AJKD recently published a Core Curriculum entitled “Management of the Hemodialysis Unit” by Blankschaen et al. Corresponding author Dr. Jay Wish (JW) discusses this paper with Dr. Kenar Jhaveri (AJKDblog), AJKD Blog Editor.
AJKDblog: Why are you interested in this topic, and why is it important?
JW: As medical director of a hospital-based out-patient dialysis facility for over three decades, I have had the opportunity to work closely with the hospital administrator responsible for the dialysis program to understand the many challenges that go into managing a dialysis facility. I understand that the successful management of a dialysis facility requires a partnership between the medical director and administrator. The medical director must be cognizant of the fiscal realities of the business. As members of the governing body, the medical director and administrator jointly establish a culture of quality and safety in the facility, respond to changes in regulatory mandates, and work to provide an environment where patients and staff are highly satisfied.
AJKDblog: In your opinion, what is the most challenging component in the management of the hemodialysis unit?
JW: The most challenging component is responding to continuous changes in the regulatory environment and identifying the resources needed to address unfunded mandates and quality improvement activities to improve patient outcomes and satisfaction. Since Medicare margins are small and Medicaid margins are negative, developing innovative programs can be risky financially, especially for small dialysis providers with a payer mix that is thin on commercial insurance.
AJKDblog: Is there anything you would have liked to include in the article if there was unlimited space?
JW: The original manuscript was 11,000 words. Sections addressing staffing and physical plant had to be curtailed to adhere to the word limit. Even though these areas are primarily the responsibility of the administrator, the medical director should be familiar with the applicable regulations and some of the challenges administrators face in satisfying these requirements.