Tele-nephrology

[Nephro critical care]

I am starting a nephrology + critical care practice in a rural community. I have a long commute and am wondering if I can just do tele nephrology on the weekends rather than driving in. Anybody have experience in using tele-nephrology codes ?

---

Members don't see this ad.

 

[Renal_Prometheus]

I did some during the pandemic and I never really liked it. I always feel like you miss something without a proper PE. How do you know how much lasix to prescribe without palpating for leg edema? Pts oral history is just not reliable. I know some people use tele-HD rounds but I feel like they are short-changing the process. It makes financial sense if you are rural and trying to cut down amount of traveling(which is a big issue with nephrology).

 

[NewYorkDoctors]

i do a form of tele nephrology. but I only do this after I have set up a baseline visit and set up remote vital sign monitoring for the patient.
The initial consult for my renal patients (albeit not too many) is the most involved. The most crucial aspect is to establish the baseline weight, volume status (a combination of squeezing for edema , obtaining their pulmonary status, and doing POCUS with lung U/S and IVC) and baseline labwork. I also set them up for RPM BP, SpO2, and weight monitoring. This way I can do a telehealth session with objective data. Without objective data (other than maybe a recent labwork), I cannot give any concrete recommendations on things without potentially making mistakes.

But in general the telephone and video telehealth E&M codes do not pay as well as an in office visit.

However, I would not want to do tele-nephrology consults for hospital patients whom I do not know and can quickly make a major mistake on without a proper physical exam and trending that said exam.

I mean I would totally defer overnight consults by reviewing the EMR overnight and then just choosing fluids or lasix based on the basic info and giving basic reccs and then seeing what has changed in the morning since those evaluations during a consult. But I would not want to do just remote work like that.