What are the options for nephrologists under capitation?

Nephrologists will play a pivotal role in changing tomorrow's renal delivery system. Nephrologists still control patients and drive the health care delivered to patients suffering from ESRD. As a result, practice management companies, independent consulting firms, renal societies, hospitals, dialysis providers, insurance companies, managed care plans, government agencies, and, yes, even independent practice groups are exploring business strategies that will unite nephrologists under a common goal--that of an integrated renal delivery network. Nephrologists face what is probably their professional career's most important business decision: Partner with such organizations as hospitals, dialysis providers, or practice management companies, or form an independent nephrologist owned IPA and contract with an MSO. As nephrologists evaluate the options, they should seek partners that will at a minimum provide the following: a business plan that spells out the relationships of all the players; practice evaluations that can improved efficiencies; skilled day-to-day practice management; model legal documents; human resource management; expert, pro-physician reimbursement negotiation, coupled with a system to track contract profitability; case management, critical paths, practice guidelines; and renal industry expertise. Above all, nephrologists should seek partners in the formation of an integrated delivery system that offer an attitude dedicated to physician empowerment in the interest of good patient care.