It’s no secret that technology is becoming increasingly important in the medical field. More medical schools are using tablets with textbooks preloaded in place of printed textbooks, and social media is gaining popularity among clinicians and patients alike. As technology plays a bigger role in healthcare, learn how the latest trends can help improve your quality of life – and your patients’, too.

Take social media. Beyond Facebook and Twitter, there is a host of helpful outlets specifically for subsets of the population, such as CKD and ESRD patients. A recent study titled Meaningful Use of Social Media by Physicians, presented at the Stanford Summit and Medicine 2.0 Congress, noted that two-thirds of physicians who were familiar with online patient communities believe that those communities have a positive effect on patients.

Making the transition to dialysis can be emotionally and physically difficult at first. Online communities provide a forum for people to share their experiences with fellow patients and caregivers, regardless of geographic location. It is a helpful way for patients to inform themselves about their diet, modality options and other ways to take charge of their health and improve their quality of life.

There are various non-medical resources available to patients and caretakers through the DaVita.com website that physicians can point to when patients ask for help:

• MyDaVita.com is a personalized online portal where patients and other members can save and share favorite articles and recipes, access health-management tools and connect with others. Message board topics include:
  • Education and sharing resources
  • Diet tips and recipe sharing
  • Caregiver support
  • Inspirational messages
• DaVita Diet Helper™ is a tool that helps patients plan their meals for each day and calculates the phosphorus, protein, potassium and sodium in each meal.

 

• CKD education class online registration:
  • Instructor-led classes for Stage 3 and Stage 4 CKD teach patients how to stay healthy and take control of their condition
  • Patients can learn about different dialysis modalities to prepare for dialysis

These resources are all available at no cost for CKD and ESRD patients, and their caregivers.  Encourage your patients to visit and register for MyDavita.com today.

Article courtesy of Renal Business Today

By Betty Johnson, CPC, CPC-I, CPC-H, CPCD, CCS-P, PCS, CCP, CIC, RMC

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 included provisions for standardization of healthcare information, which opened the path to ICD-10-CM in the United States.  The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) was developed by the U.S. National Center for Health Statistics (NCHS) along with an advisory panel to ensure accuracy and utility in 1993.  On January 5, 2009, the U.S. Department of Health and Human Services (DHHS) announced that ICD-9-CM would be replaced by the ICD-10 system (ICD-10-CM and ICD-10-PCS) on October 1, 2013.  All HIPAA covered entities must comply with this date.  ICD-10-CM codes are all alphanumeric, starting with an alpha character, as opposed to V and E codes in ICD-9-CM.  This article will discuss the guidelines and diagnosis codes related to dialysis patients.

According to the National Kidney Foundation, 26 million American adults have CKD.  Dialysis is most commonly prescribed in adult patients for temporary or permanent kidney failure.  Diabetes and hypertension are responsible for CKD in up to 2/3 of the cases.  We will address the ICD-10-CM codes and guidelines for diabetic chronic kidney disease and hypertensive chronic kidney disease.

Diabetes with Diabetic Chronic Kidney Disease

In ICD-10-CM, more than one code is required to diagnose diabetic chronic kidney disease: one combination code that indicates the type of diabetes with chronic kidney disease and one that indicates the stage of CKD.  The diabetes codes in ICD-10-CM are found in Chapter 4, Endocrine, Nutritional, and Metabolic Diseases (E00-E89).  There are five (5) categories for diabetes codes in ICD-10-CM, compared to one in ICD-9-CM.  This is due to the fact that the diabetes mellitus codes in ICD-10-CM are combination codes.  The codes include the type of diabetes mellitus, the body system affected, and the complications affecting that body system.  There five categories are as follows:

• E08 Diabetes mellitus due to an underlying condition
• E09 Drug or chemical induced diabetes mellitus
• E10 Type 1 diabetes mellitus
• E11 Type 2 diabetes mellitus
• E13 Other specified diabetes mellitus

The following codes indicate CKD in diabetic patients in ICD-10-CM:

• E08.22 Diabetes mellitus due to underlying condition with diabetic chronic kidney disease
• E09.22 Drug or chemic induced diabetes mellitus with diabetic chronic kidney disease
• E10.22 Type I diabetes mellitus with diabetic chronic kidney disease
• E11.22 Type II diabetes mellitus with diabetic chronic kidney disease
• E13.22  Other specified diabetes mellitus with diabetic chronic kidney disease

Only one code from above would be chosen, based on the type of diabetes.

Under each of the codes listed above, there is a note that directs the user to “Use additional code to identify stage of chronic kidney disease.”  This indicates that a second code would need to be listed after the diabetes code.  This code will be used to specify the stage of CKD of the patient.

The codes for chronic kidney disease are found in Chapter 14, Diseases of the Genitourinary System (N00-N99).  ICD-10-CM classifies CKD based on severity.  The following codes indicate CKD in ICD-10-CM:

• N18.1   Chronic kidney disease, stage 1
• N18.2   Chronic kidney disease, stage 2 (mild)

Hypertensive Chronic Kidney Disease

In ICD-10-CM, more than one code is required to diagnose hypertensive chronic kidney disease: one combination code that indicates the patient has both hypertension and CKD, and one that indicates the stage of CKD.  The hypertension codes are found in Chapter 9, Diseases of Circulatory System (I00-I99).

According to the ICD-10-CM Draft Official Guidelines for Coding and Reporting 2011 (C.9.a.2), assign codes from category I12, Hypertensive chronic kidney disease, when both hypertension and a condition classifiable to category N18, Chronic kidney disease (CKD), are present.  Unlike hypertension with heart disease, ICD-10-CM presumes a cause-and-effect relationship and classifies chronic kidney disease with hypertension as hypertensive chronic kidney disease.  The appropriate code from category N18 should be used as a secondary code with a code from category I12 to identify the stage of chronic kidney disease.  If the patient has hypertensive chronic kidney disease and acute renal failure, an additional code for the acute renal failure is required.

The guidelines also state (C.9.a.3) to assign codes from combination category I13, Hypertensive heart and chronic kidney disease, when both hypertensive kidney disease and hypertensive heart disease are stated in the diagnosis.  Assume a relationship between the hypertension and the CKD, whether or not the condition is so designated.  If heart failure is present, assign an additional code from category I50 to identify the type of heart failure.  The appropriate code from category N18, Chronic kidney disease, should be used as a secondary code with a code from category I13 to identify the stage of chronic kidney disease.

The following codes indicate hypertensive CKD in ICD-10-CM:

• I12.0    Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
• I12.9    Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
• I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
• I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
• I13.2    Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease

Just as with diabetic chronic kidney disease, under each of the codes listed above, there is a note that directs the user to “Use additional code to identify stage of chronic kidney disease”.  This indicates that a second code would need to be listed after the hypertension code.  This code will be used to specify the stage of CKD of the patient.  In the case of I13.2, Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease, here is another note that directs the user to “Use additional code to identify type of heart failure (I50-)” also.

Example 1:  Patient has malignant hypertension and end stage renal disease.  The proper ICD-10-CM codes, in order, for this patient would be:

• I12.0        Hypertensive chronic kidney disease with stage V chronic kidney disease or end stage renal disease
• N18.6     End stage renal disease

Example 2:  A patient has acute diastolic heart failure due to hypertension with stage 5 CKD.  The proper ICD-10-CM codes for this patient would be:

• I13.2    Hypertensive heart and renal disease with both heart failure and chronic renal failure
• N18.5   Chronic kidney disease, stage 5
• I50.31  Acute diastolic (congestive) heart failure

The ICD-10-CM Draft Official Guidelines for Coding and Reporting 2011 give further instruction on the usage of the combination code category I13.  It states that the combination codes in this category include hypertension, heart disease, and chronic kidney disease.  The Includes note at I13 specifies that the conditions included at I11 and I12 (hypertension and hypertensive CKD, respectively) are included together in I13.  If a patient has hypertension, heart disease and chronic kidney disease then a code from I13 should be sued, not individual codes for hypertension, heart disease, and chronic kidney disease.

Additionally, there is a code in ICD-10-CM for dependence on dialysis – Z99.2.  It is for hemodialysis status, peritoneal dialysis status, renal dialysis status NOS, or presence of arteriovenous shunt for dialysis.

The examples and guidelines outlined above should help to gain an understanding of the documentation necessary for ICD-10-CM in regards to dialysis.

Article courtesy of Renal Business Today

Written by Balihoo Nephrology

With the growth of the digital age, the way patients and referring physicians investigate and find doctors is rapidly changing. A recent Harris Interactive Poll¹ found that 76 percent of adults search for health information online and over 30 million adults turn to the web each month to find a doctor.  In addition, a HealthGrades survey² found that 74 percent of patients will consider and compare two or more physicians for their current medical needs. Having a strong online presence enables you to leverage the power of the Internet and ensure your practice is found easily by prospective patients

There are three components necessary in building a strong online presence:

1. Create a professional and informative website

2. Ensure your website is easy to find

3. Establish an online presence beyond your website

1. Create a Professional and Informative Website

More than 30 million adults go online each month in search of a doctor. This means the first encounter that a potential patient has with your practice could be online. With74 percent of patients considering multiple physicians, even patients who have been referred to your practice, they may go online to learn more about you. Your website is a potential patient’s first impression of you and your practice and you need it to communicate the appropriate, professional effect.

In addition, considering the increase in the adoption of technology across the board (if your patients don’t use it today, they will soon), more and more patients are using the Internet to look up your address or phone number in order find your office or schedule an appointment.  Even if you fall into the category of physicians who have a full patient panel, your existing patients will likely try to find you online and will quickly become frustrated when nothing turns up.

2. Ensure Your Website is Easy to Find

The old adage, “build it and they will come” no longer holds true in the cluttered digital environment that exists today. Unfortunately, most people create and launch a website and think that is all it takes to drive traffic. However, unless you take certain steps, your website will be lost in the abyss.

These steps include ensuring your website is:

• Easily found by search engines
• Highlighted when someone is searching for you
• Added to the “indexes” of someone who searches for you

Having your website ‘Search Engine Optimized’ (SEO) ensures your site can be accessed by the major search engines (Google, Yahoo, Bing) and that it will show up in their listings. To confirm whether or not this is the case – do some simple searches online to ensure you are shown in the listings for your targeted keywords [ex: nephrologist in Colorado Springs, kidney doctor in Omaha]. Also, make sure you have accurate and claimed “profile” listings on the local versions of the search engines (Google Places, Yahoo Local, Bing Local). Remember, the more sites and resources linking to your website, the better.

3. Establish a Presence Beyond Your Website

Once you have a website and have optimized it for the search engines, there is one final, crucial step to take.  When searching for physicians, health-specific directories, such as Vitals.com, HealthGrades.com, and WebMD.com, are valuable sources of information for potential patients and referring physicians. Virtually every physician has a profile on these sites; check these sites and ensure your profile information is accurate.

During a recent pilot program³ conducted by Balihoo Nephrology (a provider of nephrology-focused, local marketing technology and services), not a single practice had complete and accurate content in the directory listings, and none of the practices had their website domain address in their profiles.

The more complete your information, the more likely your practice is to appear at the top of the search engine listings. With more than 14 million patients visiting HealthGrades.com and Vitals.com each month⁴, this becomes an important tool for increasing awareness of your practice, Additionally, these sites provide the ability for patients to review practices and nephrologists, so it’s important that you regularly monitor posted reviews and ratings.

While setting up a website, managing your online presence and controlling your presence on directories may seem like a waste of time or just another item to check off of the list, many physicians have begun to realize the value and benefit of staying competitive, managing patient relationships and growing their practice through online activity.

It’s time to take control of your online presence, before someone else takes care of it for you!

Download ‘The 3 Cardinal Rules of Nephrology Practice Communication’ on managing your online presence and nephrology communication.

Receive a complimentary Search Engine and Directory Audit and learn how to successfully grow your practice by visiting BalihooNephrology.com, emailing nephrology@balihoo.com, or requesting more information .

Nephrology Growth Solutions is offered by Balihoo, whom has a relationship with DaVita, whereas DaVita provides awareness for their offering to their physician community.

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Sources:

1 Harris Poll: The Harris Poll was conducted by telephone within the US between July 13-18, 2010 among 1,066 adults (aged 18 and over).

2 HealthGrades Survey, Jan 2010 (2161 patient responses)

3 Balihoo Pilot Program Directory Audits were performed between 4/15/11 and 7/15/11 for 11 Nephrologist

4 Compiled data found on www.vitals.com and www.healthgrades.com 7/26/11

Influenza kills more people in the United States each year than all other vaccine-preventable diseases combined, causing more than 36,000 deaths annually. Most of these deaths are among the elderly.

According to American Society of Nephrology, patients with CKD are less likely to receive vaccinations for influenza and pneumococcal infections than non-CKD patients.

In a 2010 study, only 56% of dialysis and transplant patients received influenza vaccinations each year despite the Centers for Disease Control and Prevention (CDC) Healthy People 2010 target objective of 90%*.

Myths about the safety of vaccinations have been disseminated across the Internet by anti-vaccine proponents embellishing vaccine side effects or coincidental illness as “allergic reactions,” when in reality life-threatening allergic reactions to the flu vaccine are very rare.

However there are some people who should not be vaccinated without first consulting the physician, including those who have a severe allergy to chicken eggs, those who had a severe reaction to a previous influenza vaccination, who have developed Guillian-Barre syndrome within six weeks of getting an influenza vaccine, or who currently have a respiratory infection or moderate-to-severe illness with a fever.

To help combat this misinformation about the flu vaccination, patients often refer to their physician to help make the decision of whether to get vaccinated.

The frequency and extent of interaction required to care for patients with a life-altering chronic condition, such as kidney disease, places nephrologists in a unique position to influence their patients’ therapeutic decisions; an influence that transcends age, gender and culture. The chronic and life-changing nature of kidney disease therapy results in longstanding doctor-patient relationships in which a level of trust, both in clinical and non-clinical aspects of patients’ lives, is built over time. Additionally, with every scheduled visit in the office or round at the dialysis facility, the nephrologist has an opportunity to promote and revisit therapeutic options with their patients, such as getting immunized against influenza.

“The physician is an important part of the vaccination team and an extremely influential factor for patients who are undecided about vaccinations,” said Susan Rizkalla DaVita’s Quality Assurance manager.

Rizkalla said the process to get patients to consider getting vaccinated includes several members of the clinic team, starting with the nurse, then, if the patient still declines to get vaccinated, a vaccination champion takes over, then a social worker and, finally, the patient’s nephrologist.

According to Rizkalla, there are some basic ways that nephrologists can help encourage their patients to get vaccinated for influenza. First and foremost, they can give patients factual information about influenza and how they could be affected given their current health. Also, tell them the facts about the flu shot itself, potential side effects and benefits. If they believe they are allergic, check their prior medical records to see the reaction they had and how long after the injection the reaction occurred.

In the first quarter of 2011, DaVita, through the work of Rizkalla, other teammates and our physician partners, was able to achieve a flu vaccination rate for our patients of 90.9 percent. The industry average during that same period of time was 66.5 percent.

For more information on DaVita’s Influenza Vaccination program, or their other clinical initiatives by visiting the Clinical Initiatives page or emailing physicians@davita.com.

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* http://home.smh.com/sections/services-procedures/medlib/Pandemic/Pan_Renal/PanRenal_Naqvi_050809.pdf
**Gesundheitswesen. 2003 Jul;65(7):464-70. Fam Syst & Health. 2001;19:221-226. Serodiagnosis and Immunotherapy in Infectious Disease. 1990 Jun;4(3):167-171

By Tammy Elzy, Director of DaVita SOURCE

“Plan B” is a well-known way to describe a person’s back-up career plan. Being the back-up plan for your new hire isn’t a very attractive position to be in and it usually doesn’t result in an optimal outcome for either party involved. As a seasoned physician recruiter and consultant, I have encountered countless discussions around this topic with the same result.

In most cases, the Plan B practice has little or no experience in recruiting and hiring a physician associate. How hard can it be? Place a few ads, sit back and wait for people to apply, right? Generating interest is usually not the problem, it’s getting the attention of the candidates you want to talk with, creating a competitive compensation and partnership plan, and closing the deal that are the real challenge. This article focuses on closing the deal the way a “Plan A” practice would.

The scenario: Fast forward to the point at which the practice extends an offer and the candidate says they are very interested or that they plan on joining, but will need some time to review the contract. It makes complete sense for them to review the contract and think over a life-changing decision for a few days, right? At this point the practice stops interviewing and reviewing candidate CVs and waits. They are so sure this candidate is going to the practice because they said they were. A week goes by, then a month, then two months. The candidate says they are still considering the offer or that they have a few more interviews to go before making a final decision.

Sound familiar? The hard truth is the candidate already knows whether they were going to take your offer or not in the first few days (after the offer is made?), but they won’t commit because they don’t have to. You are willing to wait. This is when your practice becomes Plan B.

While your practice is waiting, the candidate is shopping for better offers. They stop thinking about your practice and focus on their next interview. The candidate is not a 100% committed to your practice anymore. In some cases, the practice will never hear back from the candidate, and in other cases, they will hear back months later when the candidate has exhausted all other opportunities. If you’re the back-up plan, how long do you think they will stay?

How can you avoid Plan B syndrome?

• Put a deadline on the offer. Give the candidate 7 to10 business days to finalize their decision. It’s okay to extend a little more time if they tell you upfront they have another interview scheduled very soon, however don’t let the decision process go more than a month.
• Don’t stop interviewing. Inform the candidate you will continue to review prospective candidates and interview through the deadline. (If you don’t, you will be that much farther behind in your hiring timeline.)
• Be prepared to pull the offer. Be prepared to send an email or call at the end of the deadline and rescind the offer.

Recruiting and hiring the right talent is hard, and avoiding the Plan B scenario is even harder. By being proactive, firm and focused, you can ensure you are finding the right prospects and adding the right physicians to your practice—ensuring you are the Plan A.

For more information on how to ensure you are the Plan A, visit DaVita.com/SOURCE or call 1-866-262-4004. If you want to make sure your practice is operating optimally at all levels, consider a Practice Assessment which includes a comprehensive diagnostic evaluation of your practice’s financial and operational health.

Operating a nephrology practice and caring for patients with a complex, ever-evolving set of chronic medical conditions is incredibly challenging. In recent years, it has become even more so due to healthcare reform and new government regulations. While the intent of many of these regulations is to ultimately improve the healthcare system and enhance patient care, they can seem daunting to already overburdened and under-resourced healthcare professionals.

As nephrologists have seen this complexity grow and their day-to-day schedules become busier than ever, many have been hesitant to introduce new technology and processes into their practice. For a variety of reasons — mostly falling into the categories of being too time consuming, expensive, distracting and/or difficult — they have chosen to backburner the adoption of new technology and instead focus on what they excel at: providing the best possible patient care.

While these reasons may seem legitimate, many are misconceptions — and physicians are missing tremendous opportunities to improve their practices starting immediately in 2011. Whether considered independently or in aggregate, these opportunities should prompt physicians to not only reassess the potential of new healthcare technology, but embrace it as a means to optimize their care of patients. Specifically, physicians should be considering an electronic health records (EHR) solution that can not only streamline operations and improve practice outcomes, but also enable them to spend more time caring for patients.

While there are many benefits and opportunities, here are five of the best reasons to consider an EHR now:

1. You can qualify for up to $44,000 in potential government Medicare EHR incentives by attesting to “meaningful use” of a certified EHR starting in 2011. The American Recovery and Reinvestment Act of 2009 (ARRA) authorizes the Centers for Medicare and Medicaid Services (CMS) to provide reimbursement incentives for eligible professionals and hospitals that are successful in becoming “meaningful users” of certified EHR technology during a specified EHR reporting period — and the first federal stimulus incentive payments start in 2011. By using an EHR in a meaningful way (as defined by ARRA) for a minimum of 90 days in 2011, you can meet the initial  “meaningful use” requirements for this year and qualify for up to $44,000 through the Medicare EHR incentive program with continual meaningful use over the following four years. In addition to this incentive, by implementing an EHR now, you can avoid the financial penalties that the government will impose beginning in 2015 for physicians not using a certified EHR.

2. You can choose an EHR that is nephrology specific and customized to your needs.You specialize in kidney disease, so it only makes sense that your EHR should be specialized too, providing the tools and templates you need to efficiently deliver superior care to your patients. A generic EHR will likely not meet the very specific needs of your nephrology practice and will therefore require more of your and your staff’s time and effort. When choosing an EHR solution, remember that beyond the basics, not all EHRs are created equal. Look for an EHR vendor that has developed its system from the ground up in collaboration with nephrologists. Next, determine whether the EHR has the flexibility and breadth of functionality to meet the unique needs of your specialty. It should include nephrology-specific templates for comprehensive and follow-up visits in your office, as well as for ESA therapy. Equally important, it should allow you to function easily in locations outside your office, including dialysis centers, hospitals, vascular access centers and surgical centers. The right EHR will not only bring optimum value to your nephrology practice; it can bring more efficiency to your work and more balance to your life.

3. You can use your EHR to help you track, benchmark and improve your practice performance. With a well-designed EHR, you can review patient data in an easy-to-track format and compare data points across disease states and patients. In addition, an intelligently designed EHR can act as a second set of eyes on your patients. Look for a disease management protocol that will help you identify where risks exist or improvements can be made, thus ensuring that you don’t miss any opportunities to provide the most comprehensive care to your patients — and to bill appropriately for that care. Finally, since an EHR allows you to easily access, understand and analyze data, it will prove invaluable in improving decision making and decision support.

4. You can make your practice data as mobile as you are. Nephrologists are by nature constantly on the move between their practice and dialysis centers, hospitals and vascular access centers, not to mention the work done at home following up and covering for your partners. By selecting a web-based EHR versus an EHR that must be installed on your office computer, you can access patient information wherever you have a computer and an Internet connection, and act on that information immediately. With an EHR, gone are the days of transporting bulging files home to finish chart reviews or delivering small scraps of paper to billing staff after rounds. A web-based EHR enables you to work the way you want anywhere, anytime.

5. You can rid your practice of excess paperwork, save money on the costs associated with paper records and transform record-storage areas into potentially revenue-generating spaces. An EHR will let you clear out the glut of paper records that may fill your practice while ensuring that vital patient data is available electronically in mere moments. When selecting an EHR, keep in mind that those that are “web-based” do not require servers, manual updates or technology upgrades in your practice. By removing those potential expenses and converting paper records into electronic files, you may experience cost reductions resulting from the need for fewer servers, less paper and less space devoted to storing files than with a server system. And you now have the option of converting that freed-up space into a patient care/treatment area that can increase the financial health of your practice.

Implementing an EHR in 2011 will give you the opportunity to maximize government incentive dollars. Equally important, it will also provide you with the tools and resources to begin improving your practice’s efficiency and overall level of care, and enable you to establish and reach your long-term goals. To learn more about an EHR that can help you move towards these outcomes, visit FalconEHR.com.

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Related resources: 

• Benefits of an Electronic Health Record (recorded webinar) – Learn more about EHRs and the ways in which they can support you and your practice. Hosted by Falcon EHR.
• Decoding Meaningful Use (recorded webinar) – Find out how to qualify for EHR “meaningful use” incentives. Hosted by Falcon EHR and its practice management solutions partner, athenahealth.
• Meaningful Use Final Rule Overview (white paper) – Read an explanation of the final ruling on the federal government’s “meaningful use” incentive. Written by Allen Nissenson, MD, FACP, CMO, and Anthony Gabriel, MD, CIO of DaVita.
• 7 Strategies to Improve Your Practice in 2011 (recorded webinar) -Learn how an EHR and practice management solution can help you streamline your practice, improve your outcomes and strengthen the financial health of your practice in 2011. Hosted by Falcon EHR and its practice management solutions partner, athenahealth.
• Falcon EHR: The innovative, web-based, nephrology-focused EHR, designed from the ground up by technology experts in collaboration with nephrologists. To learn more about how Falcon EHR can help you streamline your processes, improve your practice and qualify for “meaningful use” incentives, visit FalconEHR.com, call 1-877-99-FALCON, or click here.

Nephrologists understand that end stage renal disease (ESRD) patients are healthier and less prone to infections and hospitalizations when they dialyze with a permanent access rather than through a central venous catheter (CVC). Additionally, the first 90 days play a critical role in the life expectancy of dialysis patients.

Two recent programs that have yielded strong results for physicians and exceptional outcomes for patients with ESRD are called IMPACT™ and CathAway™, both initiated by DaVita®.

IMPACT, which stands for Incident Management of Patients, Actions Centered on Treatment, focuses on patients who are within their first 90 days of dialysis and is an interdisciplinary approach to manage outcomes of this high-risk patient population. The goal is to reduce mortality in new patients during the first three months of dialysis, when patients are most vulnerable. Using IMPACT, DaVita’s physician partners and clinical team have had proven positive results in addressing the critical issues of the incident dialysis patient.

IMPACT concentrates on patient education and important clinical outcomes, such as the measurement of adequate dialysis, access placement, anemia, and albumin levels, monitoring the patient’s overall health in the first 90 days on dialysis.

To achieve that goal, IMPACT centers on three main areas:

• Patient admission into our facilities
• Patient education and care planning
• Quality outcomes reporting

The results of the IMPACT pilot study showed that better management of incident patients in these three areas was associated with greater placement of the AVF access, thus reducing the patient’s risk of infection and other catheter-related complications.

In addition, a higher number of IMPACT patients versus non-IMPACT patients had an arteriovenous fistula (AVF) in place. Research show that fistulas – the surgical connection of an artery to a vein – last longer and are associated with lower rates of infection, hospitalization and death compared to all other access choices.

The second DaVita initiative, CathAway, is a collaborative initiative aimed at transitioning patients’ dialysis access from CVCs to arterial venous fistulas (AVF) in collaboration with our physician partners. The program has resulted in dramatic reductions in the prevalence of catheters in DaVita patients, in turn reducing their morbidity and mortality risk.

Taking a very structured and realistic approach to the implementation of CathAway, DaVita followed a step-by-step protocol that was implemented at each of its more than 1,600 centers. The protocol included:

• A field-level Vascular Access Manager role to implement specific clinical support in managing AVF and arterial venous graft (AVG) placement and maintenance in patients.
• Process-mapping and intervention of the 150-day process of transitioning from a CVC to an AVF or AVG.
• A barriers-analysis tool to identify root causes for delays in removing catheters.
• A CathAway Management Report, a single source of actionable data and metrics to track catheter reduction efforts.
• Programs and tools to educate clinical caregiver and patients about the hospitalizations and mortality rates associated with CVCs.
• A communications plan for DaVita to address patients’ concerns and frequently asked questions.
• Social worker training to help patients overcome fears regarding surgery and body image issues associated with fistulas. Using the Life Preserver Toolkit helps social workers identify and address barriers to catheter reduction.
• Dietitian training on the detrimental effect of catheters on nutrition.
• Expert Cannulator identification and training to work with each facility.
• A 10-Second Access Check monitoring program to ensure the timely maturation of new accesses and that mature accesses do not fail requiring the patients to convert back to CVCs.

DaVita has placed a high priority on these two clinical initiatives because they have demonstrated strong results that continue to improve annually. By focusing on the specific fundamentals of these two clinical initiatives both catheter rates and patient survival have improved on a yearly basis.

Some of these fundamentals include:

• Individually assess incident patients regularly in their first 150 days.
• Minimize the “catheter-removal” cycle time.
• Review each catheter patients with the facility staff and identify obstacles causing delays in catheter removal.
• Work with the staff and patients to develop action plans for catheter removal.
• Plan fistula and graft placements.
• Start AV placement plans early by scheduling vessel mapping and surgery evaluation appointments for Stage 4 Chronic Kidney Disease (CKD) patients.
• Schedule fistula placement surgery for those patients where ESRD is imminent in the next three to six months.

Learn more about CathAway and IMPACT, or click here.