Back on the change, gang. What we may expect from Congress and CMS this year and the impact on nephrology.

In short, the lessons of this story are: Don't eat at a place called "Ma's". Don't play poker with a man named Doc. Don't go too far out on a limb making predictions in the 21st century's U.S. health policy arena.

What a difference a year makes--for better and for worse.

These are times of turbulence and change at many levels-for the nation at large, within the health care delivery arena broadly, and for nephrology specifically. The factors outlined above have created a degree of complexity in developing solutions for these issues never seen before. We'll see how the next 12 months unfolds.

Medicare physician payment: change is in the air, but not on the ground.

There is little good news on the physician payment front for all of organized medicine in general, and for specifically nephrology. While the CHAMP bill is a clear indicator of recognition among some legislators that fundamental change is necessary in the near future, the factors complicating efforts to make that change happen are numerous and substantial. Details on the resolution of physician reimbursement issues for 2008 and how these issues may develop for 2009 will be outlined on the RPA website at www.renalmd.org as they become available.