DaVita Medical Insights

The Growing Potential of Telehealth in Kidney Care

Discussions on ways to leverage telehealth (two-way video visits between physicians and their patients) are accelerating across numerous medical organizations, health care providers, insurance carriers, and government agencies throughout Washington. Recent legislative proposals have focused on the substitution of monthly physician and patient in-person visits with a remote telehealth visit for home dialysis patients. Although an exact timetable for its rollout is unclear, there is consensus among policy makers that home dialysis patients are the best starting use case.

In medical literature, a growing number of reports outline observations on how telemonitoring or virtual visits are being utilized to manage various acute and chronic disease states (i.e., congestive heart failure, asthma and diabetes) to achieve the following:

Telemonitoring may need to be combined with other interventions and programmatic changes, such as health coaching telephone calls, well-structured home visits and evolving skill sets (for clinical coordinators and other health care professionals) to achieve its full potential.

For the most part, telehealth has been underutilized by nephrologists. It has the potential to have a significant impact on the dialysis industry moving forward, particularly on home dialysis, by:

  • Improving program accessibility
  • Challenging geographic and socioeconomic barriers
  • Picking up on health changes that may occur in between clinic visits, and
  • Avoiding the sense of isolationism that some patients feel.

We should reimagine how telehealth techniques could, in part, replace regular face-to-face interactions, such as treatment data monitoring, biometric data surveillance, physical examinations, nursing communication, laboratory test result discussions and support care team accessibility.

While definite progress is being made in the telehealth arena, continued studies in the dialysis population can help provide solutions to questions regarding regulatory and reimbursement issues, liability questions, technology costs and return on investment, physician and patient acceptance, efficient integration of patient/device data into the unit workflow pattern and ways to avoid alert fatigue.

I encourage physicians to think how leveraging technology may help drive improved outcomes and reduce costs of care in a value-based health system where outcomes will be aligned to dollars spent—whether for transitioning new patients to dialysis, managing complications (i.e., line infections or hospitalizations) or ensuring a great patient experience.

Telehealth may drive us to a new era of value-based care centered on the patient, where managing health is best accomplished in the patient’s home!

Martin Schreiber, MD

Martin Schreiber, MD

With nearly 40 years of experience in nephrology, Martin Schreiber, MD, serves as vice president of clinical affairs for DaVita Kidney Care's home dialysis. Before this role, he worked primarily with Cleveland Clinic and held a number of key positions there, including member of the Board of Governors, chairman of the Department of Nephrology and Hypertension and director of home dialysis.