Chronic kidney disease (CKD) affects an estimated 37 million U.S. adults — more than 1 in 10 — making it one of the most common chronic conditions in the country. But access to nephrology care is uneven. Patients in major metros are far more likely to have a nephrologist within reach, while those in rural and medically underserved communities often travel significant distances for specialty kidney care, if they get there at all.
Becker’s Healthcare recently spoke with Phuc Nguyen, DO, a nephrologist at Access TeleCare, about the challenges providers face in caring for patients with CKD and how tele-nephrology can address gaps in care and improve access.
Question: With nephrology facing rising demand and a projected workforce shortfall, hospitals are rethinking how they cover kidney care. Can you describe what tele-nephrology is and how it fits in?
Dr. Phuc Nguyen: “Medical deserts” exist in many communities, especially rural areas, where there are few, if any, specialists. For patients with chronic kidney disease or kidney problems who live in a medical desert, this might mean having to travel hours to see a nephrologist.
This problem is worsening as the few nephrologists in these communities are spread thin and overburdened, and many are nearing retirement. And community and rural hospitals face great difficulty in recruiting nephrologists and other specialists.
For patients with kidney disease, a lack of nephrologists in their community makes accessing the care they need — both regular care as well as care in urgent situations — extremely difficult.
Tele-nephrology, delivered in partnership with existing community providers, can fill this gap.
Tele-nephrology leverages technology to connect patients and general practitioners with board-certified nephrologists. These remote nephrologists are credentialed experts, are privileged by the provider organizations and can access and review the patient’s EHR. Through telehealth, they can assess patients remotely and can order tests and review results.
Q: Take us inside a typical case. When a patient with an acute kidney issue presents at a hospital without nephrology coverage, what shapes the decision to transfer or keep that patient? What role can a virtual nephrologist play in that moment?
PN: If a patient with a kidney issue presents at a hospital that lacks nephrology coverage, an ER doctor or a hospitalist — who is a generalist that lacks kidney expertise — will often be extremely conservative in care delivery to avoid litigation. This means they will frequently transfer the patient out of their community to a larger hospital with on-site nephrologists.
Having access to an expert nephrologist changes the decision-making process. The remote nephrologist, who is available immediately, can review the patient’s medical information, visit with and assess the patient, decide on the best course of action and follow the patient until they are discharged.
In many instances, instead of transferring the patient, this might result in treating and managing the patient in their local hospital — which is usually preferable for the patient, their family and the community or rural hospital.
Q: Inpatient dialysis supervision is a distinct piece of this work. What does that oversight involve day to day, and what does it take for a hospital to build or sustain a dialysis program it can run safely and consistently?
PN: Access TeleCare and its experienced board-certified nephrologists provide a complete nephrology service, including oversight and supervision of inpatient dialysis. Currently, about one-third of Access TeleCare’s tele-nephrology consults are related to dialysis.
In some situations, Access TeleCare works in conjunction with one of the large national dialysis providers. But if these providers don’t offer services in a particular community, Access TeleCare will find alternatives for the patient. An option that Access TeleCare is increasingly recommending for patients involves collaboration with Outset Medical, which offers mobile dialysis machines.
Q: What changes for a hospital — and for the surrounding community — when kidney patients can receive that level of care locally?
PN: What changes is that patients can receive quick and timely management of their kidney disease in their own community, without having to drive a considerable distance or be transferred. This is what most patients prefer, and it helps boost the reputation of the local hospital as a full-service provider that doesn’t need to transfer patients to larger hospitals.
Q: What else should hospital and virtual care leaders understand about this work?PN: In a perfect world, having an in-person nephrologist is preferred. But we don’t live in a perfect world. We live in a world where most specialists congregate in the big cities and where small community and rural hospitals get the least funding. In this environment, tele-nephrology and tele-medicine can make it a little more perfect and can level the playing field.
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