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Issue Date: October 2006

Reform Forces Practices to Be More Efficient
Physicians nationwide are feeling the effects of changes brought about as a result of the Medicare Prescription Drug Improvement and Modernization Act of 2003. This year, the provisions of the act make it imperative that all physicians operate more efficiently than they have at any time in the past, says Robert Provenzano, MD, a nephrologist and chief operating office of St. Clair Specialty Physicians in Detroit. Provenzano is a member of the editorial board of CKD Practice Options and is president of the Renal Physicians Association, in Rockville, Md.

SWOT Analysis Leads to Nephrology Practice Success
By analyzing a practice’s strengths, weaknesses, opportunities, and threats, nephrologists can make strategic business and clinical improvements that can enhance the strength of their business and improve the quality of care they deliver. “Strategic planning is absolutely essential in enabling a nephrology practice to create a valued product for its community,” says Robert Provenzano, MD, a nephrologist and chief executive officer of St. Clair Specialty Physicians in Detroit. Provenzano also is president of the Renal Physicians Association, in Rockville, Md.

Practices Feeling the Effects of MMA
The Medicare Prescription Drug Improvement and Moderniza-tion Act (MMA) includes a number of provisions that are affecting nephrology practices. In some cases, the effect on practices is significant. The act is driving changes in how care is provided and causing nephrologists to renew their efforts to increase practice efficiency. In particular, three aspects of MMA are having a significant effect on nephrology practices. They are provisions that call for reimbursement based on average sales price plus 6% (rather than the earlier method which was based on the average wholesale price). One of the most significant aspects of the act is Medicare Part D, the prescription drug plan for senior citizens. The third aspect of the act that may have a significant effect on practices is the competitive acquisition program, which would give practices a new way to acquire medications.

Minnesota Group Gets P4P
Many experts advocate paying more to physicians who meet performance measures and follow treatment guidelines. Toward that goal, health plans and the federal Centers for Medicare & Medicaid Services (CMS) are developing and using pay for performance (P4P) initiatives to improve quality. While P4P is not widespread among nephrology practices, a nephrology group in Minnesota has been involved in a P4P program for the treatment of patients with CKD for two years. Michael G. Somermeyer, MD, a nephrologist with the 16-member Kidney Specialists of Minnesota in Robbinsdale, Minn., says the effort has been beneficial to patients and physicians. “We think it will be the wave of the future,” he adds.

Recruiting the Best Nephrologists
When a nephrology practice is growing, the partners must work harder and at the same time recruit new practitioners to take up the slack. But before adding staff, nephrologists should consider the options carefully, because new staff will shape the practice’s future direction, says Martin H. Osinski, president of Nephrology USA, a recruiting and consulting firm in Miami. Practices have several options, says Osinski, who has 20 years of experience in nephrology recruiting. They can hire a young nephrologist out of fellowship training, a seasoned nephrologist, or a midlevel practitioner, such as a physician assistant or nurse practitioner. This third option is becoming increasingly popular. A growing number of nephrology practices are turning to midlevel practitioners, rather than hiring a new physician. With supervision, midlevel practitioners can assume some of the work that physicians would do otherwise, such as primary care, following up on office visits, and working with dialysis patients. They also staff chronic kidney disease clinics and vascular access centers.

Practice Aims to Increase Efficiency
The nephrologists and endocrinologists in Renal Endocrine Associates in Pittsburgh, Pa., are developing several strategies aimed at increasing practice efficiency. Given that the greater Pittsburgh area has one of the highest concentrations of Medicare patients in the country, the group faces unusual challenges. Reimbursement has declined as a result of the Medicare Prescription Drug Improvement and Moderniza-tion Act of 2003 and so the group has been forced to find ways to become more efficient while continuing to meet its commitment to provide high quality patient care, says James Weiss, MD, one of 16 physicians (11 nephrologists and five endocrinologists) in the practice. The group has 50 employees including six physician extenders (nurse practitioners and physician assistants). Some 80% of its patients are on Medicare.