DaVita Medical Insights

4 Initiatives to Revolutionize the Nephrology Industry

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Healthcare is rapidly evolving toward delivering high-quality services at lower costs (value-based services). For nephrology practices to survive this new era, we must identify a model in which nephrologists can optimally leverage their skills, experience and expertise. One proposed model places nephrologists in leadership positions to oversee and focus on quality, processes and practice retooling.

The good news is this model already exists. Most dialysis facilities use a team-based approach to deliver population health care: Medical directors (nephrologists) provide oversight while others deliver individual patient care. Not only is this model successful; it also has contributed to improvements in kidney care.

This model can be applied to the general practice of nephrology through the following four initiatives:

1. Hire more non-physician providers

Partnering with non-physician providers (physician assistants and nurse practitioners) in office, clinic, dialysis facility and hospital settings can create tremendous capacity for nephrologists. Most of kidney care is predictable, quantifiable and easily managed using clinical practice guidelines—and can be delivered by non-physician providers. Quality metrics and outcomes can easily be tracked and measured using robust electronic medical records, patient satisfaction surveys and other tools.

2. Develop “nephro-hospitalists”

Nephro-hospitalists can free up time for senior nephrologists to focus on process improvements as necessary, particularly in mature practices with established referral patterns and robust patient populations. The concept is relatively simple. New fellow graduates (many of whom choose hospitalist work for financial reasons) would serve as hospital-based nephrologists representing the practice. They would have fixed hours, be able to quickly and efficiently see consults and do rounds with existing patients. In addition, they could develop and maintain relationships with intensive care, cardiac, emergency room and primary care hospitalist staff.

3. Fully leverage electronic medical records

Given the increased focus on population risk management and quality measurement, getting full use out of electronic medical records (EMRs) is essential. Aggregating this data at local, regional and national levels is also critical. The Renal Physicians Association and other EMR vendors have developed registries to accomplish this. Senior nephrologists, ideally freed up with help from non-physician providers and nephro-hospitalists, can better focus on these endeavors.

4. Expand the use of telemedicine

Expanding the use of telemedicine, a practice that is growing and is reported to become an $18 billion business by 2020, can also help modernize the nephrology industry. Payers and patients are slowly accepting telemedicine, and its use in remote care settings should be viewed as an efficient way to treat underserved populations.

Incorporating these changes could elevate nephrologists to the position of overseeing the care of kidney patients and leading quality population management. It also will allow senior practice physicians to focus on the restructuring necessary to cope with the evolving requirements of risk management.

Note: Some of the content within this article has been republished with permission from Nephrology News & Issues.

Robert Provenzano, MD, FACP, FASN

Robert Provenzano, MD, FACP, FASN

Robert Provenzano, MD, is a clinical professor of medicine at Wayne State University School of Medicine in Detroit, where he earned his medical degree. He completed his fellowship training at Henry Ford Hospital and served as the chief of the nephrology, hypertension & transplantation section and director of nephrology research at St. John Hospital and Medical Center in Detroit. Dr. Provenzano is former president of the Renal Physicians Association and chair of the National Kidney Foundation of Michigan. He recently stepped down as the CEO of St. Clair Specialty Physicians, PC, a multistate nephrology practice. He has published extensively on kidney care business models and currently oversees Nephrology Practice Solutions (NPS), a national kidney care practice management solution affiliated with DaVita. He also serves as the medical director of DaVita Hospital Services, which supports more than 1,000 hospital acute dialysis programs.