Busy Nephs

There was a post at another group about the fact that lots of nephs breeze in and out so fast when they do rounds that they don’t even sit down, let alone adress patient concerns or educate. I understand why the staff is so busy with the heavy caseload they have and I understand that nephs see patients at the hospital and at their office. I have had nephs that see me every week and others that do rounds only 1x a month. I’ve had 7 to date and none have been educators. Can someone tell me what they do in the course of a day that they are always in such a rush?

At the first unit I was at my neph. didn’t visit pts at all; I had to go to his office to see him at all, and did that once a month. What really pissed me off is that he was getting paid twice, a lump sum to care for me, and then I would make a copay for the office visit and he would get even more from my ins…co… After I switched to the new unit (I see my neph. once a week) my first neph.'s office sent me a bill for an amount Medicare and ins. didn’t pay for one of my last visits with him. I didn’t pay it and they never sent another bill. I was prepared to tell them it’s against Medicare rules, and I had been Medicare primary at that point in time. I’m curious how often my neph. will want to see me and if he will charge extra when I go on home hemo… I’m wondering if he will still get paid by Medicare that lump sum per month for my care. Lin.

Nephrologists for home dialysis patients get a payment that is the same as if the nephrologist saw you 2-3 times per month in-center.

It’s likely that the reason why your nephrologist is seeing you weekly in-center is because a year or so ago the payment structure for nephrologists changed. They used to get paid a monthly fee whether they saw patients or not because they were available to patients on an as needed basis. If you saw the physician in his/her office about your kidney condition, Medicare considered that not separately billable because the doctor was being paid to take care of kidney issues already. If you were hospitalized, the doctor had to break the bill down separately with daily charges for the hospital and pro-rate the monthly fee for days you were in the clinic.

In an effort to improve outcomes, it was thought that patients who see their doctors more would likely do better. So Medicare started paying doctors based on the number of times they saw patients each month. The lowest rate is for 1 visit per month. The middle rate is for 2-3 visits a month (the same as for home patients). The highest rate is for 4 visits a month. A nephrologist must do at least one of these visits but can have a physician assistant or nurse practitioner to do the other visits. It doesn’t matter where the physician sees the patient – in the office or in the clinic so far as these charges are concerned. If a patient is hospitalized, physicians can charge for seeing patients in the hospital.

With commercial payers, all bets are off and doctors and dialysis clinics charge as they wish and get paid based on what the commercial payer pays. This is still true.

Still wondering if someone can answer my question re what do nephs do in the course of their day that makes them so rushed?

Heck, you don’t know? :?

Just imagine all the patients they have…on call, paper work, visits, and so on…its like they hardly rest…

No Gus, actually I don’t know and that’s why I am asking. My neph spends about 30 min. in my unit on rounds once a month. So, does the bulk of a neph’s time consist of pre dialysis patients they see in their office or other activities?

Nephrologists have been warning us for years that we were going to be facing a nephrologist shortage. This is happening for several reasons. The baby boomer and older nephrologists are reaching retirement age. Not enough students are entering nephrology because they think it requires too long hours for too little pay and the field of practice isn’t as “sexy” as some other fields. Keep in mind that the largest single payer of claims for most nephrologists is Medicare which pays doctors less than other insurance. There have been estimates that the ESRD patient population will reach 660,000 by 2010. This estimate may turn out to be low with the growing incidence of obesity and diabetes in the U.S. While the number of patients is growing at 12% per year, the number of nephrologists is increasing at 2% per year. It is estimated that by 2010, each nephrologist will be caring for 140 people with kidney failure alone.

Nephrologists don’t just see patients with kidney failure. Many see patients with kidney disease or other internal medicine concerns in their office. They may have more than one office in different areas of the city and some travel to rural communities to see patients. The doctor may be in the office to see patients who end up calling at the last minute to cancel or may not show up.

Nephrologists go on rounds at one or more hospitals where they examine and treat hospitalized patients and talk with families. They go to these hospitals every day to see patients and sometimes are called in again if a patient is not doing well. They may spend time in the inpatient dialysis area or in the ICU taking care of very sick patients or helping families of dying patients make painful decisions. Some do some access procedures. They also must examine and treat patients that other doctors refer when there is a possibility that someone has kidney disease. They advise the other doctor kidney damage and treatment to prevent or postpone kidney failure.

Nephrologists also see patients in dialysis clinics. Some go to dialysis clinics to see in-center HD patients as often as daily while others go as infrequently as once a month. They may have multiple dialysis clinics where they have patients. In addition, if they have home patients, the doctor has see them at home dialysis clinic visits. Doctors also have to attend meetings at the dialysis clinic with staff to discuss patient care needs and patient goals. Doctors also need to meet occasionally with the facility administrator and other administrative staff about their questions or concerns or to fill out various forms required by the government, not counting dealing with issues related to billing and claim denial.

Speaking of claim denial, doctors have to write letters of medical justification to get insurance companies to pay claims they don’t want to pay, request prior authorization for drugs patients need that insurance companies don’t want to cover, sign forms to get patients free drugs, paperwork for disability claims, write letters to employers, and write prescriptions.

Nephrologists also have to spend time on the phone talking with doctors, nurses, pharmacists, patients and family members, insurance companies, and anyone else that happens to catch them by a phone.

A good nephrologist also spends some time reading medical journals, doing Internet research, and attending nephrology meetings to stay up-to-date in nephrology. Some also volunteer for kidney organizations.

Those that are in academic medicine also have to teach medical students, interns, and residents and spend some time doing clinical research and writing publications to help others in non-academic medicine.

I’m sure I haven’t included all the things that a nephrologist does. These are just the things that I observed nephrologists I worked with doing. A nephrologist’s day is very busy, especially if he/she doesn’t have at least one partner to help share the load and nurses that he/she can trust to take care of some of the more easily handled situations that come up.

Check out this article from 2005:

Couldnt of said it better myself Beth!!!
Its the same with nurses, there are things that have to bo done behind the scenes, and dont forget that one nurse could be looking after 8 or more patients at once.

The amount of things I see my neph do actually amazes me.

When I was on in-center HD, he came around and saw his patients on average once a week. Albeit these patient visits on the floor were fairly quick visits (I would say he averaged about 5 minutes per patient), but he has a lot of in-center patients and when he did make in-center visits, he visited his patients during all 3 shifts.

I also know that he spent quite a bit of time with the staff at my clinic participating in the monthly patient evaluation meetings that he was responsible for every month.

On top of that, he spends a whole lot of time at the hospital where he has patients. Unfortunately, I have been one of his patients who has been hospitalized several times over the past 3 years. During each of my visits to the hospital, whether directly related to my CKD or not, I saw him there every day and he usually focused his attention on my case for quite a long time - reading other doctor’s notes, or changing my prescription, or going over my daily labs, or answering my never ending questions. I know that I was never his only patient in the hospital, so if you add all of that time up that he spent with his hospital patients - it is quite a lot.

Along with all the above, I know that he does see some patients in his office (although not that many, from what I’ve seen). He is also available by phone if I ever need him.

That’s a whole lot of stuff in my opinion.

Hi y’all,

From what I hear from the nephrologists I know who are in private practice, they are generally working 12-hour days, just about every day of the week, to try to fit everything in. Of course, I only talk to the good ones. :wink:

And that doesn’t count the middle of the night phone calls for emergencies…