Saying “in this economy” is quick becoming a frequent addition in many people’s conversations—whether it is looking for a new job, deciding to rent or own a house, and for many doctors, deciding to place a financial stake in a clinic and create a joint venture.
For nephrologists, healthcare reform and especially the new bundling payment add layers of doubt to the decision to joint venture. Even in the best of times, a joint venture isn’t for everyone. Therefore, Renal Business Today spoke with three nephrologists to gain some insight into the real experience of being a part of a dialysis clinic joint venture.
"You’re investing more that just money," said Dr. Paul Panebianco who runs two centers in south New Jersey in joint ventures with Liberty Dialysis. "You’re investing time. For example I may have to fit into my day going to the dialysis unit to interview a nurse. You have to have a certain willingness to do that. You can’t be at the end of your career where you’re trying to slow down. You still have to have the passion to do that.
"It’s very difficult to be a passive investor when the product you’re investing in is the product that I provide," he added. "I’m investing in what I do. It’s completely different than if you invest in a shoe store. I am bound by more than just the regular legal codes. I have a moral obligation to see that these patients do well."
Earlier in his career, Amit Sharma, MD, FACP, FASN, was at the Naval Medical Center in San Diego and was initially interested in the academic side of nephrology. However, he moved to Idaho in 2005 in search of new opportunities, and partnered with the Boise Kidney and Hypertension Institute, which is also affiliated with Liberty.
"I wanted see what the best role for me," Sharma said. "It was difficult to find a job that was exciting. Instead of being an employee, I took a shot [with a joint venture]. It’s up to our own work ethic to be successful."
In five years, Boise Kidney has expanded to three dialysis clinics and runs new research on a regular basis. In Boise, Sharma is the director of clinical research and has been part of clinical trials in chronic kidney disease, anemia management, and dialysis treatment standards of care. And in March, the Renal Physicians Association recognized the organization with its 2010 Exemplary Practice Award.
"We can prioritize what is important," Sharma said. "The nephrology community is dynamic. We don’t have to go through approval hoops. We can make changes that are not blocked by corporate. We have more freedom."
Local Governance
“We try and meet patient's needs if they have a particular problem," Panebianco said. "We tend to individualize it. We have local governance in the system we’re in right now, which means that in spite of a parent company some place, I can pretty much do what I need to do for my patients on a local level.”
As an example, Panebianco's clinics trained a patient in home dialysis, but he wanted to travel. Therefore, he and the clinic's nurses helped him put his home dialysis machine into his RV. He travels all over and can dialyze himself.
Before Dr. Mitch Vernace partnered with Liberty in a joint venture in Doylestown, Pa., he had an experience that made him appreciate local governance. "We had a nearly 400-lb. patient, and the larger someone is, the longer you have to dialyze them," he said. "You can also get a larger dialyzer and enhance the clearance. I made a request for a larger dialyzer. It took three months to get an approval from some central area because of cost. If that was my brother sitting in that chair I would be pretty mad that I would have to wait for approval. That started my thinking that maybe there is a different model out there."
Increased Involvement
"You become a jack of all trades," Vernace said. "Nephrology is a subspecialty of medicine that a lot of physicians find very complex and too detailed. Patients tend to have a lot of medical problems, so it’s not an attractive area of medicine to begin with. And to stay on top of your game is hard enough to do. Now, in a joint venture, you need to become a plumber, a technician, a physicist, an engineer."
