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Darren C. Schmidt

Nephrology care requires a long-term collaboration among the patient, his or her nephrologist, and the many other essential members of the healthcare team. However, in some situations, circumstances evolve to where it is in the best interest of all parties (including the patient) for a change in provider and/or facility. If an individual has a history of disruptive or maladaptive behaviors, the potential new provider or medical director is confronted with the dilemma of whether to accept the patient (1). There are a number of factors to weigh in making this decision (Table 1), running the

Monica Kaul

The use of home dialysis has increased substantially by ~93% over the 10-year period from 2007 to 2017, based on a 2019 report published by the United States Renal Data System (USRDS). Home dialysis and transplants currently account for ~39% of all treatments (~30% transplants, ~7% peritoneal dialysis [PD], and ~2% home hemodialysis [HHD]) (13). However, the most recent update to dialysis public policy has set a goal that by 2025, 80% of end-stage kidney disease (ESKD) be treated at home or via transplant. Unless there is a significant increase in kidneys available for transplant, HHD

Adam Weinstein

Although nephrologists complete the “End Stage Renal Disease (ESRD) Medical Evidence Report Medicare Entitlement and/or Patient Registration” form (form 2728) 138,000 times per year, the form is underappreciated and surprisingly important (1). Form 2728 was born in 1973 out of necessity. The form is, primarily, a nephrologist's attestation to the Centers for Medicare & Medicaid Services (CMS) that a patient is eligible to receive the ESRD Medicare benefits, irrespective of age and based solely on his or her diagnosis (2). However, form 2728 is also a critical point of data collection for understanding the population of

Varsha Danda and Sri Lekha Tummalapalli

Electronic health records (EHRs) have untapped potential for population health management. Population health focuses on the health outcomes of a group of individuals, rather than considering the health of one person at a time (Figure 1) (1). New value-based care models, such as Kidney Care Choices, provide an additional incentive to use EHRs for population health management. Value-based care models tie performance on quality metrics to financial bonuses or penalties and increasingly hold practices at financial risk for total costs of care. If EHR-based tools are effective in improving quality metric performance and preventing unnecessary hospitalizations,

Ojas Mehta

At the start of my second year of fellowship, I started considering what career opportunities were available to me within the vicinity of my fellowship training. I had been in the central Jersey area for many years and had established a strong referral network from colleagues, which I wished to maintain. Once I determined that I did not want to pursue further subspecialty training (i.e., transplant, interventional, etc.), the next decision was academic versus private practice.

My original desire was to join the faculty of my fellowship. Unfortunately, due to budget cuts at the time, there was not enough funding

Andrew E. Lazar
The case for more PD

According to the United States Renal Data System (USRDS)'s Annual Report for 2020, the number of incident patients with end stage kidney disease (ESKD) in 2018 was 131,636, which was an increase of 2.3% from the year prior (1). Although all-cause mortality increased among patients on dialysis in the first half of 2020 by 29% and 48% for those with a functioning kidney transplant compared with the same 5-week period in 2019 (2), overall mortality in patients with ESKD has trended downward, leading to an increase in prevalent patients on dialysis

Katherine Kwon

Much has been written in the past few years about the nephrology workforce crisis. Fellowship positions go unfilled; some recent graduates choose to work as hospitalists instead. However, there are many bright spots on the horizon. Exciting new therapies, such as the sodium-glucose cotransporter-2 (SGLT2) inhibitors, offer the chance to help keep more people from reaching kidney failure. Meanwhile, recent policy advances, especially the Advancing American Kidney Health Executive Order in the United States, will help shift the practice of nephrology toward more comprehensive care of patients living with kidney diseases.

Nephrologists in private practice tend to value their independence

Francis L. Weng and Heather Lefkowitz

Over the past 30 years, kidney transplantation has grown greatly, and there are now >200 Centers for Medicare & Medicaid Services (CMS)-approved kidney transplant centers. As a result, many transplant nephrologists are not faculty members at a medical school and do not attend at large teaching centers but instead work in private practice. Almost all private practice nephrologists see some kidney transplant recipients, typically patients who are at least several months posttransplant and relatively stable. Private practice transplant nephrologists, however, also care for transplant recipients during the immediate peri- and posttransplant periods and are on staff at kidney transplant centers.

Gurdev Singh, Lauren Ellenburg, and Rajiv Poduval

Value-based care (VBC) is the buzzword in healthcare today, and nephrology is not behind in this venture. The word evokes anxiety and fear in most, as it is usually equated with a push to reduce costs by deploying expensive infrastructure, which comes with significant regulatory burden. What really happens is that the payor (insurance entity) delegates a subset of the population to a risk-bearing entity (RE) that has the skill set and resources to improve the quality of care provided at a lower than historical cost by use of innovative care models and technology. The financial savings (or losses) are

Nityasree Srialluri and Stephen M. Sozio

The past decade has been a challenging time for nephrology. The increasing demand for kidney care combined with recent match challenges calls for the strengthening of fellowship training. This translates into a need to evaluate nephrology training, with the American Board of Internal Medicine (ABIM) nephrology subspecialization certification traditionally an objective way to accomplish this. The pass rate for the board exam, however, has seen continued struggles, with the 80% pass rate in 2020 being an improvement from the year prior but still the lowest among medicine subspecialties. A recent Kidney News article hypothesizes that this decline is