NewYorkDoctors

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Has anyone heard of any intensivist (other than renal-intensivist) obtaining privileges in prescribing CRRT and HD? I can imagine from a nephrologist perspective and political perspective this is a big no-no in terms of revenue stream and outpatient continuity. Plus the intensivist is already too busy running around doing other things to care.

But just wondering out loud. I mean I hear in Europe intensivists do their own renal replacement therapy.
 
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chessknt

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I've heard of crrt being done by intensivists (culture dependent) but never hd.
 

EMIM2011

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Where I did residency, the surgical units would do their own CRRT w/o nephrology input
 

ANCAdoc

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Bad idea. I've heard of that, more so in Europe. I'm not sure why a credentialing committee in the US would allow that. What standards would they require?
 

NewYorkDoctors

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Honestly dialysis doesn't seem terribly hard.
My nephrology friends tell me HD orders are learned in no more than one week and most of the nuances in one month.
Choose a bath, choose a blood flow rate, choose a dialysate flow rate, choose a replacement fluid rate (for hemofiltration), choose an ultrafiltration rate, choose anticoagulation regional or systemic.
The difficulty probably lay in how not to screw up a recovering kidney in ATN.

But honestly, given how busy the ICU consults are, the rapid responses, the code blues, the crashing patients and the constant barrage of tasks to do, it's probably best for the intensivist only to dabble in the HD stuff when things are in a down period for academic reasons rather than be in sole custody of it if only for the intensivist's sake.
 

Nephro critical care

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I am nephrology-critical care but practice critical care only. Never desired CRRT privileges although I did CRRT all the time while moonlighting as a nephrologist. See it's not worth the headache and the calls from the dialysis nurse about filter clotting etc. And financially it doesn't make sense as at most I will be able to bill an additional CRRT code and that also maybe. If I could bill an additional hour of critical care then it would make sense but I would try to stay under the Medicare radar if I possibly could.
 

leviathan

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Lots of academic ICUs in Canada that do CRRT without nephro input. Definitely some turf wars depending on where you go where nephro want a portion of the billings, even if they aren't managing it. I'm still training and don't know the specifics, but I believe they are billed as new dialysis initiation which usually is pretty lucrative.
 
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