1. The Renal Physicians Association

2. Who is The Renal Physicians Association? A national organization with the expertise and successful track record of pro-actively defending the discipline of nephrology. The voice of nephrology practice to the renal community, payors and federal policy makers. Provider of innovative, consistent and relevant programs and services to improve nephrology practice. A national organization that is dedicated to business issues for the practicing nephrologist and advocating for improvements in quality of care for patients with kidney disease.

3. RPA Represents Nephrologists RPA has an established relationship with CMS, the federal agency overseeing the Medicare Program RPA represents nephrology at the CPT Editorial Panel (for coding issues) RPA represents nephrology at the AMA’s Relative Value Update Committee (RUC), which determines reimbursement levels for all physician services

4. RPA Represents Nephrologists RPA is the only nephrology organization with a Political Action Committee (PAC), to advocate for nephrology in Congress Annual Capitol Hill Day Grassroots advocacy network to organize RPA members to speak to elected representatives with one voice NCAP convenes local nephrologists around coverage and policy issues

5. American Society of Diagnostic and Interventional Nephrology The mission of the American Society of Diagnostic and Interventional Nephrology (ASDIN) is to promote the appropriate application of new and existing procedures in order to improve the care of patients with kidney disease

6. Diagnostic Renal Ultrasound Being done by many private nephrologists but very few academic training programs. Training in the use and interpretation (but not performance) required by ACGME but not ABIM; no minimum number. Currently not being taught in most nephrology training programs. Certification for nephrologists and accreditation for training programs currently offered by ASDIN.

7. Certification Required training –6 weeks during fellowship or –50 CME-accredited hours Required experience –125 performed and/or interpreted –At least 80 supervised –Remainder with confirmation (documented in up to 20) Submitted studies –Normal – Nephrolithiasis –CRF – Biopsy marking –Cyst – Allograft –Hydronephrosis

8. Accreditation Faculty –At least one ASDIN-certified faculty –Other faculty must be ASDIN-certifiable –At least 0.25 FTE devoted solely to sonography Facility –Adequate equipment and supplies –Adequate record-keeping Procedural volume –300 per year Didactic training –Lectures, books, articles –Evaluation

9. Ultrasound Guidance for Central Vein Cannulation Training bundled with entire procedure. Competence required by ACGME and ABIM but ultrasound guidance not specified and no minimum number required. Performed by most nephrology training programs. Currently no guidelines for training but are being considered by ASDIN. ASDIN certification bundled with procedures.

10. Ultrasound Guidance for Renal Biopsy Training bundled or not bundled with entire procedure. Competence required by ACGME and ABIM but ultrasound guidance not specified and no minimum number required. Performed by about half of nephrology training programs. Currently no guidelines for training but are being considered by ASDIN. ASDIN certification bundled with renal ultrasound.

11. Vein Mapping and Fistula Ultrasound Being done by a small but increasing number of nephrologists. Training in the use or interpretation required by ACGME but not ABIM; no minimum number. Currently not being taught in most nephrology training programs. Currently no guidelines for certification or training but are planned by ASDIN.

12. Challenges Faculty training. Getting academic programs to buy in. Finding time in the training program. Incorporation into ABIM and ACGME requirements.