CHICAGO — The economic and regulatory environment for kidney care is undergoing a whirlwind of change as the primary payer — Medicare — seeks improved outcomes at lower costs. Some of those changes are positive, Keith Bellovich, DO, said in a presentation here. However, nephrology practices, faced with a graying workforce and more data-driven scrutiny on the delivery of quality care, will need to change as it is estimated that 1 million people will need treatment for kidney disease by 2030.
The escalating demands for treating more patients in the future clashes with a slowdown in interest among trainees to enter nephrology. In addition, those who are joining the specialty have different priorities than the previous generation.
“RPA members need to reach out to the future of nephrology and engage with young physicians,” Bellovich, who went to his first RPA meeting 24 years ago, said. “When you ask young nephrology practitioners what is important, they talk about [limiting the] frequency of overnight calls, weekend duties, and about their desired practice and location ... They value quality of life. That is their value system. We have to be willing to adjust to that.”
As HHS begins discussions in earnest about new clinical and payment models that couple late-stage CKD care with ESRD, the potential for a shrinking workforce raises greater concerns.
“Individuals were not encouraged to come into the [nephrology] fellowship. Why? ‘Work is too hard, too complicated,’ ” Bellovich said. There has also been a significant decline in international medical graduates — a source for new nephrologists for many years — and a decline in interest among U.S. medical graduate students as well.
The interest in new payment models that focus on value-based care over paying fees for medical services is incentivized by the $113 billion spent by Medicare in 2016 for kidney care. HHS Secretary Alex Azar II “has a vision to shift these benefits to paying for kidney health rather than kidney disease,” through increases in preventive care and reduce hospitalization costs and increased utilization of home therapies, Bellovich said.
For nephrology, working within new payment systems means eliminating the silos of care — CKD, ESRD, inpatient acute care and transplantation — so that nephrologists can collaborate with other providers to deliver better outcomes.
“Change — we sometimes have a hard time with it,” said Bellovich. “But what does it mean for nephrology and your practice?” –by Mark E. Neumann
Bellovich K. Presented at the Renal Physicians Association Annual Meeting; March 28-31, 2019; Chicago.
Disclosure: Bellovich reports he is a Davita Inc. medical director and joint venture partner.