The Medicare Improvement of Patients and Providers Act (MIPPA) was initiated in 2010. It allows for nephrology practices to give chronic kidney disease (CKD) stage 4 Medicare beneficiaries 6 hours of kidney disease education. How have the practices in United States implemented this program? In a research letter published in the American Journal of Kidney Diseases, Zuber et al discuss the results of a recent survey of nephrology practices in the United States regarding this act. Dr. Dana Rizk (DR), senior investigator from University of Birmingham, Alabama, discusses this survey with Dr. Kenar Jhaveri (eAJKD), eAJKD Blog Editor.
eAJKD: Can you tell us about your survey?
DR: One year after the implementation of the MIPPA Act, we decided to survey practitioners and see how many of them actually adopted the program and developed educational classes for their patients. If they were providing the classes, who was teaching them and what formats were being used to deliver the content. If the practices did not implement the educational classes, what were the barriers they faced? We distributed a survey at both the National Kidney Foundation annual national meeting in Las Vegas in 2011 and the Renal Physician Association (RPA) annual meeting in 2011. Another medium we used was the listservs of the two meetings. The results of the survey are presented as this research letter in the journal.
eAJKD: Around 137 individual nephrology groups participated in the study, but only 82 of them offered the classes. What were the barrier to implementing these classes in the remaining?
DR: The two biggest barriers identified in the survey were “lack of time” and “lack of manpower”. It’s worth mentioning that most of the practices that were not offering the classes this year were planning to develop them for next year.
eAJKD: In your study, classes were mostly taught by advanced practitioners (87%) as opposed to physicians (only 6%). Can fellows teach these classes at academic centers?
DR: Of the practices surveyed, none had fellows teaching the classes. Fellows can lead them in certain settings, and experienced second or third year fellows might be comfortable doing it.
eAJKD: In terms of the type of practices you surveyed, academic versus private groups, was there any difference in how many of them completed it?
DR: We surveyed all centers, regardless of being academic or private practice. We did not have enough academic centers to break it down and have meaningful information for subgroup analysis.
eAJKD: What needs to be studied further regarding these educational sessions?
DR: Now that the act is implemented and many centers are providing it, we need to explore if there is a change in patient outcomes? In other words, is there any meaningful impact of this educational activity? Additional studies need to be done to see those effects.
Furthermore, we also need to document whether we are reaching our goal in terms of education. When we talk to 4-6 people with CKD in a group, do they feel more empowered? Do they know more about their kidney disease? Most of the practices did not assess that. A pre- and post-evaluation of these sessions will be helpful.
eAJKD: The health literacy level and the educational classes might not match up. Any concerns regarding the mixed literacy rate?
DR: The health literacy level is extremely variable among patients. The MIPPA Regulation Agency has requested that programs should be developed at the literacy level of the patient. That is very vague. Most material should be made to target a sixth- to eighth-grade educational level to cover all patients involved.