American Renal Associates
Joseph Carlucci
CEO
American Renal Associates opened its 100th clinic this past summer; could you speak to the significance of that event?
We founded American Renal and opened our first clinic on Dec. 8, 2000, and we started American Renal from our homes. Ever since I started in dialysis in 1978, I always worked for either a nephrologist or a nurse. We felt that the model of nephrologist ownership was a powerful model. To the extent that we could provide a balanced partnership, we felt we would create a good company and a good service to patients. Starting the company as a co-founder from our homes, hitting 100 facilities was an incredibly exciting point in our development. We had a reasonable celebration within the company, but having said that I think American Renal is really in its infancy. American Renal is the only organization that employs the joint-venture partnership with nephrologists exclusively, so all of our centers are in partnerships with nephrologists. We’ve declined opportunities to acquire 100 ownership in clinics to preserve our model. This model is the wave of the future in dialysis. The dialysis clinic is really an extension of the nephrology practice. One hundred facilities is a great achievement, but that’s just our first 100.
Now that we are nearing a year into the bundled payment, what would you say its biggest effect on the renal community has been?
Clearly, its biggest effect has lead to reduced consumption of ancillary services. Patient care has been preserved and continues to be preserved in the highest form. Quite frankly, the bundle was actually a good thing for the renal community. Caring physicians need to and will continue to focus on their patient and provide services appropriately. The physicians in American Renal took the lead in caring for their patients and prescribing medication as they felt it was necessary for their patients.
How did American Renal Associates best position itself to deal with these payment changes? Were there any major lessons learned?
We started to look at the bundle in September 2009. We gathered a group of nephrologists to look at anemia guidelines, iron protocols, vitamin, oral medication and laboratory. The doctors really formulated best practice guidelines. Then we met with them again in June 2010, again in September 2010 and October 2010. The nephrologists within our organization developed best practice guidelines, and then we submitted those guidelines, and the prescribing physician and medical directors tweaked the guidelines based on what they thought was best. American Renal will never get between the doctor and the patient. The prescription is always driven by the doctor. The whole process was nephrologist driven, and it has led to declining ancillary services but hemoglobins have stayed relatively stable.
Even in the days of fee-for-service, EPO doses tracked 15-17 percent below the national average for American Renal. We have approximately 135 physician owners, and because we never got between the patient and the doctor, the doctors provided their own prescriptions. So when we entered the bundle, we were already in a reasonably good position because that’s how the doctors practice medicine. Some doctors gravitated towards subcutaneous administration, some doctors decided to provide both IV and sub-q in their facilities, and some doctors stayed with IV. In total, hemoglobins stayed relatively stable in the bell curve, but doses came down.
What are some ways American Renal sets itself apart?
Our clinics run well from day to day, and one of the reasons they run so well is that have a local owner at every single clinic. Turnover for staff is almost nonexistent. Last year, we turned over only a couple of clinic managers, and our staff turnover is in the 6-7 percent range. When you think about the quality of care being provided at the clinic, the clinics have to be well run. Also, when you think about the chronically ill patient coming in three times a week for the rest of their life, it’s pretty nice to have low turnover, continuity of care, and a staff the patients recognize and trust. That is a direct result if local ownership with nephrologists.
The ASN meeting is certainly the largest gathering of nephrologists, what are some of the things you look forward to with this event?
I really enjoy going to ASN because I’ve been in the industry since 1978, and I see a lot of my old friends there. I attend ASN as an exhibitor and as the CEO of American Renal, and I’m really proud to showcase American Renal to future physicians who are looking to facility ownership as an alternative to simply being a medical director.
Learn more about American Renal Associates and its products and services by visiting booth #611 during ASN or visit www.americanrenal.com for more information.
