC It's 9:00 Time for another exciting episode of #NephJC. I'm Joel Topf and will be the host for tonight's chat on California's Prop 8. |
| Michael Shapiro, MD @mdsmd1 The LA Times also recommended a NO vote on Prop 8. #nephjc |
| Graham Abra, MD @GrahamAbra RT @NephJC: It's 9:00 Time for another exciting episode of #NephJC. I'm Joel Topf and will be the host for tonight's chat on California's Prop 8. |
 | Silvi Shah, MD, MS @silvishah Hi this is Silvi Shah from U Cincy no Coi #nephJc |
| Nephrology Journal Club @NephJC Please introduce yourself and reveal any COI. I am an owner in multiple Davita JV, none of which are in Michigan. #NephJC |
 | Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 #NephJC @gratefull080504 : Pre-emptive #KidneyTransplant recipient President, The Voice of the Patient, Inc. |
 | Matthew Sparks, MD @Nephro_Sparks Matt Sparks, lurking tonight. No COIs #NephJC work in VA healthcare system and academic hospital |
 | Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD Gary Singer COI: practicing nephrologist (?) and dialysis medical director #nephjc |
 | Joan Allen @Jallen_sf This is an excellent explainer on the funding behind Prop 8. #nephJC https://t.co/At86oYcATx |
 | Swapnil Hiremath @hswapnil@bsky.social @hswapnil Swapnil Hiremath #nephjc co-creator from @OttawaHospital Canadian Bystander - but curious & opinionated No disclosures https://t.co/mWWaxgQusc |
 | KatieOverV @KatieKwonMD Katie Kwon, private practice, JV owner. #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @mdsmd1 Welcome to #NephJC! |
| Nephrology Journal Club @NephJC Hello @RobertBlaser1 hello @mdsmd1 welcome to #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @kidney_boy: This #NephJC on prop 8 is like no previous #NephJC Chat but it has profound implications for the delivery of dialysis to people in the US> Please join us for this very special episode of #NephJC |
 | Kidney Rebel @kidneyrebel Kidney patient. No COI. #nephjc |
 | Mario Funes, MD @MarioFunesMD Mario Funes. PGY2 Internal Medicine. Future Nephrologist! No COI. #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 As well as several other California newspapers #nephjc |
| Nephrology Journal Club @NephJC Hi Silvi and Kevin, thanks for coming #NephJC |
 | Phillip Madonia @PMNax2 Phillip Madonia, private practice, BHAM AL. Very interested in this discussion #NephJC |
 | Diana Mahbod, MD, CPE, FASN, FNKF @DiMiRenalMD Hi, Diana here, recent nephrology fellowship graduate and starting my private practice job next month. Looking forward to this discussion! #nephjc |
| Robert Blaser @RobertBlaser1 As a non doc I forget to say no COI, but no COI #nephjc |
| Michael Shapiro, MD @mdsmd1 Michael Shapiro: RPA President, formerly Pres and CEO of Denver Nephrology, have residual dialysis JV ownership. #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @kidney_boy: Nice opinion piece in the LA times on Proposition 8 that urges people to vote no. Check it out: Nice opinion piece in the LA times on Proposition 8 that urges people to vote no. Check it out: https://t.co/8999363TZu #NephJC H/T @GarySingerMD (BTW he is smart, if you don't follow him, you should) |
 | Charlie M. Wray, DO, MS @WrayCharles RT @kidney_boy: This #NephJC on prop 8 is like no previous #NephJC Chat but it has profound implications for the delivery of dialysis to people in the US> Please join us for this very special episode of #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @NephJC You are welcome + thanks for having this #nephJC chat |
 | Joel M. Topf, MD FACP @kidney_boy RT @mdsmd1: Michael Shapiro: Michael Shapiro: RPA President, formerly Pres and CEO of Denver Nephrology, have residual dialysis JV ownership. #nephjc |
 | Bob Provenzano MD FACP FASN @DrBobPro #nephjc @kidney_boy thanks for hosting this important issue on Prop 8 |
 | Michelle Starr MD MPH @mcstarr1 Michelle Starr, peds nephro fellow and NSMC intern. Policy nerd and wannabe wonk, happy to learn! No COI #nephjc |
 | Pablo Garcia @PabloGarciaMD Pablo Garcia @StanfordNeph 1st year fellow. Today from my home country Guatemala City, Guatemala #Nephjc |
| Graham Abra, MD @GrahamAbra Hi All, really appreciate all the political enthusiasm - nephrology has a rich history of it #NephJC |
| Joel M. Topf, MD FACP @kidney_boy @mdsmd1 Dr. Shapiro, thanks for coming. Does the RPA have an official position on Prop 8? #NephJC |
| Joan Allen @Jallen_sf Introducing myself - I am a healthcare advocate working with one of the groups that supports Prop 8 and other reforms in the dialysis industry. #nephJC |
 | Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD Hector Madariaga, mostly lurking tonight; Cambridge, MA. Curious to learn more about this as it’s important as it could make a big impact in the #Nephrology community. No COI. #nephjc |
| Michael Shapiro, MD @mdsmd1 Yes, @RPANephrology is opposed to Prop 8. #nephjc |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD .@GrahamAbra thanks for the great summary #NephJC |
| Bob Provenzano MD FACP FASN @DrBobPro welcome RPA to #nephjc do you have a position on Prop 8? |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 #NephJC COI: @OtsukaUS @RetrophinRare Protalix, Hansa Medical, Bayer, Gilead |
| Graham Abra, MD @GrahamAbra Absolutely, not just a CA issue, Prop 8 could impact how dialysis is delivered across the country #NephJC |
| Nephrology Journal Club @NephJC @Jallen_sf Hey Joan, thanks for coming. How did you get interested in dialysis? Are you or a loved one a patient or provider? #NephJC |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD RT @GrahamAbra: Absolutely, not just a CA issue, Prop 8 could impact how dialysis is delivered across the country #NephJC |
 | Gates Colbert, MD @DoctorGates Dallas Nephrologist. #NSMC. COI: Big fan of visiting Santa Barbara County #nephjc |
| Joel M. Topf, MD FACP @kidney_boy RT @mdsmd1: Yes, @RPANephrology is opposed to Prop 8. #nephjc |
| Graham Abra, MD @GrahamAbra @GarySingerMD My pleasure, such an important issue for our patients and nephrology at large #nephjc |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @Jallen_sf Thank you for accepting my invitation #nephjc |
| Graham Abra, MD @GrahamAbra RT @mdsmd1: Yes, @RPANephrology is opposed to Prop 8. #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Jallen_sf Welcome to #NephJC |
| Graham Abra, MD @GrahamAbra @DrBobPro It did not, thrown out on procedureal grounds #nephjc |
| Nephrology Journal Club @NephJC @GrahamAbra mind giving some tweet length background bites about Prop 8? #NephJC |
| Robert Blaser @RobertBlaser1 Definitely not just california, there are efforts to do similar things in Ohio, PA, for sure, I believe AZ, NC as well #nephjc |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @Nephro_Sparks Hi @Nephro_Sparks Hi Matt, I was at Chapel Hill at UNC today. Beautiful part of the country #nephjc |
| Graham Abra, MD @GrahamAbra @NephJC Will do :) #nephjc |
| Graham Abra, MD @GrahamAbra Prop 8 is about dialysis care in CA #nephjc |
| Nephrology Journal Club @NephJC The Ohio initiative was thrown out by their supreme court on a procedural basis. I suspect it will return. #NephJC |
| Graham Abra, MD @GrahamAbra It limits what private insurance companies have to pay dialysis providers for dialysis #NephJC |
 | Ross Nesbit @RossNesbit Ross Nesbit, nephrologist at UT Medical Center in Knoxville TN. In and out on baby bedtime duty but interested to hear discussion about this topic. #nephjc |
| Robert Blaser @RobertBlaser1 sorry to mislead, Cali only pressing vote, but likely to be pursued in other states in coming years. #nephjc |
| Bob Provenzano MD FACP FASN @DrBobPro Sorry, to introduce myself, Nephrologist, 25 years-Detroit. VP Physician relations DaVita #nephjc |
| Graham Abra, MD @GrahamAbra In addition to limiting what insurance companies have to pay for dialysis Prop 8 restricts what a dialysis provider can count as a cost #NephJC |
 | Joshua Waitzman, MD PhD @Jwaitz Josh Waitzman, Nephrology fellow. Reimbursement : me :: Structural biology : general nephrologist. No COI #NephJC |
| Joan Allen @Jallen_sf Prop 8 mirrors the medical loss ratio that insurance companies have to follow as part of the ACA. #nephjc |
| Nephrology Journal Club @NephJC Isn't all ESRD care paid for by Medicare? What is this private insurance company stuff? #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 #NephJC I was contacted by the Union sponsoring #prop8. I will share my perception of that conversation |
| Michael Shapiro, MD @mdsmd1 Prop 8 would cap how much dialysis providers could receive from commercial insurers at 115% of "costs". #nephjc |
 | Naseer Khan @NaseerKhan43 #nephrologist #ochsner #nephjc no COI |
| Graham Abra, MD @GrahamAbra As an example, Medical Directors, the people charged by CMS with ensuring that high quality care is delivered in dialysis centers cannot be counted as a cost #NephJC |
| Bob Provenzano MD FACP FASN @DrBobPro sure but what is "cost"? #nephjc |
| Nephrology Journal Club @NephJC @gratefull080504 That would be great Kevin. #NephJC |
| Joel M. Topf, MD FACP @kidney_boy @Jallen_sf I'm sorry can you explain "medical loss ratio" not sure what that means. #NephJC |
| Michael Shapiro, MD @mdsmd1 Medicare becomes the primary payer after 33 months. If a patient has commercial, that's primary until then. #nephjc |
| Graham Abra, MD @GrahamAbra Prop 8 defines costs as "direct patient care services" and "health care quality improvement costs" but of course the devil is in the details of what these are #NephJC |
| Robert Blaser @RobertBlaser1 Re RPA position, we sent a letter to all members of the Dem Steering Committee in June urging them to oppose the ballot initiative #nephjc |
| Joel M. Topf, MD FACP @kidney_boy RT @mdsmd1: Medicare becomes the primary payer after 33 months. If a patient has commercial, that's primary until then. #nephjc |
| Graham Abra, MD @GrahamAbra @S_brimble None provided in the Prop 8 language #nephjc |
| Michael Shapiro, MD @mdsmd1 Exactly @DrBobPro. Cost in Prop 8 excludes administrative payroll and medical director fees, and others. #nephjc |
| Nephrology Journal Club @NephJC @RobertBlaser1 How did the Dems respond? #NephJC |
| Graham Abra, MD @GrahamAbra RT @RobertBlaser1: Re RPA position, we sent a letter to all members of the Dem Steering Committee in June urging them to oppose the ballot initiative #nephjc |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD RT @mdsmd1: Exactly @DrBobPro. Cost in Prop 8 excludes administrative payroll and medical director fees, and others. #nephjc |
| Graham Abra, MD @GrahamAbra @gratefull080504 That would be very helpful #nephjc |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 #NephJC I was contacted by the union official + employee based upon my @CJASN commentary on dialysis referrals They asked if I would get involved + I passed It was clear to me it was not a patient care issue "Patients as Pawns" |
| Nephrology Journal Club @NephJC @mdsmd1 @DrBobPro Shouldn't a medical director salary be considered direct patient care because without a medical director you can't have a dialysis unit? #NephJC |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD Is Prop 8 about quality of ESRD care or unionizing dialysis clinic staff? #NephJC |
| Robert Blaser @RobertBlaser1 Unfortunately, it made the ballot #NephJC |
| Nephrology Journal Club @NephJC Why did you see this as a "Patient as Pawns" legislation? #NephJC |
| Michael Shapiro, MD @mdsmd1 @GarySingerMD, if "XS"revenue gets returned to commercial insurers, it's certainly doesn't seem to be about doing more for patients. #nephjc |
| Phillip Madonia @PMNax2 @NephJC @mdsmd1 @DrBobPro For now....just wait. The “protocols” are the first step to phase us out #nephjc |
| KatieOverV @KatieKwonMD So Prop 8 seeks to limit what insurance companies will pay? Haven’t found they needed help to do that TBH. Sort of their whole business model. #nephjc |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 #NephJC As all of you know I am very dissatisfied with our system of #kidneycare but this is not #patientcare How many patient advocacy organizations support #prop8? I believe zero |
 | Ralph Atkinson MD @rcamd Late. Sorry. #NephJC #NoToProp8 |
| Graham Abra, MD @GrahamAbra @mdsmd1 @GarySingerMD Agree, and there is no language in Prop 8 that passes along return of revenue to private insurance to policy holders through lower premiums #nephjc |
| Nephrology Journal Club @NephJC Great question, you need to tag with #NephJC to be part of the conversation. |
| Joel M. Topf, MD FACP @kidney_boy RT @mdsmd1: @GarySingerMD, if "XS"revenue gets returned to commercial insurers, it's certainly doesn't seem to be about doing more for patients. #nephjc |
| Joel M. Topf, MD FACP @kidney_boy @PMNax2 @NephJC @mdsmd1 @DrBobPro Doubt it. I don't see nephrologists being pushed out of chronic dialysis. #NephJC |
 | Mo Alzubaidi @NephrosisMo Mo Alzubaidi. Private practice in SC. Joining late #nightcall #NephJC |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD @mdsmd1 Question gets at the motivation of SEIU United Healthcare Workers West #NephJC |
| Kidney Rebel @kidneyrebel I find Prop 8 to be depressing. The patients are caught in the middle between the union and the highly profitable large dialysis chains. #nephjc |
| Diana Mahbod, MD, CPE, FASN, FNKF @DiMiRenalMD @GarySingerMD Can you clarify which companies? Do you mean the large dialysis organizations (LDOs)? #NephJC |
| Robert Blaser @RobertBlaser1 I think you're right about that @gratefull080504 , I have heard of none. #nephjc |
| Graham Abra, MD @GrahamAbra @RobertBlaser1 Really unfortunate, the wrong position from the Democratic party for something that will harm patients if passed #NephJC |
| Bob Provenzano MD FACP FASN @DrBobPro @DiMiRenalMD @GarySingerMD all companies that provide dialysis services in CA #nephjc |
| Nephrology Journal Club @NephJC @Jallen_sf @kidney_boy But dialysis companies aren't insurance companies. Does MLR apply to surgical centers? Infusion centers? Hospitals? #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @NephJC : Was the patient community involved in the development of #prop8? No Besides, I can distinguish between sincerity + insincerity #nephJC |
| Phillip Madonia @PMNax2 @kidney_boy @NephJC @mdsmd1 @DrBobPro We shall see. Lotta moving parts in play with this prop #nephjc |
| Michael Shapiro, MD @mdsmd1 I was also disheartened to see that the CA Dem Party supports Prop 8. #nephjc |
| Nephrology Journal Club @NephJC @Jallen_sf @kidney_boy you need to tag your responses with #NephJC to be part of the conversation. Again thanks for coming. |
| Bob Provenzano MD FACP FASN @DrBobPro @kidney_boy @PMNax2 @NephJC @mdsmd1 really, if no profits, how will they get paid? #nephjc |
| Ralph Atkinson MD @rcamd @GrahamAbra @mdsmd1 @GarySingerMD Actual Prop 8 language: https://t.co/tZ7UUTw9kn #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @renalpolitics @RobertBlaser1 @NephJC Rob! Welcome back to #Nephjc How are things in Portland? |
| Robert Blaser @RobertBlaser1 Interesting that when push came to shove Gov Brown always vetoed these types of measures, can't count on that with Newsome #nephjc |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD @DiMiRenalMD Prop 8 affects all dialysis companies #nephjc |
| Nephrology Journal Club @NephJC RT @gratefull080504: @NephJC : @NephJC : Was the patient community involved in the development of #prop8? No Besides, I can distinguish between sincerity + insincerity #nephJC |
| Graham Abra, MD @GrahamAbra @Jallen_sf @GarySingerMD CMS has held the providers of dialysis accountable for the quality of care for many years through bundling of payments, quality incentive payments, the 5 Star system... #nephjc |
 | rob @renalpolitics #nephjc. Isn't this mostly about preserving diversity of dialysis providers. Hard to imagine LDOs going bankrupt with this bill passing but, Satellite and others might? FMC is opposed it seems from what I can see. |
| Phillip Madonia @PMNax2 @DrBobPro @kidney_boy @NephJC @mdsmd1 EXACTLY. Even if the protocols don’t phase us out...why would we do it for free? #nephjc |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 #NephJC #Prop8 is not example of patients as pawns I am deeply infuriated that our energy is not directed towards addressing root issues of the system rather than this hidden agendas Disgusting |
| Nephrology Journal Club @NephJC RT @rcamd: @GrahamAbra @mdsmd1 @GarySingerMD Actual Prop 8 language: @GrahamAbra @mdsmd1 @GarySingerMD Actual Prop 8 language: https://t.co/tZ7UUTw9kn #NephJC |
| Graham Abra, MD @GrahamAbra Indeed, including hospital based and non-profit dialysis providers #NephJC |
 | Raymond Hsu @DrRaymondHsu Playing devil's advocate (not voting yes) but it's time we reexamine the ethics/profit margins for for-profit dialysis companies? #nephjc |
| Joan Allen @Jallen_sf @NephJC @kidney_boy None of those other parts of the healthcare sector have the extreme market concentration that the dialysis industry does. Government intervention is most necessary when there is a market failure. #nephjc |
 | Edgar V. Lerma 🇵🇭 @edgarvlermamd Edgar Lerma, Chicago-based Nephrologist #NephJC https://t.co/OfyKL0JJD3 |
| KatieOverV @KatieKwonMD @DrBobPro @kidney_boy @PMNax2 @NephJC @mdsmd1 Or cover the costs of dialyzing the 90+% patients on Medicare/Medicaid, which don’t pay enough to break even. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @GrahamAbra: @mdsmd1 @GarySingerMD Agree, and there is no language in Prop 8 that passes along return of revenue to private insurance to policy holders through lower premiums #nephjc |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 This says it all @RobertBlaser1 #nephJC |
 | Dr. Vanessa Grubbs (she/her) @thenephrologist Thanks for sharing this @LTummalapalli. So since only affects private insurers, would this make private dialysis units actually view Medicare-Medicaid patients more favorably (ie lucrative)? COI: CA nephrologist at public hospital. #nephjc |
| Bob Provenzano MD FACP FASN @DrBobPro @Jallen_sf @NephJC @kidney_boy what market failure? quality best every, expanded services? #nephjc |
| Joel M. Topf, MD FACP @kidney_boy @Jallen_sf @GarySingerMD I don't see how this hold dialysis units accountable. It makes dialysis a poorer investment. That seems like a net loss to patients. #NephJC |
 | Deneen @Deneen37837633 RT @AdvDialysis: Health-related quality of life is not only associated with clinical outcomes in #dialysis patients, but also highly valued by patients. #Nephrology #ESRD #nephjc #nephforward https://t.co/hcCzg64GKH |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @KatieKwonMD exactly #nephJC |
| Joel M. Topf, MD FACP @kidney_boy @renalpolitics Seems like we will see exodus from the California market. #NephJC |
| Joan Allen @Jallen_sf @GrahamAbra @GarySingerMD But they are only compared to themselves. The CDC has identified dialysis clinics as a vector for infectious disease transmission. We can do better. #nephJC https://t.co/It0W30D95h |
| KatieOverV @KatieKwonMD @thenephrologist @LTummalapalli Personally I doubt it. Medicare is break even at best. Prop 8 does nothing to balance the extreme disparity between private insurance and Medicare in a sustainable fashion. #NephJC |
| Phillip Madonia @PMNax2 @kidney_boy @Jallen_sf @GarySingerMD Why is the dialysis industry a market failure? #nephjc |
| Phillip Madonia @PMNax2 RT @kidney_boy: @renalpolitics Seems like we will see exodus from the California market. #NephJC |
| Ross Nesbit @RossNesbit @kidney_boy @renalpolitics It’s almost as if these for-profit companies seem to care about the bottom line >>> care of the patient? #nephJC |
| Dr. Vanessa Grubbs (she/her) @thenephrologist This. #nephjc |
| Robert Blaser @RobertBlaser1 I have heard some Cali nephs say the only choice will be to shut down some dialysis shifts, no exactly patient-centric #nephjc |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @Jallen_sf : Now we are taking about the root issues that are harming the future of #nephrology + the lack of #innovation The duopoly in #dialysis is not being addressed Bingo #nephjc |
| Bob Provenzano MD FACP FASN @DrBobPro @Jallen_sf @GrahamAbra @GarySingerMD so how is limiting profit helping? #nephjc |
| Joan Allen @Jallen_sf @kidney_boy @GarySingerMD Right now dialysis companies have a financial incentive to reduce costs. Prop 8 will mean that increased investment in patient care will mean companies can keep more revenue. #nephJC |
| Phillip Madonia @PMNax2 RT @RossNesbit: @kidney_boy @renalpolitics It’s almost as if these for-profit companies seem to care about the bottom line >>> care of the patient? #nephJC |
| Bob Provenzano MD FACP FASN @DrBobPro @KatieKwonMD @thenephrologist @LTummalapalli exactly correct #nephjc |
| Mo Alzubaidi @NephrosisMo RT @kidney_boy: @renalpolitics Seems like we will see exodus from the California market. #NephJC |
| Joel M. Topf, MD FACP @kidney_boy There is no doubt there is room for improvement in dialysis, but making units look under every chair for the last nickel seems like the wrong way to do it. How about lying for better outcomes? #NephJC |
| Michael Shapiro, MD @mdsmd1 @kidney_boy imagine a scenario where more and more dialysis patients use ER for their dialysis - a major concern of the CA ER docs #nephjc |
| Graham Abra, MD @GrahamAbra @KatieKwonMD @thenephrologist @LTummalapalli Right, Prop 8 if passed would lead to closure and consolidation of dialysis centers #nephjc |
| Michael Shapiro, MD @mdsmd1 And of course the patients' nephrologists. #nephjc |
| Joan Allen @Jallen_sf @PMNax2 @kidney_boy @GarySingerMD Extreme market consolidation has lead to many counties in California having only one company providing dialysis. Combine that with the Medicare restrictions on paying for transportation, and it means many patients have no choice in providers. #nephJC |
| KatieOverV @KatieKwonMD @RossNesbit @kidney_boy @renalpolitics That seems simplistic. A business cannot stay open indefinitely if losing money. If Prop 8 supporters don’t want insurance payments to carry the units, how do they propose to make Medicare cover the costs? #NephJC |
| Joel M. Topf, MD FACP @kidney_boy @KatieKwonMD @thenephrologist @LTummalapalli But the idea of basing the national dialysis system around milking the private insurance companies for 33 months while taking a loss on publicly financed dialysis is shameful. We do need to do better. #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @thenephrologist : Rather than dictating profits Let's reform the market to reward early detection of #ckd, coordination of care, early interventions #kidneyfailure is failure!! Let's address the core #nephjc |
| Michael Shapiro, MD @mdsmd1 Agree with you @DrBobPro regarding integrated kidney care. #nephjc |
| Bob Provenzano MD FACP FASN @DrBobPro @Jallen_sf @kidney_boy @GarySingerMD the incentive is to provide value, dec'ed cost and improved outcomes. and that is being met at all levels #nephjc |
| Ralph Atkinson MD @rcamd @mdsmd1 @kidney_boy @latimes hit job on #LDOs and #Prop8 https://t.co/f71yTmOcPr #NephJC |
| Diana Mahbod, MD, CPE, FASN, FNKF @DiMiRenalMD @PMNax2 @kidney_boy @Jallen_sf @GarySingerMD If units close, patients may have no choice in a dialysis unit anywhere near their home. Saw this in the rural areas of Northern Cali already #NephJC |
| Robert Blaser @RobertBlaser1 Great point re integrate care, @DrBobPro #nephjc |
| Graham Abra, MD @GrahamAbra @Jallen_sf @PMNax2 @kidney_boy @GarySingerMD This would worsen under Prop 8 with more market consolidation, many smaller non-profit and hospital based units will close without significant revenue from outside of CA to offset losses #nephjc |
| Michael Shapiro, MD @mdsmd1 Saw that @rcamd. #nephjc |
| Phillip Madonia @PMNax2 RT @gratefull080504: @thenephrologist : @thenephrologist : Rather than dictating profits Let's reform the market to reward early detection of #ckd, coordination of care, early interventions #kidneyfailure is failure!! Let's address the core #nephjc |
| Graham Abra, MD @GrahamAbra RT @DiMiRenalMD: @PMNax2 @kidney_boy @Jallen_sf @GarySingerMD If units close, patients may have no choice in a dialysis unit anywhere near their home. Saw this in the rural areas of Northern Cali already #NephJC |
| KatieOverV @KatieKwonMD @kidney_boy @thenephrologist @LTummalapalli Completely agree. But I don’t see how Prop 8 achieves this. The fundamental problem is that Medicare 1) doesn’t cover the full cost and 2) offers little incentive to innovate since rates are low and fixed. #NephJC |
| Joan Allen @Jallen_sf @Adjweinstein I disagree. Right now the big companies have a stranglehold on the market. Making dialysis less of a profit-driven business will enable more innovative providers to enter the market. #nephJC |
| Phillip Madonia @PMNax2 @gratefull080504 @thenephrologist The premise that “profits” are the enemy here is the wrong starting point. The only way to make a “profit” is to provide care for a patient. That is the goal. #nephjc |
| Gates Colbert, MD @DoctorGates @GrahamAbra @KatieKwonMD @thenephrologist @LTummalapalli Truth. Thus leading to decreased access to care, a big issue. #nephjc |
| Kidney Rebel @kidneyrebel The large dialysis chains made themselves easy targets with lack of innovation, poor outcomes, DaVita CEO's Musketeer costume, etc. The John Oliver show on DaVita should have been a huge wake up call to all that change is needed ASAP. #nephjc |
| Graham Abra, MD @GrahamAbra RT @renalpolitics: #nephjc. Isn't this mostly about preserving diversity of dialysis providers. Hard to imagine LDOs going bankrupt with this bill passing but, Satellite and others might? FMC is opposed it seems from what I can see. |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD @GrahamAbra @Jallen_sf @PMNax2 @kidney_boy Good opinion piece from Bryan Wong MD living with this issue #nephjc https://t.co/xHIc7SX8zF |
| Raymond Hsu @DrRaymondHsu @rcamd @mdsmd1 @kidney_boy @latimes wow article:"DaVita putting up about $61.5 million, Fresenius about $27.7 million" against Prop8 #nephjc |
| Dr. Vanessa Grubbs (she/her) @thenephrologist @gratefull080504 All this and expand #peritoneal dialysis. #nephjc |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 Real value will be achieved when we #kidneyfailure as failure My expectations are higher #Prop8 is such an unnecessary distraction #nephjc |
| Nephrology Journal Club @NephJC Why did the Service Employees International Union-United Healthcare Workers West sponsor this proposition? #NephJC |
| Joan Allen @Jallen_sf @DrBobPro @kidney_boy @GarySingerMD Ideally yes, but I don’t see that in the current system. That’s why we need to return the focus to patients instead of profit. #nephJC |
| Graham Abra, MD @GrahamAbra @renalpolitics You are correct, smaller non-profits and hospital based units would likely have a hard time staying sustainable if Prop 8 passes which hurts patients access to care and choice #nephjc |
| Phillip Madonia @PMNax2 @Jallen_sf @kidney_boy @GarySingerMD So...is no place for HD better than only 1 place for HD?? #nephjc |
| Matthew Sparks, MD @Nephro_Sparks #nephjc |
| Bob Provenzano MD FACP FASN @DrBobPro @Jallen_sf @Adjweinstein i am sorry you feel that way but economically in a free market system no profit, no innovation---patients suffer. but I admire your passion! #nephjc |
| Ralph Atkinson MD @rcamd Ethical Dilemmas: The View from a Tower of Ivory #nephjc https://t.co/mMxQKsVz5y |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @DoctorGates @GrahamAbra @KatieKwonMD @thenephrologist @LTummalapalli & can I say: the whole principle of Prop 8 seems distastefully unAmerican to this Canadian? #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 Let's prevent #kidneydisease to progressing to #kidneyfailure Let's raise the incredibly low expectations that patients have accepted #nephjc |
| Phillip Madonia @PMNax2 @Jallen_sf @Adjweinstein Because innovation is always following the “no profit” areas...#nephjc |
| Ross Nesbit @RossNesbit @KatieKwonMD @kidney_boy @renalpolitics My takeaway from this whole issue is that the proposal a) understands that there’s rampant exploitation of cost and benefits to the tune of 1,000,000,000 in revenue, while b) overstepping/not understanding the necessary costs/needs (ie medical directors) of a unit #nephjc |
| Graham Abra, MD @GrahamAbra We can certainly agree on focusing on improving the quality of patient care. The question is how to do this. Prop 8 is not the answer. #nephjc |
| Joel M. Topf, MD FACP @kidney_boy @Adjweinstein @Jallen_sf Hey adam, try to use just #NephJC, the #NephJCDontYouForgetAboutMe is for suggesting songs for the Friday night beach party in San Diego. |
| Robert Blaser @RobertBlaser1 @NephJC I think its all about greater penetration of union membership among non-clinician dialysis facility staff #nephjc |
| Joan Allen @Jallen_sf @GrahamAbra @PMNax2 @kidney_boy @GarySingerMD The initiative doesn’t apply to hospital outpatient units, so there would be no impact on those providers. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Why did the Service Employees International Union-United Healthcare Workers West sponsor this proposition? #NephJC |
| Graham Abra, MD @GrahamAbra @RossNesbit @KatieKwonMD @kidney_boy @renalpolitics Well put #nephjc |
| Ross Nesbit @RossNesbit RT @kidney_boy: @KatieKwonMD @thenephrologist @LTummalapalli But the idea of basing the national dialysis system around milking the private insurance companies for 33 months while taking a loss on publicly financed dialysis is shameful. We do need to do better. #NephJC |
| Nephrology Journal Club @NephJC RT @rcamd: @mdsmd1 @kidney_boy @latimes hit job on #LDOs and #Prop8 https://t.co/f71yTmOcPr #NephJC |
| Matthew Sparks, MD @Nephro_Sparks RT @NephJC: Why did the Service Employees International Union-United Healthcare Workers West sponsor this proposition? #NephJC |
| Joan Allen @Jallen_sf @GrahamAbra The current system isn’t getting there. What would you recommend? #nephJC |
| Bob Provenzano MD FACP FASN @DrBobPro @Jallen_sf @GrahamAbra @PMNax2 @kidney_boy @GarySingerMD not sure that is true #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @DrRaymondHsu @rcamd @mdsmd1 @kidney_boy @latimes And the SEIU (big labor) another 20$ million or so Am I the only one thinking how many #dreamRCTs I could do with that kind of money? #NephJC |
 | Adam Weinstein @Adjweinstein @Jallen_sf Outpatient hospital units bill the same as any other unit... #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @PMNax2 : To be clear, I am not stating profits are the issue It is lack of #patientcenteted design for #kidneydisease #nephjc |
| Ralph Atkinson MD @rcamd Elephant in room is #AKF. I find that specious at best. #nephjc |
 | Sri Lekha Tummalapalli, MD, MBA @LTummalapalli @DrBobPro @Jallen_sf @Adjweinstein Medical care is not a functioning free market. Prices are set by the government and a consolidated insurance industry. But I agree innovation is desperately needed. #nephjc |
| Graham Abra, MD @GrahamAbra Not only a distraction but one that has diverted attention and tremendous resources away from patient care where they are truly needed #nephjc |
| Joan Allen @Jallen_sf @DrBobPro @Adjweinstein Companies will still profit under Prop 8. There is an appeal process if they are not getting a fair return on their investment. #nephJC |
| KatieOverV @KatieKwonMD @RossNesbit @kidney_boy @renalpolitics The LDOs have multiple revue streams, and each unit’s own balance sheet determines if that unit stays open. The units with 20% private insurance patients will be fine. The ones with 3% private payer will close, and those are going to be in poorer areas. #NephJC |
| Bob Provenzano MD FACP FASN @DrBobPro @hswapnil @DrRaymondHsu @rcamd @mdsmd1 @kidney_boy @latimes they do not spend $20 M unless they see a return #nephjc |
| rob @renalpolitics #NephJC How would one design legislation to shift more focus from profit to patient. It may not be all focus on profit but perhaps too much in this system. There is no right currently in this country to easy/rational access to care. That is the central concern. |
| Dr. Vanessa Grubbs (she/her) @thenephrologist Interesting. And how much do @Davita and @Fresenius executives and shareholders make again? #nephjc |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 #nephJC If I were living in California I would vote a resounding NO Don't interpret my negation as an affirmation of our #kidneycare ecosystem |
| Joan Allen @Jallen_sf @Adjweinstein But outpatient hospital units are regulated under a different section of the California Health Code than is amended by Prop 8. They are not impacted. #nephJC |
| Graham Abra, MD @GrahamAbra @Jallen_sf @DrBobPro @Adjweinstein Approximately 80% of CA dialysis centers will have negative operating margins under Prop 8 #nephjc |
| Adam Weinstein @Adjweinstein @Jallen_sf profits that are fixed and have no ability to flex with the market will limit care... #NephJC |
| Mo Alzubaidi @NephrosisMo RT @KatieKwonMD: @kidney_boy @thenephrologist @LTummalapalli Completely agree. But I don’t see how Prop 8 achieves this. The fundamental problem is that Medicare 1) doesn’t cover the full cost and 2) offers little incentive to innovate since rates are low and fixed. #NephJC |
| Mo Alzubaidi @NephrosisMo RT @KatieKwonMD: @kidney_boy @thenephrologist @LTummalapalli Completely agree. But I don’t see how Prop 8 achieves this. The fundamental problem is that Medicare 1) doesn’t cover the full cost and 2) offers little incentive to innovate since rates are low and fixed. #NephJC |
| Gates Colbert, MD @DoctorGates There are dialysis centers in CA that are profit neutral or financially losing every month. How does Prop 8, or proponents of voting for it ,improve this unsustainable situation? Their closure seems likely if law passed. #nephjc |
| Nephrology Journal Club @NephJC Computer crash. I’ll be back soon. #dontyouforgetaboutme #NephJC |
| Graham Abra, MD @GrahamAbra Absolutely. So much energy in the wrong place. #nephjc |
| Kidney Rebel @kidneyrebel As a kidney patient, it is very distressing to see $100M spent by the dialysis chains and $20M spent by the unions in what is basically a fight over money. #nephjc |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @GrahamAbra : Amen That is why I am so ticked off that thinly disguised agenda manipulating patients with fear Oldest trick in the playbook, fear. #nephjc |
| Michael Shapiro, MD @mdsmd1 @grateful080504 agree that Prop 8 is not about whether patients get good care. #nephjc |
| Phillip Madonia @PMNax2 @gratefull080504 Yes - I was replying to a different tweet...thing ls are happening fast on my timeline haha 😉#nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @DoctorGates: There are dialysis centers in CA that are profit neutral or financially losing every month. How does Prop 8, or proponents of voting for it ,improve this unsustainable situation? Their closure seems likely if law passed. #nephjc |
| Nephrology Journal Club @NephJC @Jallen_sf @Adjweinstein Is this a gift to hospital outpatient dialysis? Does this clear the field for them to move in when LDOs and smaller independents leave? #NephJC |
| Joan Allen @Jallen_sf @Adjweinstein Profits will flex with size. The easiest ways a company will be able to increase their profit will be to expand access and open new clinics. #nephJC |
| Phillip Madonia @PMNax2 RT @KatieKwonMD: @RossNesbit @kidney_boy @renalpolitics The LDOs have multiple revue streams, and each unit’s own balance sheet determines if that unit stays open. The units with 20% private insurance patients will be fine. The ones with 3% private payer will close, and those are going to be in poorer areas. #NephJC |
| Graham Abra, MD @GrahamAbra RT @renalpolitics: #NephJC How would one design legislation to shift more focus from profit to patient. It may not be all focus on profit but perhaps too much in this system. There is no right currently in this country to easy/rational access to care. That is the central concern. |
| Raymond Hsu @DrRaymondHsu It seems Prop8 is about unionizing dialysis staff cloaked as measure 2 improve patient care #nephjc |
| Matthew Sparks, MD @Nephro_Sparks @gratefull080504 I would agree with Kevin. Distraction. General ballot measure on something life and death to so many is scary. We have room for improvement/reform. but change like this could equal serious consequences. #nephJC |
| Bob Provenzano MD FACP FASN @DrBobPro @kidneyrebel dialysis providers are regulated to provide transparent improved patient outcomes and have done so, year over year. Unions??????? #nephjc |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD RT @Nephro_Sparks: @gratefull080504 I would agree with Kevin. Distraction. General ballot measure on something life and death to so many is scary. We have room for improvement/reform. but change like this could equal serious consequences. #nephJC |
| Joan Allen @Jallen_sf @NephJC @Adjweinstein There are aren’t many outpatient dialysis units left in California hospitals. They are such a small part of the market that they don’t really factor in. #nephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Jallen_sf @Adjweinstein I am sorry, I don’t understand that. Who will innovate if there is no profit? #NephJC |
| KatieOverV @KatieKwonMD ESRD Care is the US experiment with universal health care (for one disease) and it’s a mess. Stagnant innovation, huge administrative burdens, distorted incentives. Prop 8 addresses a symptom but not the root cause. #nephjc |
| Phillip Madonia @PMNax2 @renalpolitics Are you saying that there are no kidney patients with access to care ? #nephjc |
| Bob Provenzano MD FACP FASN @DrBobPro @hswapnil @Jallen_sf @Adjweinstein that would be...no one! #nephjc |
| Joan Allen @Jallen_sf @hswapnil @Adjweinstein Are LDOs innovating now? #nephJC |
| Robert Blaser @RobertBlaser1 NKF has an advocacy piece that calls Prop 8 the 'Leave Bnhind Low Income Patients Act #nephjc |
| Ralph Atkinson MD @rcamd How about #LDOs paying premiums and steering pts to #MA policies? Anyone uncomfortable with #AKF ? #nephjc |
| KatieOverV @KatieKwonMD @Jallen_sf @Adjweinstein The need to grow big in order to stay competitive is what has given us two LDOs in the first place. #NephJC |
| Robert Blaser @RobertBlaser1 sorry for all the typos, btw #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @rcamd Yeah - such a 🤢 story...@michelaccad would point to all the problems with incentives and third party payer model #NephJC |
| Phillip Madonia @PMNax2 RT @hswapnil: @Jallen_sf @Adjweinstein I am sorry, I don’t understand that. Who will innovate if there is no profit? #NephJC |
| Adam Weinstein @Adjweinstein @Jallen_sf @hswapnil Yes. Slow, steady improvements in process, workflow, and progressively better outcomes. See the 5-star programs, mortality, etc. #NephJC |
| Joel M. Topf, MD FACP @kidney_boy @Jallen_sf @NephJC @Adjweinstein Same around Detroit. Most of the hospital units sold to the LDOs decades ago. Beaumont still operates a handful of clinics and Henry Ford has a large network of dialysis units. #NephJC |
| Graham Abra, MD @GrahamAbra @Nephro_Sparks @gratefull080504 Absolutely! #nephjc |
| Joan Allen @Jallen_sf @GrahamAbra @DrBobPro @Adjweinstein That analysis was funded by the opposition campaign. They paid more than $150,000 for that answer. #nephJC https://t.co/hIw3RnrjHR |
| Bob Provenzano MD FACP FASN @DrBobPro @rcamd don't confuse educating patients with steering. it is all about patient choice. #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Nephro_Sparks @gratefull080504 @GrahamAbra Great minds https://t.co/ptyxW6C0hr #nephjc |
| Joel M. Topf, MD FACP @kidney_boy @EricJAlfaro It seems that if cockroaches are the problem voting to increase inspections would be better than voting to stop paying for janitorial services. #NephJC |
| KatieOverV @KatieKwonMD @Jallen_sf @hswapnil @Adjweinstein Not much, because Medicare pays exactly the same for dialysis no matter what you offer. And especially in rural areas, the market and private payers can’t change that calculus. Patients can’t travel two towns over for care. #NephJC |
| Ralph Atkinson MD @rcamd @DrBobPro #Optics are bad DocPro. Very bad. #nephjc |
| Joan Allen @Jallen_sf @Adjweinstein @hswapnil We can do so much better than slow steady improvements. Let’s think big. #nephJC |
| Bob Provenzano MD FACP FASN @DrBobPro @EricJAlfaro get your facts right and stop with the scare tactics #nephjc |
| Kidney Rebel @kidneyrebel @rcamd Yes, I am uncomfortable with AKF. The large chains funding a "charity" to help fund their business leaves me very uneasy. #nephjc |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 #NephJC Here is a suggestion to @KHNews @WSJhealth @NYTHealth : How allocating some resources + stories on the need to reform our #kidneydisease ecosystem so that incentives are aligned in patient's best interests |
| Phillip Madonia @PMNax2 RT @kidney_boy: @EricJAlfaro It seems that if cockroaches are the problem voting to increase inspections would be better than voting to stop paying for janitorial services. #NephJC |
| Joan Allen @Jallen_sf @KatieKwonMD @hswapnil @Adjweinstein Completely agree about patients being stuck! There is no choice for so many patients. #nephJC |
| Adam Weinstein @Adjweinstein @Jallen_sf @hswapnil Hmmm... I don't know that big innovation happens by further constraining resources. #NephJC |
| Graham Abra, MD @GrahamAbra @EricJAlfaro But Prop 8 does not increase the frequency of dialysis center inspections... It also won't lead to more investment in improving patient care, quite the opposite, it will lead to clinic closure, consolidation and less $ available for innovation by dialysis providers #nephjc |
| Phillip Madonia @PMNax2 RT @Adjweinstein: @Jallen_sf @hswapnil Hmmm... I don't know that big innovation happens by further constraining resources. #NephJC |
 | Stacey Loomis @StaceyLoo19 RT @kidney_boy: Nice opinion piece in the LA times on Proposition 8 that urges people to vote no. Check it out: Nice opinion piece in the LA times on Proposition 8 that urges people to vote no. Check it out: https://t.co/8999363TZu #NephJC H/T @GarySingerMD (BTW he is smart, if you don't follow him, you should) |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @EricJAlfaro : How many patient organizations are supporting #prop8? Were patients included in the design of #prop8 #nephJC |
| Joan Allen @Jallen_sf @KatieKwonMD @Adjweinstein And now it is up to us to regulate them like the market-controlling companies that they are. The same way we regulate utilities and insurance companies. #nephJC |
| Bob Provenzano MD FACP FASN @DrBobPro @EricJAlfaro try to be serious with this group. #nephjc |
| Ralph Atkinson MD @rcamd @RobertBlaser1 @DrBobPro Doesn’t exist w/o #LDO support. Sorry. It’s a #scam. Admit it a move on. #NephJC |
| Graham Abra, MD @GrahamAbra @Jallen_sf @Adjweinstein @hswapnil Agree with thinking big... Let's rehabilitate... Let's improve quality of life... Expand access to home and after hours dialysis... #nephjc |
| Graham Abra, MD @GrahamAbra @Jallen_sf @Adjweinstein @hswapnil Prop 8 just unfortunately doesn't do any of the above. Wrong tool for the job. #nephjc |
| Adam Weinstein @Adjweinstein @EricJAlfaro Stating facts that are beside the point does not get to the heart of this problem. #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 Let's think even bigger... It is so long overdue #nephJC |
| Michael Shapiro, MD @mdsmd1 That's the point, agree @GrahamAbra #nephjc |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD @GrahamAbra @Jallen_sf @Adjweinstein @hswapnil Agree 100% and innovate using shared risk/savings to improve patient care and outcomes #NephJC |
| Joel M. Topf, MD FACP @kidney_boy RT @GrahamAbra: @Jallen_sf @Adjweinstein @hswapnil Prop 8 just unfortunately doesn't do any of the above. Wrong tool for the job. #nephjc |
| Kidney Rebel @kidneyrebel I hope that everyone on tonight's NephJC will also look beyond Prop 8 to how they can create new RRT's that are safe, cheap, and highly effective #nephjc |
| Robert Blaser @RobertBlaser1 RT @GrahamAbra: @Jallen_sf @Adjweinstein @hswapnil Prop 8 just unfortunately doesn't do any of the above. Wrong tool for the job. #nephjc |
| Ralph Atkinson MD @rcamd @GarySingerMD @GrahamAbra @Jallen_sf @Adjweinstein @hswapnil #ESCOForAll #NephJC |
| Graham Abra, MD @GrahamAbra @Jallen_sf @KatieKwonMD @hswapnil @Adjweinstein Agree, let's expand choice, non-profits and smaller providers won't be able to do this under prop 8 #nephjc |
| KatieOverV @KatieKwonMD @Jallen_sf @Adjweinstein You can’t change the economics of the business by hacking away revenue while having no power over Medicare - which is by volume the biggest payer by far. I’d like to see patients and dialysis companies working together to get sustainable Medicare reimbursement. #NephJC |
| Nephrology Journal Club @NephJC Is there any polling on Prop 8, does it look like it is going to pass? #NephJC |
| Joan Allen @Jallen_sf @GarySingerMD @GrahamAbra @Adjweinstein @hswapnil How does the current system that is dominated by LDOs encourage that? #nephJC |
| Graham Abra, MD @GrahamAbra RT @kidneyrebel: I hope that everyone on tonight's NephJC will also look beyond Prop 8 to how they can create new RRT's that are safe, cheap, and highly effective #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @GrahamAbra: @Jallen_sf @KatieKwonMD @hswapnil @Adjweinstein Agree, let's expand choice, non-profits and smaller providers won't be able to do this under prop 8 #nephjc |
| Graham Abra, MD @GrahamAbra @kidneyrebel Well said and certainly something I think we can all agree on #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @GrahamAbra: @Jallen_sf @Adjweinstein @hswapnil Agree with thinking big... Let's rehabilitate... Let's improve quality of life... Expand access to home and after hours dialysis... #nephjc |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @Jallen_sf : I see things differently I don't see dictating profits leads to true + sustained reform The #ESRD benefit was developed with good intentions but we need to start over with a redesign #nephJC |
 | Nathaniel Reisinger @nephrothaniel RT @GarySingerMD: @GrahamAbra @Jallen_sf @Adjweinstein @hswapnil Agree 100% and innovate using shared risk/savings to improve patient care and outcomes #NephJC |
| Adam Weinstein @Adjweinstein @kidneyrebel I think many of us here have a strong dedication to making dialysis safe, sustainable, and higher quality over time. It is a steady march, not leaps. #NephJC |
| Joel M. Topf, MD FACP @kidney_boy @Jallen_sf @GarySingerMD @GrahamAbra @Adjweinstein @hswapnil I think the consensus here is that ESRD dialysis care is not optimal and can be improved but this Prop 8 does not move us in the right direction and in fact looks like it will make it worse. #NephJC |
| Matthew Sparks, MD @Nephro_Sparks RT @GrahamAbra: @Jallen_sf @KatieKwonMD @hswapnil @Adjweinstein Agree, let's expand choice, non-profits and smaller providers won't be able to do this under prop 8 #nephjc |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD @Jallen_sf @GrahamAbra @Adjweinstein @hswapnil It's occurring now in the form of ESCOs #NephJC |
| Phillip Madonia @PMNax2 RT @kidney_boy: @Jallen_sf @GarySingerMD @GrahamAbra @Adjweinstein @hswapnil I think the consensus here is that ESRD dialysis care is not optimal and can be improved but this Prop 8 does not move us in the right direction and in fact looks like it will make it worse. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @kidneyrebel: I hope that everyone on tonight's NephJC will also look beyond Prop 8 to how they can create new RRT's that are safe, cheap, and highly effective #nephjc |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 I agree I think reimbursement for dialysis needs to be increased #nephJC |
| Joan Allen @Jallen_sf @KatieKwonMD @Adjweinstein Prop 8 actually builds in a cost shift from Medicare to commercial payers. A company’s entire patient care cost across all payers is added up and used as the basis for calculating their revenue limit. #nephJC |
| Bob Provenzano MD FACP FASN @DrBobPro @GarySingerMD @Jallen_sf @GrahamAbra @Adjweinstein @hswapnil and the Patient care act will help #nephjc |
 | ~~~ @DrNamkeen RT @kidney_boy: @Jallen_sf @GarySingerMD @GrahamAbra @Adjweinstein @hswapnil I think the consensus here is that ESRD dialysis care is not optimal and can be improved but this Prop 8 does not move us in the right direction and in fact looks like it will make it worse. #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 Well said @kidney_boy #nephJC |
| Joel M. Topf, MD FACP @kidney_boy Bob, you ay stepping on a live wire there. #NephJC |
| Graham Abra, MD @GrahamAbra Let's choose the right tool for the job at hand which is improving the lives of people living with kidney disease, No on 8, let's find a better way #nephjc |
| Joan Allen @Jallen_sf @KatieKwonMD @Adjweinstein So spending more on a Medicare or Medicaid patient would increase the revenue cap just as much as spending more on a commercial patient. #nephJC |
| Adam Weinstein @Adjweinstein @Jallen_sf @KatieKwonMD This does not strike me as a pathway to innovation #NephJC |
| Joan Allen @Jallen_sf @kidney_boy @GarySingerMD @GrahamAbra @Adjweinstein @hswapnil I’d raise my hand to say this isn’t quite a consensus. #nephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @NephJC Looks like the new governor in waiting is a Prop 8 supporter? Big Labor and Dems go together or is it a principled stance? #NephJC https://t.co/BNhrQLd4qT |
| Bob Provenzano MD FACP FASN @DrBobPro @hswapnil @NephJC i am so surprised....not! #nephjc |
| Nephrology Journal Club @NephJC We are in the final minutes of the evening. Time for witty wrap ups and final arguments. #NephJC |
| Joan Allen @Jallen_sf @gratefull080504 I would welcome a more complete overhaul, but until we get a functional federal government, that won’t happen. This is what we in California can do now. #nephJC |
| Ralph Atkinson MD @rcamd Looks like #Patriarchy loves #AKF . Just typing acronym makes me feel #Sleazy. #nephjc |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @Adjweinstein : #Dialysis have been approved for over a half a century + we have one sort of #patientpreference QIP indicator The innovation in #dialysis has been glacial + that is unacceptable Today it is marginally better than when my mom was dialyzed in the 80s #nephJC |
| Robert Blaser @RobertBlaser1 Among the people involved with nephrology it's a consensus. #NephJC |
| Nephrology Journal Club @NephJC Please sign up for the NephJC weekly news letter: https://t.co/5aumn8ImwF #NephJC |
| Michael Shapiro, MD @mdsmd1 Appreciate the opportunity to participate and see others' comments. Thank you from @RPANephrology #nephjc |
| Bob Provenzano MD FACP FASN @DrBobPro thank you all for your measured input and opinion. provision of dialysis services over the past 25 years has improved year over year in a FFS world. next IKC! #nephjc |
| Joan Allen @Jallen_sf @RobertBlaser1 @kidney_boy @GarySingerMD @GrahamAbra @Adjweinstein @hswapnil That’s not actually true. Many dialysis patients are supporting Prop 8. #nephJC |
| Diana Mahbod, MD, CPE, FASN, FNKF @DiMiRenalMD @Jallen_sf @gratefull080504 But first, do no harm #NephJC |
| Robert Blaser @RobertBlaser1 Yes, Joel and all of @NephJC, thanks for the invite and opportunity. #nephjc |
| Nephrology Journal Club @NephJC Dr. Shapiro, Robert Blaser, Bob Provenzano, it was a pleasure having the leaders of nephrology show up to chat. #NephJC |
| Phillip Madonia @PMNax2 Conceptually, limiting profits with a goal of expanding options and stimulating innovation seems terribly misguided. #NephJC |
| Bob Provenzano MD FACP FASN @DrBobPro Thank you all, this has been a Hoot! #nephjc |
| Mario Funes, MD @MarioFunesMD Goodnight everyone! Lots of learning. Thanks to @kidney_boy for hosting #NephJC |
| Graham Abra, MD @GrahamAbra Thank you all for the stimulating discussion #nephjc |
| Nephrology Journal Club @NephJC A special thank-you to @Jallen_sf for coming and being a good sport and challenging supporter of Prop 8. This chat would have been decidedly one sided and less effective without you. #NephJC |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD Ditto - great debate and discussion #NephJC |
| Graham Abra, MD @GrahamAbra @NephJC @Jallen_sf Agree, debate is the life blood of democracy, on that we can agree #nephjc |
| Ross Nesbit @RossNesbit RT @PMNax2: Conceptually, limiting profits with a goal of expanding options and stimulating innovation seems terribly misguided. #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 #NephJC See everyone in San Diego at #kidneywek |
| Joan Allen @Jallen_sf @DiMiRenalMD @gratefull080504 Here’s the competition #nephJC https://t.co/SxVKJRZBfH |
| Gates Colbert, MD @DoctorGates We need to hear from @CMAdocs on Prop 8. @AmerMedicalAssn #nephjc |
| Joel M. Topf, MD FACP @kidney_boy @LTummalapalli We owe our patients so much better than the status quo. We need to do better. #NephJC |
| Graham Abra, MD @GrahamAbra RT @kidney_boy: @LTummalapalli We owe our patients so much better than the status quo. We need to do better. #NephJC |
| Bob Provenzano MD FACP FASN @DrBobPro @Jallen_sf @DiMiRenalMD @gratefull080504 oh Joan #nephjc |
| Raymond Hsu @DrRaymondHsu @NephJC we should also thank those pro-Prop 8 who showed up to discuss its possible merits, in the spirit of fair discussion #nephjc |
| Matthew Sparks, MD @Nephro_Sparks The Prop 8 numbers: 376 Tweets. 57 Participants. October 16th 2018. More #NephJC 📊 here https://t.co/WiOvgKyGe7 via @symplur |
| Joan Allen @Jallen_sf @GrahamAbra @NephJC Thanks for including me. I appreciate the chance to discuss something that I’m obviously passionate about. I’m always available to continue the conversation. #nephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Please sign up for the NephJC weekly news letter: https://t.co/5aumn8ImwF #NephJC |
| rob @renalpolitics #nephjc Thank you all. Thanks indeed to @jallen_sf. No longer live in CA so don't have to agonize over this decision. We should continue to brainstorm ways to shift focus percentage from profit to patients. perhaps #MedicareForAll. Just sayin |
 | ⛵ 🐋 Cali 🌻 Lady 💪🌊 @CA_Lady RT @gratefull080504: @thenephrologist : @thenephrologist : Rather than dictating profits Let's reform the market to reward early detection of #ckd, coordination of care, early interventions #kidneyfailure is failure!! Let's address the core #nephjc |
| Gates Colbert, MD @DoctorGates @noproposition8 @CMAdocs @californiaacep @ANACalifornia #NephJC |
| Joan Allen @Jallen_sf @DrBobPro @DiMiRenalMD @gratefull080504 ?? #nephJC |
| Mo Alzubaidi @NephrosisMo RT @kidney_boy: @LTummalapalli We owe our patients so much better than the status quo. We need to do better. #NephJC |
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