By Daniel K. Brantley
[Deck] Over the past 44 years, Nephrology Associates of Syracuse, P.C. has continued to grow and enhance the kidney care they provide, making them a top choice for advanced, compassionate care.
Founded in 1978, Nephrology Associates of Syracuse, P.C. began with a small team that held an important but simple goal: “To provide high-quality nephrological care for our patients.” However, achieving that goal requires nephrologists and other specialists to work closely together. When they do, remarkable things can happen.
“If you get 10 nephrologists in a room, you’re going to have 10 different opinions,” says Matthew Chaffin, MD, a nephrologist with Nephrology Associates of Syracuse and Medical Director of the DaVita Central New York Dialysis Clinic. “Our unified way of practicing and approaching patients is unique for nephrologists, and it is ultimately better for the patient.”
Integral to their practice is taking a comprehensive, holistic approach to kidney care by looking at each of their patient’s medical conditions to determine if and how they might be affecting the kidneys. Dr. Chaffin says they view nephrology “not solely as the practice of caring for kidneys, but for the overall person.”
Over the years, Nephrology Associates of Syracuse, P.C. have increased their locations and grown their service area. They’ve also established an in-house laboratory to provide rapid blood-test results that clinicians can discuss with their patients the same day. The main office, numerous satellite locations and six dialysis units are located in and around Syracuse, accessible to patients from Canada, Pennsylvania and everywhere in between.
As it was for all healthcare facilities, the COVID-19 pandemic was challenging for Nephrology Associates of Syracuse, P.C. But in time, the stresses of the pandemic also offered growth opportunities that ultimately improved how they provided nephrology care.
“The pandemic changed a lot of what we do — especially during the early stages when everything shut down,” says Antoine Azar, MD, nephrologist and internal medicine physician with Nephrology Associates of Syracuse, P.C. and Medical Director of the DaVita Dialysis Clinics in Syracuse and Ithaca. “We had to improvise, to find ways to see kidney patients and ensure they remained stable during unstable times.”
While much of the world shut down, that wasn’t an option for the practice. When serving patients with chronic kidney failure (CKD), closing the doors — even temporarily — could be disastrous. However, some patients started to miss necessary appointments because they were afraid of contracting the virus. That’s when the organization implemented some creative solutions. In addition to setting up virtual visits, the group established alternate, standalone blood test locations that allowed patients to receive necessary tests near their homes, with minimal interaction with others. All visitors and staff must wear masks and be screened upon arrival. The results were forwarded to Nephrology Associates of Syracuse, P.C., for review, and a nephrologist discussed the results with patients in the office or via video conference.
Most patients have returned to in-person visits, where extra precautionary steps continue in place, as kidneys can suffer substantial damage from COVID-19, particularly among ICU patients placed on ventilators. Patients remain isolated from others throughout their visit, reducing their infection risk. Telemedicine is available for patients who cannot make in-person appointments.
Prioritizing Value-Based Care
Today, nearly $114 billion (20%) of Medicare spending goes toward kidney disease care, according to CMS. Value-based programs were designed to reduce the cost of care to patients with CKD and improve the quality of care they receive, ultimately reducing hospitalizations and readmissions.
Nephrology Associates of Syracuse, P.C. makes sure every laboratory test ordered is necessary and that patients receive the appropriate when and where they needed it. An essential element of delivering value-based care is coordination.
“In general, Syracuse-based providers do a good job of coordinating care amongst hospitals and physicians from the moment of discharge until the patient returns to the clinician’s office,” Dr. Chaffin says. “But every step along the way could use improvement.”
One of those improvements is rooted in better communication, particularly with the release of ICD-10, the medical coding system that makes condition recordkeeping more specific. CKD coding is more fragmented, and diagnostic details require even more specificity. While certainly helpful for improving patient outcomes, inputting so much more data is time-consuming. To improve the speed and specificity of data entry, Nephrology Associates of Syracuse, P.C. modified its software. The IT improvement can now more accurately describe a patient’s condition, enhance the patient transition from hospital to office setting and improve the ability to predict potential expense and real-world risk of future events.
Identifying Risk of Rapid Decline
Until recently, clinicians who attempted to predict kidney function decline couldn’t be 100% certain. Nephrology Associates of Syracuse, P.C. now uses KidneyIntelX™, which provides sophisticated and precise data to help forecast rapid decline among their CKD patients. Primarily limited for use on patients with diabetes and those who are nephrotic, KidneyIntelX scores patients based on their risk of experiencing rapid kidney failure progression.
“Although we can use charts and graphs to look at the rate at which a patient’s creatinine is rising, you’re only estimating what [that future level] is going to be,” Dr. Chaffin says. “KidneyIntelX uses a set of newer, novel blood and urine tests to give better predictive values of whether someone is at high risk for kidney failure progression that will ultimately lead to a need for dialysis.”
To complement these new advancements, Chaffin says they are considering the value of offering genetic testing. For example, certain genes, such as apolipoprotein(a) in Black patients, are more common among those at highest risk for progressive CKD and they will eventually require dialysis. Even among patients experiencing mild kidney failure, the presence of certain genes increases the potential risk for future dialysis. Genetic testing can empower providers to further educate their patients to take control of their health in ways that may postpone the need for dialysis.
Smarter Patients Are Healthier Patients
The goal of kidney care is the same for both patients and clinicians: to find ways to maintain optimal kidney health throughout life. Reaching this goal requires medical expertise and patient participation.
“Patients are a key part of their own care team, and to play their role well requires appropriate and frequent education,” Dr. Azar says. “When patients know what’s going on and understand their disease, they tend to be more compliant and follow up.”
In the U.S., 9 of 10 people with kidney disease are unaware they have the condition. These same statistics are mirrored in Syracuse. When referred patients come in for their initial appointment at Nephrology Associates of Syracuse, 90% don’t know why they were referred by their primary provider. Dr. Azar says even among patients who have advanced kidney disease, an estimated 50% to 65% are unaware of their condition.
“This lack of education is striking,” he says. “So we try to shed some light on things.”
In many cases, diagnosis is the first bit of light shedding to take place. Since so many patients are generally unaware of their health problem, and are unfamiliar with kidney disease in general, education is the critical next step. Patients immediately receive education from their care team during each visit and are offered additional educational opportunities.
During CKD education classes, patients learn the specifics of their disease, what may happen to their kidneys in the coming years, available treatment options that are most likely to succeed, diet and lifestyle modifications and more. These one-on-one classes give patients the opportunity to learn at their own pace and engage with an advanced practice provider in person or online about their disease.
Patients who want to learn more can sign up for advanced education classes which go into greater depth on a variety of topics. Classes are also tailored to meet patient needs. They may learn the difference between hemodialysis and peritoneal dialysis, survival rates for their condition and other information that helps them get a firmer grasp on their health. Each educational session concludes with an opportunity for patients to ask clarifying questions that help ensure they’re understanding what they’ve learned and can put it into action.
“No matter what disease a patient comes to us with, we strive to make their lives better every day,” Dr. Chaffin says. “It’s why we’re here, and that united philosophy we follow drives everything we do.”
Nephrology Associates of Syracuse, P.C. diagnose and treat the following conditions:
- Acute kidney conditions
- Anemia management
- Autoimmune disease of kidneys
- Blood pressure management
- Chronic kidney disease (all stages)
- Diabetic nephropathy
- Electrolyte abnormalities
- Metabolic bone disease management
- Polycystic kidney disease
- Renal-related diabetes management
- Renal transplant care, pre- and post-transplant
Nephrology Care Begins With Primary Care
With so many patients unaware of their kidney disease, many present to Nephrology Associates of Syracuse, P.C. with late-stage disease. As a result, nephrologists often have limited treatment options when a patient arrives for evaluation and therapy. An earlier diagnosis goes a long way toward changing that circumstance.
To increase the number of people diagnosed in the early stages of kidney disease, primary care providers should screen patients regularly. Annual blood and urine tests, especially for those with high blood pressure or diabetes, can detect kidney disease before it progresses.
However, early detection is not always sufficient, as patients may not understand, listen to or act on their provider’s advice. That’s why PCPs should do what nephrologists do: educate their patients until the education has an effect.
“When someone hears they have kidney disease, they may not pay attention or they may be in denial, because it’s a silent disease in the early stages,” says Antoine Azar, MD, nephrologist and internal medicine physician with Nephrology Associates of Syracuse, P.C. and Medical Director of the DaVita Dialysis Clinics in Syracuse and Ithaca. Because it doesn’t cause symptoms early on, Dr. Azar estimates more than 50% of PCP-referred patients neglect their initial nephrology appointment.
“Unfortunately, the majority come back in a year or two with worse kidneys and symptoms,” he says. “By that time, it may be too late to intervene.”
To combat this tendency to ignore kidney disease, patients must understand the severity of their problems and take appropriate action. For this to occur, clinicians should educate patients at each visit, underscoring the fact that they themselves are their best advocate for improved health.
Early Referral Improves Results
Declining kidney function commonly leads to dialysis, whether hemodialysis or peritoneal, in-home or at a dialysis center. When dialysis is insufficient or inappropriate, transplant becomes an option. In these cases, Nephrology Associates, P.C. providers refer patients to the nearest transplant center. They also prepare patients for their transplant and resume care when patients get discharged post-transplant.
But with an early referral, patients may eliminate the need for transplant. Studies have found patients who are referred to a kidney specialist prior to needing dialysis have reduced mortality. Providers are urged to continue referring patients when urine or blood tests indicate kidney disease.
Whether transplant or dialysis is necessary or appropriate, Nephrology Associates of Syracuse, P.C. has the expertise and experience to diagnose and treat all forms of kidney disease.
When the COVID-19 pandemic exacerbated the need for convenient care, Nephrology Associates of Syracuse, P.C. adopted telemedicine technology, which they continue using to this day. Virtual medicine is not, however, the only convenience-enhancing approach they use.
Satellite locations throughout the area make it easier for those with kidney disease to receive the care they need, close to home. Nephrology Associates of Syracuse, P.C. satellite offices can be found in the following locations:
Additionally, nephrologists visit patients weekly at Crouse Hospital and St. Joseph’s Hospital and rotate through Central New York dialysis centers.
To refer patients to Nephrology Associates of Syracuse, P.C. in Syracuse or a satellite location, visit nephrologysyracuse.com/contact or call 315-478-3311