Columns

From the Chair: Managing Nonvalvular Atrial Fibrillation in Dialysis Patients: What Should You Do?

Ajay K. Singh, MBBS, FRCP, MBA The Controversies in Nephrology series1-7 in the Clinical Journal of the American Society of Nephrology (CJASN) covered a topic that virtually every nephrologist has had to wrestle with, namely how to manage a dialysis patient who develops nonvalvular atrial fibrillation (NVAF). The articles are outstanding and thoughtful. A stroke from NVAF could have devastating ... Read More »

From the Field: Competing Medicare and Medicaid Regs: You Lose

Sarah Tolson Providers are in a no-win situation when Medicare and Medicaid regulations conflict with one another. A perfect example of this is reflected in the sample question below we received from several billers: Question: Medicaid requires us to report the NDC (National Drug Code) for each vial size we use in dosing a patient. For example, if our physician ... Read More »

From the Field: Hard Lessons about the Business Side of Healthcare

Rick Collins One of the bitter lessons of life is that you can be the very best at what you do and still have an unsuccessful business. Prior to entering healthcare 16 years ago, I sold newspaper advertising and contacted hundreds of small businesses, including healthcare providers, about marketing their products and services. I was frequently amazed at the high ... Read More »

From the Editor: Improving the Patency of AV fistula—The Type of Anesthesia Used during Surgery Is Important

Ajay K. Singh, MBBS, FRCP (UK), MBA In hemodialysis patients, vascular access is a lifeline to survival. A primary arterio-venous (AV) fistula is preferred over an indwelling tunneled catheter or an AV graft because of lower infection, sepsis rates, and vascular access interventions, including replacements/removals, revisions, angioplasties, and declotting procedures. Since about one in three AV fistulae fail to mature, ... Read More »

From the Chair: CKD Prevalence Rises Dramatically in African Americans

Ajay Singh, MD There are approximately 20 million Americans with chronic kidney disease (CKD) and approximately 400,000 patients on dialysis. Commensurate with this is the cost of treating kidney disease—approximately one in every five Medicare dollars is spent on CKD and ESRD (nearly $50 billion). A paper published in the Annals of Internal Medicine1 and data from the United States ... Read More »

From the Field: ICD-10 Update, Audits, and Patient Coinsurances

Rick Collins ICD-10 FLEXIBILITY ENDS There was a lot of hoopla and fear accompanied by the implementation of ICD-10 a year ago. Thanks to the “flexibility” of coding implemented by Medicare, most providers experienced few problems related to claims payment under ICD-10. October first was another significant date in the implementation of ICD-10 coding, but there has been little in ... Read More »

From the Field: New Hemo-Equivalent Calculation for Extra HD Treatments

Rick Collins The new ESRD PPS Proposed Rule includes sweeping changes that will impact every renal provider. The change receiving the most publicity so far is that outpatient dialysis facilities will be reimbursed for treating patients with acute kidney injury. There will also be a 90% increase in reimbursement for home training. However, the change that is quickly setting dialysis ... Read More »

From the Chair: What’s My Risk of Kidney Failure, Doctor?

Ajay K. Singh Risk equations such as the ACC/AHA pooled cohort cardiovascular disease risk calculator and the Reynolds risk score, among several others, have become commonplace in cardiovascular disease screening and management. For example, these risk calculators are now integrated into recommendations for statin therapy. Risk calculators are generally not used in evaluating patients for the progression of kidney disease, ... Read More »

From the Field: Misinterpreting Dialysis Frequency Rules

Rick Collins Home dialysis programs are taking a big financial hit as several commercial payers are refusing to pay for more than 13 peritoneal dialysis (PD) treatments per month. The payers appear to have misinterpreted a portion of the Medicare Benefit policy manual regarding frequency of dialysis. The information in this article will help home dialysis programs fight this misinterpretation ... Read More »

From the Editor: Should Renal Replacement Therapy Begin Early in ICU Patients with AKI? A Tale of Two Studies

Ajay K. Singh, MD The timing of initiating renal replacement therapy (RRT) among patients with acute kidney injury (AKI) in the intensive care unit (ICU), i.e., among critically ill patients, is controversial. Intuitively, it seems reasonable to think that there should be no downside to initiating therapy early in complex relatively unstable patients, especially since renal-related complications, such as severe ... Read More »