Richard A. Rettig

Federal Regulation of Methadone Treatment

For nearly three decades, methadone hydrochloride has been the primary means of treating opiate addiction. Today, about 115,000 people receive such treatment, and thousands more have benefited from it in the past. Even though methadones effectiveness has been well established, its use remains controversial, a fact reflected by the extensive regulation of its manufacturing, labeling, distribution, and use. The Food and Drug Administration regulates the safety and effectiveness of methadone, as it does for all drugs, and the Drug Enforcement Administration regulates it as a controlled substance. However, methadone is also subjected to a unique additional tier of regulation that prescribes how and under what circumstances it may be used to treat opiate addiction. Federal Regulation of Methadone Treatment examines current Department of Health and Human Services standards for narcotic addiction treatment and the regulation of methadone treatment programs pursuant to those standards. The book includes an evaluation of the effect of federal regulations on the provision of methadone treatment services and an exploration of options for modifying the regulations to allow optimal clinical practice. The volume also includes an assessment of alternatives to the existing regulations.

Kidney Failure and the Federal Government

No wonder you activities are, reading will be always needed. It is not only to fulfil the duties that you need to finish in deadline time. Reading will encourage your mind and thoughts. Of course, reading will greatly develop your experiences about everything. Reading kidney failure and the federal government is also a way as one of the collective books that gives many advantages. The advantages are not only for you, but for the other peoples with those meaningful benefits.

Assessing health and quality of life outcomes in dialysis: A report on an institute of medicine workshop

I N DECEMBER 1994, the Institute of Medicine (IOM) convened a workshop to evaluate instruments for the measurement of functional status, health status, and health-related quality of life (QOL) for use in the end-stage renal disease (ESRD) clinical setting, especially with dialysis patients. The workshop had been preceded by a 1991 IOM report, Kidney Failure and the Federal Government,’ and by a 1993 IOM conference on “Measuring, Managing, and Improving Quality in the End-Stage Renal Disease Treatment Setting.“2-4 That conference had recommended that a workshop be convened “to develop criteria for evaluation of QOL measurement tools; to generate a guide to the various measurements of functional outcome, health status, and health-related QOL; and to report this information back to ESRD treatment units.“4’5* This article reports on that workshop.

Special treatment--the story of Medicare's ESRD entitlement.

In 1972, through a last-minute provision of the Social Security Amendments, Medicare coverage was extended specifically to people with end-stage renal disease requiring hemodialysis or kidney transplantation — an entitlement that has had significant consequences.

Measuring, Managing, and Improving Quality in the End-Stage Renal Disease Treatment Setting: Committee Statement

The Institute of Medicine (IOM) committee that organized the conference reported in this issue of the journal on assessing quality of care and quality of life, wishes to emphasize that it regards the task of measuring quality as one that can be approached systematically, albeit with caution. Outcomes of end-stage renal disease (ESRD) care by dialysis and transplantation (and variations of outcomes among treatment units) and related processes of care need to be measured in ways useful to clinicians. In addition to clinical measures of outcome, the committee also favored giving greater attention to functional outcomes and health-related quality of life. The interest in maintaining and improving quality in the treatment setting reflects an underlying need to encourage its systematic assessment on a sustained basis, with appropriate weight devoted to practical issues.

Chronic Kidney Disease in the United States: A Public Policy Imperative

BACKGROUND AND OBJECTIVES In the past decade, a crisis in nephrology has slowly emerged in the areas of both clinical care and public policy. In 2003, the Council of American Kidney Societies (CAKS) identified 19 barriers to improved patient outcomes in chronic kidney disease (CKD). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Site visits and in-depth telephone interviews were conducted with 15 nephrologists focusing on current issues with identifying and treating patients with CKD. The qualitative analyses were considered in the context of CAKS-identified barriers to assess the present state of nephrology care and provide a foundation for a more detailed quantitative CKD project potential implications for advancing nephrology-related health policy. RESULTS Despite new evidence-based therapies to slow, stop, or reverse the progression of CKD to ESRD as well as premature cardiovascular disease, major systemic barriers continue to limit the implementation of this body of evidence at the level of the nephrology practice. Key factors include under- or uninsurance, unstructured medical care systems, and lack of enabling public policies. CONCLUSIONS The crisis of nephrology is embedded within the unresolved duress of the ability to provide quality early intervention juxtaposed upon inadequate reimbursement for clinical care and procedures, unfunded mandates for information technology systems, and organizational inconsistencies between nephrology and other specialties. We believe now is the time for the renal community and related stakeholders to unite in an effort to address the clinical, financial, and public policy issues that will enable the delivery of appropriate CKD care to this vulnerable patient population.

The Politics of Organ Transplantation: A Parable of Our Time

This paper reviews the historical development of federal government policy for kidney, heart, and liver transplantation. It examines several political dimensions of whole organ transplantation: the role of the print and broadcast media; the management of organ procurement; the certification of transplant centers; the evaluation of new surgical procedures; and the issues of financing, distributive justice, and rationing of scarce medical resources. The author finds that the media, though powerful in affecting transplant policy, have not been subjected to critical analysis. Organ procurement modifications, driven by a need orientation toward closing the gap between actual and desired levels of performance, may have adversely affected performance. The case of liver transplantation suggests the need for improved institutions and mechanisms for evaluating new surgical procedures. Finally, states that confront the need to meet a binding budget-balancing requirement may allocate funds away from expensive medical procedures that benefit the few toward basic services that benefit the many; the Oregon and Virginia Medicaid programs exemplify this point.