In hospital acute dialysis services are at the busy intersection which connects all other levels of care required by patients with End Stage Renal Disease (ESRD) and patients with Acute Kidney Injury (AKI). As integration and consolidation of care occur throughout the healthcare industry, we need to understand how and why these changes are occurring and how we can best respond and participate so as to maximize the quality and safety of care we provide to our patients and improve the value and efficiency of those services.
ESRD patients are scheduled to receive 156 dialysis treatments per year at their outpatient in-center hemodialysis facility. Patients will miss their treatments for both non-hospitalization reasons and because of hospitalization. While hospitalization may only account for 4 or 5 missed treatments per year, the hospitalizations are a significant portion of the annual expenditure and are a focus of attention of medical groups and payers. At the same time, the actual cost of these hospitalizations to the hospital has increased and has not been managed in any systematic manner. Careful and deliberate care is required and generally provided at the outpatient dialysis centers. Once a patient requires inpatient care, the care is now provided by a team of physicians routinely led by a hospitalist and staff nephrologist. This care provided by multiple groups of physicians and physician specialists requires oversight and guidance to as best assist in coordinating and streamlining care during the hospital stay and coordinating and executing the discharge plan.
The Nephrologist Medical Director should have experience and understanding with all levels of care required by ESRD and AKI patients. The Medical Director will provide oversight, guidance, direction, and establish protocols and policies which facilitate that care. The Medical Director should have broad based knowledge of managed care, an existing understanding of hospital policies and personnel, and existing relationships with area nephrologists and outpatient dialysis facilities. Most of all, the director should have a demonstrated capacity to provide leadership and innovation across the spectrum of services required for ESRD patients. This includes maintaining unique partnerships with local medical groups, regional health plans whom we assist with their patients’ needs, and respects the established networks that these groups have developed and the independence of each nephrologist we serve.