DaVita Medical Insights

Story: How Integrated Kidney Care Benefited a Patient

[Photo from left to right: Nurse Regina Poskus, Nurse Practitioner Debbie Abbonizio, Francis Hogan] 

Less than 10 percent of dialysis patients on Medicare have access to integrated kidney care programs—yet these programs can make a significant impact on patients’ health-related quality of life. The following story about Francis Hogan’s experience with an ESRD Seamless Care Organization (ESCO), a comprehensive care model administered by the Centers for Medicare & Medicaid Services, provides a great example of this positive impact.

Francis Hogan’s experience with integrated care

Six years ago Francis Hogan was doing what he loved most: playing golf. After his usual game, his ankle was swollen and painful. When he visited the doctor, he discovered the swelling wasn’t because of an injury: His kidneys were failing. He was diagnosed with focal segmental glomerulosclerosis and, ultimately, kidney failure. After a failed transplant, Hogan began dialysis treatments.

Fortunately, Hogan qualified for treatment at an ESCO. His care team included Nurse Practitioner Debbie Abbonizio and Registered Nurse Regina Poskus in addition to his nephrologist and dialysis center staff. The increased resources and focus on care coordination positively impacted Hogan. The care team reduced Hogan’s daily pills in half by coordinating with his other specialists to create a better prescription plan. Also, after a surgical procedure, the team recognized something was different about Hogan while managing his transition back to dialysis.

“He wasn’t interested in conversation and wouldn’t say his usual ‘Good morning!’” said Abbonizio. “He often lost his words, wasn’t hungry and couldn’t walk short distances without stopping.”

The team met consistently to identify the root cause of Hogan’s symptoms. After ruling out several possible diagnoses, the team found his recommended post-treatment target weight was too high. Extra fluid was accumulating in his body and toxic waste was gathering in his bloodstream, causing his symptoms.

Hogan’s target weight was adjusted and extra fluid slowly decreased from his body. He soon regained his health and began to greet his care team with a cheerful “Good morning!” again.

“I feel fortunate to have a team observing and supporting me daily,” Hogan said. “It gives me confidence to better manage my condition.”

Hogan is also grateful to feel better so he can spend more quality time with the love of his life, Carol, his wife of 57 years.

With consideration to the positive results integrated care programs can achieve, why not make them available to all Medicare patients on dialysis?

Bryan Becker, MD, MMM, FACP, CPE

Bryan Becker, MD, MMM, FACP, CPE

Bryan N. Becker, MD, is chief medical officer of DaVita Integrated Care and has nearly 20 years of physician executive experience. He received his AB in English at Dartmouth College and MD from the University of Kansas, and, after training at Duke and Vanderbilt, he led the nephrology group at the University of Wisconsin and developed a new kidney care venture called Wisconsin Dialysis, Inc. He also served as CEO at the University of Illinois Hospital and Clinics and president of the National Kidney Foundation. Before joining DaVita Kidney Care, Dr. Becker served as President of the University of Chicago Medicine (UCM) Care Network, a more than 1,000 physician clinical integration organization, and Vice President, Clinical Integration and Associate Dean, Clinical Affairs at UCM. Twitter: @bnbeckermd