rbt
Interview with Kent Thiry CEO DaVita "It Takes a Village"
By Tony Bingham and Pat Galagan October 2010
Unless you are a dialysis patient, or perhaps a close follower of healthcare companies, you might not have heard of DaVita, even though it is one of the largest and most admired kidney dialysis companies in the United States. It provides dialysis services and education for patients with chronic kidney failure and end-stage renal disease, but where it really rocks is in the small pantheon of companies that have built unique cultures centered around their people—the Southwests, Disneys, and Zappos of the world.
Companies in this league typically have unique leaders as well, who are charismatic, quirky, and quotable. Kent Thiry is all that and something more—a leader who is authentically aligned with his company’s mission and values to the extent that he can say that his work fits his life’s mission perfectly.
Among CEOs who profess that people are their companies’ most important assets, he is the real deal. He leads DaVita as a good mayor would lead a village—for the benefit of its people. He’s gone to bat with the DaVita board to invest more resources in the Village and to provide more development for its citizens, even when the return couldn’t be measured directly in dollars and cents
.
The DaVita success story is all the more intriguing because it unfolded against a background of bankruptcy and employee disillusionment. Its 10-year climb to a best-place-to-work company is a telling reminder of the power of intention shared by all.
In this interview at the DaVita headquarters in Denver, Thiry talks about what it means when a company really focuses on its people.
Q| DaVita has a remarkable turnaround story. When you took over 10 years ago, the company was technically bankrupt, being sued and investigated, and losing more than 40 percent of its employees every year. Now it’s not only profitable and growing, it’s recognized by Fortune and other groups for its leadership and democratic culture. The company’s success is based partly on the intent to be a community—or village—that is a special kind of place to work. In practical terms, how does the Village support business objectives?
A| It doesn’t. We think of it the opposite way. We didn’t become a Village to support the business objectives. The business objectives support the Village. As opposed to team building being the means and the profit being the end, here the profit is the means, and the health of the community is the end. It doesn’t make us any less intense about profit.
At times when I talk to the board about launching more Village programs, they’ll ask, “What’s the ROI on that?” But we refuse to calculate it. It’s like asking what’s the ROI on giving your kids a good teacher or teaching them manners. What’s the ROI on having a happy household or on being a good neighbor? It’s not an ROI thing. It’s a how-do-you-want-to-live thing. And then to sustain that kind of community, you have to have a profit.
We first rolled out the Village concept because when we just talked about mission and values, it wasn’t a concept everyone could relate to. So we instead began to ask how people behave in a healthy community, and everyone could articulate what that meant to them. In a healthy neighborhood, you watch out for the neighbors’ kids. If someone is sick, you offer to go get groceries for them. If they have someone in the hospital, you offer to babysit for their kids. You pick up litter.
In a village or a healthy community, there’s an implicit social contract that everyone can understand. The business objectives are here to support the Village, and therefore, many of the people in the Village care a lot about the business objectives because they preserve the Village many of them love.
Q| You looked at Southwest’s and Disney’s cultures as models, but you decided you wanted to create something different at DaVita. What didn’t you see at Disney or at Southwest that you wanted for DaVita?
A| Well, I don’t know enough about them to opine on what it’s really like inside, but at Disney there’s a lot of emphasis on customer service. Impressively, everything speaks to the customer and to the kids, but the Disney culture is not as much about the people who work there. And at Southwest, they’ve been very good at creating a frugal but fun culture, but it’s light on more meaningful values.
We don’t play the patient card. We’d create a village if we were doing taco stands. We’re about our teammates first. Our culture is citizen-centric, and then hopefully we live our values in a way that benefits others. We do dialysis, but we’re not about dialysis. We’re about life, but not only about giving life to the patients, though we do do that. We’re about the fact that thousands of people have to work their entire lives to pay their rent and what a terrible concession that is if the work environment is morally and spiritually sterile.
What’s different about us is that we’re more intense about adding fulfillment and a higher level of engagement than in some other places where it’s more about making work more fun. We’re about helping people’s lives be more meaningful because they feel they’re part of a team where people take care of each other.
Q| Although a lot of CEOs and companies profess that people are important, they don’t all treat employees in ways that are consistent with their words, but you clearly do. What was the reaction of your board when you first proposed the Village concept? It’s not a common way to run a company, especially one that was in the middle of a turnaround.
A| This is where the turnaround was a blessing. When things were going well, I earned political capital with the board. Just like a quarterback of a winning team, I got more credit than I deserved, but I had it and so it was a question of how to use it. If the business results were going up, the board wasn’t going to complain if we allocated some resources to the Village.
Q| Did the board question the return on that investment in the Village?
A| When there were questions from the board about a return, my responses were not always popular with all directors. We discussed that they have a fiduciary responsibility, and sure they represent the shareholders, but that’s not all they represent.
We’ve had some tough discussions about profit sharing—about how much goes to our teammates and how much to the shareholders. Profit sharing is one of our most tangible expressions of community. Once we started sharing correspondence from teammates who had been deeply touched, it prompted the board to act in a more
human way than boards often do when forced to consider the kinds of moral decisions a company should make.
In general, the board has been very supportive, and many of them do think (even though we don’t have data) that there’s a very significant business return on the investment in the Village because turnover is lower, quality is better, and we can recruit better people.
Q| How would you advise other leaders about building this kind of culture if they didn’t have your track record of business success and they are contending with the current tough economy?
A| So many leaders fall short on this stuff, including me on many days. On a good day, they do mean it. But then things get difficult, and that goal gets lost because they didn’t talk about it in a tangible way, and they didn’t pledge to follow-up on it and ask people whether or not it’s coming true.
My advice is, number one—speak the dream. Number two—enlist other people in characterizing their dreams of a special place to work. And number three—force the group to talk about it and come up with next steps to get it moving. You have to be persistent and tenacious.
So you speak it, you enlist others, and you come up with a plan for tracking progress. If you track productivity and new product development and sales, why would you not bring this same management process rigor to your culture? If you’re not going to talk about how you’re doing at living your values, how is it going to happen?
Even without a turnaround or a tough economy, if the CEO has the whole team in a few times to talk about how we’re doing at living our core values, people will say, “He’s serious about that.”
Q| You’re known for talking about “meticulous metrics.” How do you decide where to drive meticulous metrics and where not? This is of interest to people in the training community who are asked to rationalize investments in training but aren’t sure what the CEO has in mind.
A| We do believe in meticulous metrics to warrant whether or not we are making progress in the team, community, and spiritual realms. One of the most straightforward ones is to track the turnover rates of people who’ve been to our academies where we cover our mission and values. Every single team member is invited, and attendance is voluntary. We compare their turnover with that of those who chose not to attend the academies.
Another metric is to score the CEO and other executives on whether they’re living each core value. I just got my annual 360, and I got a score on each core value and a score on each component of the mission, and I can track that over time.
There is a Buddhist saying: “One cannot pour from an empty cup.” We believe that if we fill our people’s cups, they will do more good things for our community. And to see whether that’s true, we track Village service days and hours of participation. We track dollars contributed to causes such as the DaVita Village Network that helps teammates when tragedy strikes, or Bridge of Life that funds medical missions overseas. These are all metrics of health that tell us whether our community barometer is rising or falling.
Q| Have you made adjustments based on some of the metrics you’re seeing?
A| We grow some things and pull back on others. Just like in a business, you invest in the product line that’s growing, or in this case, doing more good. I vetoed Bridge of Life medical missions outside the United States a couple of times because I felt that we had to stay focused on the United States. Then we did one, and the outpouring of support was stunning. Now we’re touching more and more countries and more patients who would otherwise die.
Q| You have a rigorous recruitment process from a values perspective. What are you looking for when you bring in new leaders or develop leaders within the organization?
A| The first important point is that here everyone can be a leader. Leadership is not a function of position. Leadership is a function of behavior. So in our mind, your question applies to everyone we hire. We evaluate people on whether or not they resonate with our core values. I’ve done that with every single executive I’ve ever hired.
Q| And if you see someone who has leadership potential, how do you develop them?
A| Development is a journey that we take very seriously. For us, management is a business skill, so if you want to get better at management, you develop more business skills. But leadership is a human skill. If you want to become a better leader, you have to become a better human. And you have to understand humans, particularly yourself.
A lot of our leadership development is not about techniques of leadership because leadership is not what you do. It’s who you are. There are some things that are going to help your arrow fly farther, but whether or not your arrow leaves the bow is driven by how people experience who you are, not by any techniques. So we’re big on people becoming more self-aware and developing the comfort to talk openly about their weaknesses. If you’re going to learn to lead, you have to do it.
A lot of what we do with respect to leadership is trying to remind people to be mindful. It’s easy to be mindful. It’s hard to remember to be mindful. The times when you most should be mindful are the times when it’s hardest because you just missed budget or the market just crashed. We try to find applied situations where you’ve behaved in a way you wouldn’t like, and then we talk about them as a way of helping you grow.
Q| How would you characterize your culture in spiritual terms?
A| We do some references to Buddha, but our culture is decisively nonreligious. We do things that we think are an integral part of trying to break down behavioral barriers that get in the way of true leadership. We do songs. We do chants. We do call and response. Many kinds of organizations in all cultures (sports teams, military groups, or religions) use these methods. Why? For positive energy. They create a sense of unity and remind you of important things. Some of our new executives say, “That’s really dumb” or “That’s really cheesy.” And two years later, they’re leading it.
So we’re not weird. We’re like other institutions that are mission-driven as opposed to corporations that don’t really have missions.
Q| DaVita has a Chief Wisdom Officer, Steve Priest. How do you know that he, or anyone in a top learning position, is doing a good job? What are your expectations?
A| I chose that title for a reason. It’s one thing to teach someone how to clean a dialyzer, and that’s really important in our business, but it’s another thing to create a higher level of wisdom amongst all our people—wisdom about how to interact with other human beings and wisdom about themselves.
We look for meticulous metrics. In every class and every course, the contents and the presenter are scored. We are intense about getting market data that tells us if a class or an instructor is getting stale. And we read all the comments to see how we’re doing.
I pick up an awful lot from talking to people. For example, at our academy sessions, we have people come up with the one thing they’re going to work on in their lives. You know you’ve struck something when lots of people talk about that for weeks afterwards. If I don’t get a certain number of emails saying that the experience has changed lives, then I know that we’re starting to miss the mark. That’s highly qualitative information, but it’s a big deal.
Q| Are the classes that relate to your culture required?
A| Attending the academies where we talk about the culture is not required. It’s offered to everyone, and it’s always been voluntary. In the beginning when we were throwing out ideas about the Village, some people thought it was just rhetoric. Some were actively negative. Some said, “Who cares?” And a sliver were interested. So it was really important that it be voluntary, especially because so many people were alienated at that point. I wanted people to make a choice to give me a chance or not.
Q| What’s your personal role in engaging people in the idea of the Village?
A| Less and less as time goes on. In the beginning, half of the executives had quit or had been fired, and most of the remaining half quit or were fired in the subsequent year. So until the new team was assembled, I had a high percentage of air time but that’s gone down, down, down. Now I meet with young leaders and with facility administrators. Just like a mayor would, I work really hard to see a lot of constituents every year in a town hall type of setting where they can hear my point of view and ask questions.
For our high-performers and our high-potentials, I do mini-retreats with 10 people at a time. Part of the agenda is always about leadership and about the DaVita community and how we make it more real for more people. When people become true believers, the ripple effect is very powerful.
I also do some speeches. They pique interest, but it’s not where you get conversion. You get conversion through actual decisions and then through smaller interactions. You have to do it in small sessions to model how other people can do it in their small sessions. Unless you create the viral capability by modeling it, it can’t happen. There’s an infinite return on this if you do it right.
Q| Is it true you sometimes appear at these events in a costume that includes a cape and a hat with a feather?
A| Never in costume. Only in uniform. I like to say I’m descended from d’Artagnan [fictional adventurer created by Alexander Dumas in the 17th century as a character in The Three Musketeers]. We use the Musketeer metaphor throughout the company, and I have my Musketeer uniform. If I say, “One for all” to a group of people, most will say back, “All for one.” It’s one way to remind people about the core value of the team.
Q| How do you anticipate dealing with some of the potential cost pressures from lack of reimbursement when healthcare legislation kicks in? Do you see that impacting the culture?
A| Not if we’ve done it right. When the recession first hit we had to give up a lot of things. People were asking whether we should cancel parts of DaVita University. During one of our Voice of the Village calls where the chief operating officer and the chief people officer and I do a company update to 3,000 people on the phone and take questions, there were some questions about pulling back on training.
So I said, if you’re a village and there’s a recession, do you close the schools down? Do you cancel the Fourth of July parade? No, you don’t do any of those things. You cut back at school. You prune here and there, but you don’t stop educating. That’s the future. You don’t cancel the parade but you have people make their own floats. That’s how a village reacts to a recession.
You don’t give raises to people if it would force you to lay off valued teammates. So if things get worse for us, we will use this metaphor of the Village. Yeah, we’ll do some unpleasant things. Yeah, we’ll strain the fabric of the culture, but we’ll be very transparent about why. It would be a test of whether or not we’re a true community. You don’t want to be naive about it, but the way to create a lot more margin for community preservation is by just being as honest as possible. Will those public explanations hold water? Will they be regarded as fair?
Q| Given your 10 years of experience with the turnaround of DaVita and the creation of the Village culture, what would you do differently if you had it to do over again?
A| In terms of business strategy, it’s easy to answer. In terms of trying to create a sustainable healthy Village, not in theory but in the minds of thousands of human beings, it’s harder to say.
Given how much you learn from your mistakes, and we have made some substantial mistakes, I don’t know if we’d be where we are or if I’d have grown without them. So it’s hard to separate the mistakes from the growth.
The academy design went stale, and we waited too long to redo it. I wish I had gotten the board used to a higher level of expenditure on the academies because now it’s harder to ramp it up. I would force myself to get more days of reflection so that I could present myself in a more mindful way more often and not have as many problems with my own behavior that come from not having more quiet time.
When I’m not consistently “good,” that can make people feel less inclined to keep trying and to think maybe we are just a regular company after all.
Q| How do you manage your life, both personally and professionally, so they’re both effective?
A| I can’t even think about work-life balance because I can’t separate the two. My work fits with my life mission perfectly. It is exactly where I want to allocate my life’s energies. The more your professional life is aligned with your personal, the more difficult it is to talk about balance because there’s this huge area where they’re actually the same. I’ve evolved to a state where what I like most to do in a DaVita context is what’s most valuable for DaVita.
It was a hard decision for me to come here, so I came with a sense of purpose that I would not otherwise have had. I pulled the top 100 people together and told them I wanted us to create the greatest dialysis company the world had ever seen. That’s the first of three rings in our “Vision Circle.” There was huge skepticism at first, but when people saw that I wasn’t going to sell the company and we were making a little progress, they could get behind that.
The core of our Vision Circle is the Village—to be a community first and a company second, and to live that way. That drives everything. That doesn’t mean that you don’t care about profit. The community has to have profit to survive.
The next ring of the Vision Circle is to be a role model for American healthcare. People had skepticism about that, too. We were a little dialysis company, but after several years of work, we have people in the U.S. Congress talking about us.
The outermost ring is to send forth ripples of citizen leadership. It is the conviction that when people leave here, they will work differently than they would have otherwise.
The beautiful part is that these things became true as waves of people began to go through the company. People have a different sense of their potential because things they were sure were untrue turned out to be true.
When people tell their spouse it’s the best place they’ve ever worked (imperfect, demanding, but the best place) and when people get more engaged in life because of what they’ve been a part of here, that’s the DaVita dream.
If we do that for thousands of our people, then it’s game over. Nothing else matters.
About DaVita
DaVita, which is Italian for “giving life,” has more than 34,000 teammates (employees) around the United States working to provide superior patient care and exemplify the company’s core values:
-
Service excellence: Serving others—our reason for existing.
-
Integrity: We say what we believe, and we do what we say. We are trusted because we are trustworthy.
-
Team: One for all, and all for one! We work together, sharing a common purpose, a common culture, and common goals.
-
Continuous improvement: We never stand still, and we are never satisfied.
-
Accountability: We don’t say, “It’s not my fault,” or “It’s not my job.” We take responsibility for meeting our commitments—our personal ones as well as those of the entire organization. We take ownership of the results.
-
Fulfillment: We make a difference. We feel rewarded, personally and as a team, because what we do in our jobs is consistent with our goals and dreams.
-
Fun: We enjoy what we do. We know that kidney dialysis is hard work; but even hard work can be fun.
Author Interviews: hemodialysis
- Dialysis - ESRD - CKD |
| Mesenteric Ischemia in Patients with End-Stage Renal Disease |
| Estimated Glomerular Filtration Rate and Prognosis in Heart Failure |
| Reduction in Bloodstream Infections in Outpatient Hemodialysis Centers Participating in CDC Collaborative |
| Risk Factors for Dialysis Withdrawal |
| One-Year Assessment of Quality Indicators in Acute Dialysis Program Operated by a Large Dialysis Provider |
| Characteristics of patients most likely to have a missed Dialysis session |
| More Frequent HB measurements & ESA titrations not Associated with Inreased Time in Target HB range |
Study Shows Daily Home Hemodialysis Patients More Likely to Receive Kidney Transplant
Difference in KidneyTransplant Incidence with Daily Home Hemodialysis vs. Thrice-Weekly Dialysis |
| Characterizing Missed Dialysis Sessions in the ESRD Patient population |
| Hemoglobin Recovery following Hospitalization in ESRD patients |
| Association of Serum Sodium Levels with Mortality in Non-Dialysis Dependent Chronic Kidney Disease |
| Talking Control Support in Hemodialysis Results in Higher Patient Satisfaction Survey Response |
| Use of Fondparinux in Severe Renal Impairment & Hemodialysis |
| Contribution of CA, phosphorus & 25-VitD to the excessive severity of sPTH in African-Americans with CKD |
| Comparison of Risk Prediction Using the CKD-EPI Equation & the MDRD Study Equation for eGFR |
| Iron-Based Phosphate Binder PA21: Effective and Well Tolerated in CKD Hemodialysis Patients |
| Hemoglobin Recovery following Hospitalization in ESRD patients |
| Disease Management Program ESRD Patients Have Lower Overall Medical Costs |
Crit-Line Monitor Use in Incident Hemodialysis Patients Improves Dry Weight and Adequacy,
While Reducing Epoetin Alfa Dose: A Propensity Score Matched Study |
| Perceptions & Roles of Nephrology Social Worker Within the Suicide Continuum of Care |
| Reduced Use of ESAs and IV Iron with Ferric Citrate: A Medicare Bundle Cost-Offset Model |
| Video Education Increases Patient Knowledge About Phosphorus Control |
| Effect of a plasma sodium biofeedback system applied to HFR on the intradialytic cardiovascular stability |
| Hemodialysis Access and Age-related Postoperative Outcomes: Which Fistula First? |
| Coronary Artery Calcification & Pre-Hemodialysis Bicarbonate Levels in Hemodialysis |
| Protein/omega-3 supplementation during regular dialysis sessions & inflammatory indices in hemodialysis |
| VDRA and improved survival in dialysis patients with serum intact PTH ≤150 pg/mL |
| Relation of social support to mental health and locus of control in Chronic Kidney Disease |
| Depression and anxiety in patients with chronic renal failure |
| Self -esteem in Greek dialysis patients: The contribution of health locus of control |
| Medication adherence in Greek hemodialysis patients: Contribution of depression and health cognition. |
| Association of insomnia with kidney disease quality of life reported by patients on maintenance dialysis |
| Comorbidities/ inactivity & long-term outcomes of CABG in small number of men on chronic hemodialysis |
| Complete Recovery From Acute Kidney Injury With Incident CKD Stage 3 and All-Cause Mortalit |
| Outcomes of patients with ESRD under chronic hemodialysis requiring CRRT & in AKI requiring CRRT |
| Radiologically Placed Tunneled Hemodialysis Catheters: Pediatric Institutional Experience of 120 Patients |
| Preload dependence of gated cardiac SPECT-derived ventricular volumes in hemodialysis |
| Effect of Hemoglobin Target on Progression of Kidney Disease |
| eGFR at Reinitiation of Dialysis & Mortality in Failed Kidney Tranplant Recipients |
| Biomarkers Determining Cardiovascular Risk in Kidney Disease |
| Rural and Micropolitan Residence & Mortality in Dialysis |
| Urinalysis is more specific & urinary NGAL is more sensitive for early AKI detection |
| Vascular Klotho Deficiency Potentiates Development of Arterial Calcification & Mediates FGF23 Resistance |
| Efficacy of preventing hemodialysis catheter infections with citrate lock: Hemodialysis Int'l |
| Learn about dialysis options from a Home Dialysis Therapy Nurse |
| Optimal fluid control can normalize CV risk markers and limit LV hypertrophy in thrice weekly dialysis |
| LDL, atherosclerosis and mortality in hemodialysis |
| Pulmonary hypertension in chronic kidney disease on dialysis/ without dialysis |
| Predictors of steal syndrome in hemodialysis Hemodialysis Int'l |
| Sodium intake and blood pressure in renal transplant recipients Nephrology Dialysis Transplant |
| HIV-associated nephropathy patients with & without apolipoprotein L1 gene variants Kidney International |
| Depression and nonadherence predict mortality in hemodialysis treated ESRD patients Hemodialysis Int'l |
| Serum Metabolite Concentrations and Decreased GFR in the General Population AJKD |
| High Volume Peritoneal Dialysis in Acute Kidney Injury CJASN |
| Trial of Catheters of Different Lengths to Achieve Right Atrium vs SVC Placement for CRRT AJKidneyDs |
Pre-kidney transplant ESA agence responsiveness with post-transplant outcomes
Nephrology Dialysis Transplant |
| Prognostic Value of 48-Hour Ambulatory BP & CV Mortality in Hemodialysis Kidney Blood Press Res |
| Darbepoetin-α Cardiovascular Geometry and CKD -Cardiorenal Med |
| Influenza Vaccine Effectiveness in Patients on Hemodialysis Arch Intern Med |
| Bioelectrical Impedance Analysis & Skinfold Thickness Sum in Body Fat Mass in Dialysis J.Renal Nutrition |
| Pre-Diabetes after Renal Transplantation Nephrology Dialysis Transplant |
| Essential trace element status and clinical outcomes in long-term dialysis |
| End-of-Life Decision-Making Confidence in Surrogates of AA Dialysis Patients Is Overly Optimistic |
| Comparison of Cardiac PET Perfusion Defects During Stress Induced by Hemodialysis vs Adenosine AJKD |
| Mental Health over Time & Cardiac Outcomes in HEMO Study CJASN |
| Cholesterol Synthesis, Cholesterol Absorption, & Mortality in Hemodialysis CJASN |
| Statins, Risk & Outcome in Acute Kidney Injury in Community-Acquired Pneumonia CJASN |
| Dialysis-Dependent Changes in Ventricular Repolarization |
| High Burden of Kidney Disease in Youth-Onset Type 2 Diabetes Diabetes Care |
| Late Start Dialysis & Outcomes in Japanese Dialysis: Therapeutic Apheresis & Dialysis |
| Pica in Pediatric Dialysis - J.Renal Nutrition |
| Elemental Concentrations in Scalp Hair in Hemodialysis Patients Therapeutic Apheresis & Dialysis |
Health-related QOL was not improved by targeting higher hemoglobin in the Normal Hematocrit Trial
Kidney Int'l |
| Sevelamer on HbA1c, Inflammation, & Advanced Glycation End Products in Diabetic Kidney Disease CJASN |
| Increasing organ donation via anticipated regret proposed protocol |
| Statins on Chronic Inflammation and Nutrition status in Renal Dialysis |
| Emergency Department Use of Urinary Biomarkers of Nephron Damage |
| Preemptive renal transplant survival, access to care, & renal function at listing Nephrology Dialysis Transplant |
| Effect of Diuretic Use on 30-Day Postdialysis Mortality in Critically Ill Patients Receiving Acute Dialysis Dr. Ko |
| FGF23 predicts incident cardiovascular event before but not after the start of dialysis Dr. Isaka |
| Mortality Prediction by Surrogates of Body Composition: An Examination of the Obesity Paradox in Hemodialysis Using Composite Ranking Score Analysis: Drs. Miklos Z Molnar & Kamyar Kalantar-Zadeh |
| Plasma Sodium & Blood Pressure in Hemodialysis J.Human Hypertension |
| Increased Risk of Death in Young African American Dialysis Patient: Dr. Norman |
| Nutritional Management of Stage 5 CKD J. Renal Nutrition |
A proposed management algorithm for fistulae between hemodialysis access circuits and adjacent veins
Vasc Access |
| Percutaneous approach in maintenance & salvage of dysfunctional autologous vascular access for dialysis |
| The Kidney Disease Quality of Life Cognitive Function Subscale and Cognitive Performance in Maintenance Hemodialysis Patients Amer. J Kidney Diseases |
| Absolute Interdialytic Weight Gain is more important than Percent Weight Gain for Intradialytic Hypotension in heavy hemodialysis patients: Dr. Chen Nephrology |
| Postdialysis BP rise predicts outcomes in hemodialysis: Dr Yang BMC Nephrology |
| APOL1 allelic variants are associated with lower age of dialysis initiation Nephrology Dialysis Transplant |
| Effects of Six versus Three Times per Week Hemodialysis on Physical Performance, Health, and Functioning: Frequent Hemodialysis Network (FHN) Randomized Trials Dr. Hall CJASN |
| Variability of blood pressure in dialysis patients: a new marker of cardiovascular risk Dr. Di Iorio |
| Assessment of Body Composition Using Dry Mass Index and Ratio of Total Body Water to Estimated Volume Based on Bioelectrical Impedance Analysis in CKD J. Renal Nutrition |
| Potential Role of Active Vitamin D Treatment in Telomere Length in Hemodialysis: Dr Valdivielso |
| CKD, severe arterial & arteriolar sclerosis & kidney neoplasia MELAS syndrome Dr. Piccoli BMC Nephrology |
| Pedometer-Assessed Physical Activity in Children and Young Adults with CKD |
| Effect of Frequent or Extended Hemodialysis on Cardiovascular Parameters Amer J. Kidney Ds |
Featured Hemodialysis Interviews |
Home Dialysis Summit Recommends Policy Changes to Increase Home Dialysis Usage
WASHINGTON, April 25, 2012 /PRNewswire -- On the heels of the first National Summit on Home Dialysis Policy, Summit organizers released a report reflecting the views of the delegates -- leaders in the kidney disease patient, clinician, facility and industry communities -- on federal policy steps to improve utilization of home dialysis for patients who can benefit from this often advantageous form of treatment. Many of the organizers also announced they have formed a new alliance, called the Alliance for Home Dialysis, to advance the recommendations identified at the Summit.
The Summit's "Report of the Delegates" highlights key findings from a March 29th meeting in Washington, DC where experts probed why, despite widely accepted and well-documented benefits of home dialysis -- improved outcomes, enhanced patient satisfaction, improved quality of life, and lower costs-- fewer than ten percent of the more than 390,000 current U.S. dialysis patients receive treatment at home. Current rates of home dialysis utilization reflect a steep decline from the 1970s, when almost 40% of U.S. dialysis patients were treated in-home.
Specifically, delegates found that policymakers should work with stakeholders in the dialysis community to confront three areas:
Accessibility: Patients and clinicians face array of hurdles in education, training, and infrastructure that hinder equalized access to home dialysis.
Accountability: Utilization of home dialysis can be improved through measures within government programs that are designed to recognize and support excellence in the delivery of home dialysis services.
Aligning Incentives: Reimbursement policies, regulation of new technologies and other policy incentives can be realigned to better support federal policy goals of expanding access to home dialysis.
The Report includes 15 recommendations to serve these goals, including that federal policymakers should:
Maintain parity for home and in-center dialysis in Medicare reimbursement;
Support home dialysis mentoring programs, particularly those that use existing patients as mentors; and
Align federal and state regulatory requirements for home therapies, such as revising the Centers for Medicare and Medicaid Services Conditions for Coverage requirements, to reflect differences in home and in-center dialysis.
Summit supporters will begin work through the new Alliance to dialogue with federal policymakers and advance policy improvements in the three consensus areas that emerged at the Summit.
SOURCE National Summit on Home Dialysis Policy
|
| |
National Kidney Foundation's Top 10 Things Every Dialysis Patient Should Know.
- You have treatment choices. Options exist for how, where and when you dialyze. Dialysis can be done in a hospital, in a dialysis unit that is not part of a hospital, or at home. You and your doctor will decide which place is best, based on your medical condition and your wishes. There are different types of dialysis - peritoneal and hemodialysis. Work with your health care team to determine a treatment plan that makes you feel comfortable. Recent studies show that the majority of patients beginning in-center hemodialysis (HD) know very little, if anything, about the option to dialyze at home. Once informed, 40% or more of patients are interested in this treatment option, and yet less than 10% actually begin home dialysis. If you're dissatisfied with the type of dialysis treatment that you're receiving, ask your healthcare team if another type of dialysis treatment would be better.
- You can compare in-center dialysis facilities online. Information on over 5,600 US-based dialysis centers is available online through the Medicare website. To help you make choices about your care, you can compare different facilities side-by-side and evaluate each facility based upon clinic characteristics and quality measures. You can search for dialysis facilities by name or geographic proximity. After completing an initial facility comparison to determine which facilities best meet your needs - such as the number of hemodialysis stations at a particular location and whether there are evening shifts available - visit the facilities that you're most interested in. Talk to the staff and other patients, as well as your doctor to ensure that this dialysis facility is a good fit for you.
- There are ways to prepare ahead for an emergency. Ask your dialysis facility about their emergency plan in case of a snow storm, fire, power outage or other natural disaster. As back up, make sure you have the names, locations and phone numbers of other dialysis units and hospitals in your area. Since regular community transportation services may not be working in an emergency, be prepared to make other arrangements for getting to dialysis. You may need to contact the police and Emergency Medical Services (EMS) for assistance. If you dialyze at home, make sure you have at least two weeks' worth of unexpired supplies on hand. If you have to miss a dialysis treatment, begin your emergency meal plan.
- There is an easy way to transfer patient records between clinics. There is an easy, secure way for your health care team to transfer your treatment records online. In 2009, the Centers for Medicare and Medicaid Services (CMS) created a centralized web-based data collection system called CROWNWeb to help reduce and eliminate patient treatment interruptions. This central system helps to streamline patient care regardless of the reason for changing dialysis centers. For example, if you've been admitted to the hospital, or if you needed to relocate during an emergency evacuation, your doctors and health care team can access up-to-date information about your dialysis so that you continue to receive appropriate care no matter where you are.
- You can travel while on dialysis.
Dialysis centers are located in every part of the United States and in many foreign countries. The treatment is standardized, but you need to plan ahead by making an appointment for dialysis at another center before you go. The staff at your center may help you make these appointments.
- You can be your own best advocate. Know what key questions to ask your doctor or other healthcare professionals. Take notes so that you can refer back to them later. Partner with your doctor and decide on a treatment plan together. Advocate for yourself and share how you're feeling.
- You have many rights. You as a patient have a great deal of control over your treatments. Patients have a bill of rights which includes receiving quality care, counseling about your medical information, and an expectation of privacy.
You also have responsibilities. Once you decide on a course of treatment, it's important to follow the recommendations of your health care team. If you decide to receive in-center dialysis, arrive at dialysis on time so that you can receive the full treatment without delays.
- You can receive insurance coverage. If you have end stage renal failure, you are likely eligible for Medicare insurance coverage. Speak with your health care team and social worker for help filling out insurance paperwork.
- You may need to follow a special diet. When your kidneys are not working properly, you may not be able to eat everything you like, and you may need to limit how much you drink. Your diet may vary according to the type of dialysis you receive. It is important to speak with a renal dietitian so that you are able to understand what you can and cannot eat based on your full health history.
- Dialysis patients can work. Many dialysis patients can go back to work or school after they have gotten used to dialysis. After establishing a dialysis routine, many patients have more energy and find that they are able to time to work around this new schedule. Some patients even find creative ways to work remotely from dialysis with the use of a laptop or cell phone, depending on their field of expertise.
More from National Kidney Foundation Press Releases
|
|
New Book to Help Educate Patients with Chronic Kidney Disease who may be facing Dialysis or Hemodialysis: |
Help, I Need Dialysis!
How to have a good future with kidney disease
By Dori Schatell, MS and Dr. John Agar
An internationally known nephrologist and life-long kidney patient educator explain how dialysis works, each of the ways to do it, and how your treatment choice may affect your diet, energy level, work, travel, sexuality and fertility, sleep, and survival. Comprehensive and fully referenced, this book is a must-read if you face the life-changing choices that come with kidney failure. |
|
|
