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
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,
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
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
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
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.
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
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
Kristin Hoover, Amanda Dijanic Zeidman, and Javier A. Neyra
What is nephrology critical care?
The census of hospitalized critically ill patients has risen over the last decades (1). As this population expands, leaders of intensive care units (ICUs) are attempting to diversify the healthcare team. A rapidly expanding area within the diversified ICU team is nephrology critical care. The combination of nephrology and critical care is a seamless amalgamation of physiology, pathobiology, and organ crosstalk, which renders the clinician equipped with expertise in acute kidney injury, acid-base/electrolyte disorders, and volume management (Figure 1).
Importantly, as the critically ill population becomes sicker, reliance on
Kidney transplantation is the optimal treatment for kidney failure (1). As recently as 2019, there were 244,000 kidney transplant recipients (2) with a functioning kidney allograft, and this number continues to grow (3, 4). Thus, it is very important that we strive to ensure our workforce is trained to be able to care for this group of patients. A 2020 review article (5) estimates there are 1200-1400 transplant nephrologists in the United States. There are 149 accredited nephrology training programs in the United States (6) and <50% (63/149)