Growing Pressure on Renal Patients to Pay Out-of-Pocket

By Rick Collins At a conference I attended recently, a social worker lamented how much grief is placed on dialysis patients due to the large bills they receive from renal providers. She openly wondered why providers feel they need to bill patients since they already are paid “a lot” by Medicare and commercial insurance companies. When I first entered the ... Read More »

Initiating Dialysis in the Elderly: When Is Right?

By Ajay K. Singh, MBBS, FRCP, MBA An elderly patient of mine with stage 3 CKD recently had an episode of acute kidney injury while visiting family in Puerto Rico. His bout of gastroenteritis tipped his eGFR into the 10 to 12 mL/min/1.73m2 range and he was initiated on maintenance hemodialysis. In speaking with his nephrologist it seemed quite obvious ... Read More »

From the Field: I LIKE “POP”

Rick Collins CMS’s Patients Over Paperwork (POP) initiative signals welcome relief from decades of increasingly oppressive documentation requirements. While the proposed changes to evaluation and management services (E&M) coding levels have grabbed headlines due to concerns about possible reduced reimbursement, there is great value in allowing providers to focus more on patient care and less on documentation. For years providers ... Read More »

Guest Contributor: Breaking Down the Kidney Care Industrial Complex: Putting Kidney Disease Patients at the Center of Proactive Care

Carmen A. Peralta, MD, MAS Chief Medical Officer, Cricket Health Chronic kidney disease (CKD) affects 30 million adults in the United States—almost 11% of the population. Yet kidney disease patients are at the mercy of a system that is inadequate to care for them—from lack of, or haphazard, diagnosis and little preventative care to the financial incentives that result in ... Read More »

From the Chair: Becoming Precise in Diagnosing Acute Kidney Injury

Ajay K. Singh, MBBS, FRCP, MBA Brigham and Women’s Hospital and Harvard Medical School BOSTON, MASSACHUSETTS From the time that I trained in nephrology more than 30 years ago, I have been teaching students and fellows the importance of framing the differential diagnosis of acute kidney injury (AKI) along anatomical lines: prerenal, renal, and postrenal, and contextualizing based on the ... Read More »

From the Field: Stop Throwing Away Your Money, Part 2

Rick Collins In the last issue of Nephrology Times I addressed two common ways in which healthcare providers spend money needlessly. The first was employing management personnel with no financial training and the second was contracting with incompetent vendors. While incompetent managers and vendors may be giving an honest effort, there are, unfortunately, managers and vendors that are intentionally dishonest ... Read More »

From the Chair: Treatment of Diabetic Nephropathy: Are we witnessing the dawn of a new era?

Ajay K. Singh, MBBS, FRPC, MBA Brigham and Women’s Hospital and Harvard Medical School Diabetic nephropathy is the most common cause of end-stage renal disease. With the rates of type 2 diabetes reaching epidemic proportions worldwide, it is likely that diabetes as a cause of kidney failure will continue to increase. The current treatment of diabetic nephropathy focuses on tight control ... Read More »

From the Field: Stop Throwing Away Your Money, Part I

By Rick Collins I am sickened by the many ways in which providers wind up spending money needlessly based on faulty or incomplete information. In this first of two articles, I identify two of the four most common areas which cause providers to waste money and make poor decisions. Employees in Authority Without Financial Skills In my experience, the most ... Read More »

From the Chair: What’s the Best Way to Treat Metastatic Renal Cell Cancer?

Renal cell carcinoma (RCC) accounts for 2% to 3% of all adult malignancies.1,2 It is the most common type of kidney cancer in adults, responsible for approximately 90% to 95% of cases. Approximately, one-third of patients with RCC present, at the time of diagnosis, with metastatic disease. In addition, approximately one-third of patients who present with localized disease also end ... Read More »

From The Board: Contrast This!

From the Board Kenneth Liss, DO Hypertension and Nephrology Associates Just when I think I am going to contribute to academe and scribe something about the latest nephrologic innovation or controversy, something in real life brings me to my senses and I have to vent. The latest 3 am phone call from an even more exhausted sounding surgical resident was ... Read More »