The dialysis facility of the future: the financial and social environment

Changes in the delivery of care are being driven by the rapid advance of managed care. Nephrologists must continue to be advocates for the end-stage renal disease (ESRD) patient in a medical environment obsessed with costs. Reorganization of nephrology will be mandatory because capitation is on the immediate horizon. Fee-for-service care will diminish, and nephrologists must learn how to become the driving force for quality care in a cost-effective environment. The formation of nephrology Independent Practice Associations (IPAs) will create the structure that allows nephrologists to negotiate and accept global captitated contracts for ESRD care. Placing the patients' interests first will ultimately lead to reduced costs. Changes in the nephrology workforce over the next decade will dictate participation in a horizontal and vertical integration team approach to care of the patient with ESRD.