RPA/ASN position on the use of disease management in ESRD care

The care of patients with chronic renal insufficiency and ESRD is at a major crossroad, and there is considerable uncertainty about the future. There are substantial risks for both the patients and the caregivers as well as opportunities to improve patient care and the milieu in which the care is provided. The treatment of ESRD and chronic renal insufficiency is moving into an era of collaborative care with RCMs, physician assistants, and advanced practice nurses predicated in large part on the anticipated shortage of nephrologists as the ESRD patient population continues to increase. The future of reimbursement is uncertain and payers may well have difficulty responding to new models of providing care. It is imperative that nephrologists accept the challenge and assume the leadership role as disease management and other collaborative methodologies of caring for our patients develop.