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Issue Date: August 2005

Renal Groups Organize to Focus on Patient Care
In this issue of CKD Practice Options, we focus on the strategies that three large nephrology groups (Dallas Nephrology Associates, St. Clair Specialty Physicians in Detroit, and the Southwest Kidney Institute in Phoenix) are using to improve their results. These groups share a number of traits in common. Each has sufficient size, for example, to offer comprehensive services, such as dialysis centers, vascular access facilities, radiology, and laboratory services. Each has access to capital to be able to extend the reach and scope of the services it offers and enough physicians to encourage and support sub-specialists and to adopt a multidisciplinary approach.

Multidisciplinary Approach Improves CKD Outcomes, Reduces Care Costs
Many experts believe that a multidisciplinary model of care that includes the major specialists involved in the treatment of a particular disease or condition, and the related ancillary services improves care quality and lowers costs. The physicians and other providers of St. Clair Specialty Physicians PC in Detroit have found that a multidisciplinary approach does indeed improve care. The practice uses such an approach in the care of patients with chronic kidney disease and end-stage renal disease. About 5,000 patients are treated each year in the practice, which comprises 25 physicians (including 15 nephrologists, three vascular surgeons, six internists, and one oncologist) and ten advance practice/research nurses and physician assistants. The practice offers an array of radiology and laboratory services, a vascular access clinic, kidney and pancreas transplantation services, and hemodialysis and peritoneal dialysis (CAPD) services.

Dallas Physicians Invest in Quality
Practicing in a large, single-specialty group has allowed a nephrology group in Dallas to invest in clinical and information technologies that enhance the quality of care. Dallas Nephrology Associates, a group with 50 physicians and seven locations, is the largest single-specialty nephrology group in the country. The group aims to offer services designed to provide careful management of conditions and continual attention to quality measurement and improvement. Over the course of its 35-year history, the group has been a pioneer in the treatment of kidney patients, and, for example, was one of the first physician groups in the country to build community-based dialysis centers. The group started offering dialysis services in Dallas in 1972.

Web Extends Nephrologists’ Reach
The Internet has had a profound effect on clinical practice and the business of medicine. Many nephrologists and nephrology practices have embraced new technology but few have taken advantage of the wide range of opportunities offered in the current high-tech environment. Nephrologists are eager to provide the best care for patients with chronic kidney disease (CKD); and many practices provide state-of-the art services such as vascular access, dialysis, patient support programs, onsite management of CKD-related anemia, and other patient-centered programs. However, much of this activity is not integrated with services available through the Internet.

Clinics Find Benefits in EBM
In this interview, Brian H. Rank, MD, medical director of HealthPartners Medical Group & Clinics (HPMG), part of HealthPartners (www.healthpartners.com), a nonprofit health care organization in Minneapolis, discusses evidence-based medicine with contributing editor Richard L. Reece, MD. In particular, Rank discusses why the adoption of evidence-based medicine is such a challenge in medicine.

Practice Focuses on Charge Capture
Southwest Kidney Institute, a 20-physician kidney disease management company with six locations in and around Phoenix, is highly focused on providing high-quality kidney disease management throughout the continuum of care. But administrators are also focusing on the health of the business to ensure its continued success in an environment of increasing competition and declining reimbursement. In these efforts, Southwest Kidney has worked with consultants to educate practice staff about appropriate charge capture and to delineate and set priorities for the group’s strategic plan. Southwest Kidney has an anemia management program in which it carefully monitors chronic kidney disease patients for anemia and identifies many who require anemia management therapy.

Electronic Records Offer Raises Questions
The theory behind offering an electronic health records system to all physicians is solid. In practice, however, having every physician adopt an EHR may prove to be complicated. Early this month, the federal government announced that VistA-Office EHR, a high-quality, low-cost electronic health record (EHR) system for use in physician offices with one to eight practitioners, will be made available to any physician interested in using the system. The EHR has been developed through a collaborative effort of the federal Centers for Medicare & Medicaid Services (CMS) and the Veterans Health Administration (VHA). The system works on an open, standards-based foundation that will allow vendors to develop value-added enhancements, such as installation, training, and support for physicians. The chief concern for physicians is that the high cost of implementing an electronic record system can be a significant impediment.

Benchmarks Show Health of Practice
Many cardiology practices analyze their coding methods to ensure that they are assigning codes properly. The goal of such analyses is to prevent downcoding, which results in loss of reimbursement, and over-coding, which can result in a Medicare fraud and abuse investigation. The importance of proper coding cannot be underestimated. A rising number of cardiologists are finding that evaluation and management (E&M) coding software tools can help them validate the proper assignment of codes and audit their practices for proper coding. Now, sophisticated groups are realizing the value of coding benchmarking: the comparison of a group’s own coding patterns with those of other similar groups.

Book Says Experts Support Reform
For a new book published this year, some 40 health care experts were interviewed about what ails the health care system. Their answers are illuminating about what needs to be done to reform the system. Written by Richard L. Reece, MD, editor-in-chief of the Practice Options newsletters, the book shows that consensus exists among the 40 health care experts he interviewed for the book. The experts cite the rising cost of health and the growing number of uninsured Americans as two factors that are intensifying the need to reform the system.

New Technology Expands Options