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Dittrich M, Silberzweig J, Hymes JL, Giullian J, Green G, Wong LP, Freedman BI, Bhat JG, Spry L, Taylor R, Spech R, Durvasula R, Blue SR. Management of Patients with Multidrug-Resistant Organisms in Outpatient Dialysis Facilities. Clin J Am Soc Nephrol 2023:01277230-990000000-00320. [PMID: 38150244 DOI: 10.2215/cjn.0000000000000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/21/2023] [Indexed: 12/28/2023]
Affiliation(s)
| | | | - Jeffrey L Hymes
- Care Delivery, Fresenius Kidney Care, Waltham, Massachusetts
| | | | - Gopa Green
- Satellite Healthcare, San Jose, California
| | | | | | - J Ganesh Bhat
- Atlantic Dialysis Management Services, New York, New York
| | - Leslie Spry
- Fresenius Kidney Care, Waltham, Massachusetts
| | | | | | | | - Sky R Blue
- Sawtooth Epidemiology and Infectious Diseases, Boise, Idaho
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Bhat JG. How Much Is a Life Worth? Am J Kidney Dis 2023; 82:A8-A9. [PMID: 37422742 DOI: 10.1053/j.ajkd.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/16/2023] [Indexed: 07/10/2023]
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Silberzweig J, Bhat JG, Dittrich M, Durvasula R, Giullian J, Hymes J, Johnson D, Schiller B, Spech R, Spry L, Walker G, Watnick S, Yee J, Freedman B. Collaboration between Dialysis Providers and the American Society of Nephrology: Dialysis in the COVID Pandemic. J Am Soc Nephrol 2022; 33:1440-1444. [PMID: 35654601 PMCID: PMC9342651 DOI: 10.1681/asn.2021111475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Jeffrey Silberzweig
- J Silberzweig, Chief Medical Officer, Rogosin Institute, New York, United States
| | - J Ganesh Bhat
- J Bhat, Chief Medical Officer, Atlantic Dialysis Management Services, College Point, United States
| | - Mary Dittrich
- M Dittrich, Chief Medical Officer, US Renal Care, Plano, United States
| | - Raghu Durvasula
- R Durvasula, Chief Medical Officer, Puget Sound Kidney Centers, Everett, United States
| | - Jeff Giullian
- J Giullian, Chief Medical Officer, DaVita Inc, Denver, United States
| | - Jeffrey Hymes
- J Hymes, Chief Medical Officer, Fresenius Kidney Care, Waltham, United States
| | - Doug Johnson
- D Johnson, Chief Medical Officer, Dialysis Clinic Inc, Nashville, United States
| | - Brigitte Schiller
- B Schiller, Chief Medical Officer, Satellite Healthcare, San Jose, United States
| | - Richard Spech
- R Spech, Chief Medical Officer, Centers for Dialysis Care, Shaker Heights, United States
| | - Leslie Spry
- L Spry, Chief Medical Officer, Dialysis Centers of Lincoln, Lincoln, United States
| | - Geoffrey Walker
- G Walker, Chairman, Medical Advisory Committee, American Renal Associates, Beverly, United States
| | - Suzanne Watnick
- S Watnick, Chief Medical Officer, Northwest Kidney Centers, Seattle, United States
| | - Jerry Yee
- J Yee, Division Head, Nephrology and Hypertension, Henry Ford Hospital, Detroit, United States
| | - Barry Freedman
- B Freedman, Chief Medical Officer, Health Systems Management, Inc, Tifton, United States
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Bhat JG, Weiss S. ETC Model: How One Small Dialysis Organization Is Navigating Uncharted Policy Waters. Adv Chronic Kidney Dis 2022; 29:45-51. [PMID: 35690403 DOI: 10.1053/j.ackd.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/13/2021] [Accepted: 01/03/2022] [Indexed: 11/11/2022]
Abstract
The ETC model proposes to increase access to home dialysis and transplant for patients with ESRD. Implementation of this model is happening while many dialysis organizations are still suffering the far-reaching effects of the coronavirus disease 2019 (COVID-19) pandemic. In addition, the model has the potential to negatively affect small and independent dialysis organizations disproportionately. It incentivizes home dialysis over transplant and promotes development of new home dialysis programs, rewards achievement over improvement, and places an excessive burden on small and independent dialysis organizations. Advantages of the program include the focus on self-care as an acceptable alternative to home dialysis for some patients and the potential for some organizations to make improvements in care with increased reimbursements. The authors hope that the Centers for Medicare and Medicaid Services will address many of these concerns in updated rulemaking and guidance.
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Affiliation(s)
- J Ganesh Bhat
- Atlantic Dialysis Management Services, LLC, College Point, NY; Departments of Medicine & Physiology, Xavier University School of Medicine, Oranjestad, Aruba.
| | - Steven Weiss
- Atlantic Dialysis Management Services, LLC, College Point, NY
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Weiss S, Bhat P, Del Pilar Fernandez M, Bhat JG, Coritsidis GN. COVID-19 Infection in ESKD: Findings from a Prospective Disease Surveillance Program at Dialysis Facilities in New York City and Long Island. J Am Soc Nephrol 2020; 31:2517-2521. [PMID: 33077614 PMCID: PMC7608957 DOI: 10.1681/asn.2020070932] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Steven Weiss
- Atlantic Dialysis Management Services, LLC, College Point, New York
| | - Premila Bhat
- Atlantic Dialysis Management Services, LLC, College Point, New York
- Department of Medicine, Wyckoff Heights Medical Center, Brooklyn, New York
| | - Maria Del Pilar Fernandez
- Department of Ecology, Evolution and Environmental Biology, Earth Institute, Columbia University, New York, New York
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington
| | - J Ganesh Bhat
- Atlantic Dialysis Management Services, LLC, College Point, New York
- Department of Medicine, Xavier University School of Medicine, Oranjestad, Aruba
| | - George N Coritsidis
- Atlantic Dialysis Management Services, LLC, College Point, New York
- Division of Nephrology, Department of Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, New York
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Weinhandl E, Constantini E, Everson S, Gilbertson D, Li S, Solid C, Anger M, Bhat JG, DeOreo P, Krishnan M, Nissenson A, Johnson D, Ikizler TA, Maddux F, Sadler J, Tyshler L, Parker T, Schiller B, Smith B, Lindenfeld S, Collins AJ. Peer kidney care initiative 2014 report: dialysis care and outcomes in the United States. Am J Kidney Dis 2015; 65:Svi, S1-140. [PMID: 26003780 DOI: 10.1053/j.ajkd.2015.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Suying Li
- Chronic Disease Research Group, Minneapolis, MN
| | - Craig Solid
- Chronic Disease Research Group, Minneapolis, MN
| | | | - J Ganesh Bhat
- Atlantic Dialysis Management Services, College Point, NY
| | | | | | | | | | | | | | - John Sadler
- Independent Dialysis Foundation, Baltimore, MD
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Bhat P, Bhat JG. Tackling pay-for-performance: current and future challenges. Nephrol News Issues 2012; 26:27-29. [PMID: 22359962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Premila Bhat
- Atlantic Dialysis Management Services, New York, NY, USA
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Bhat P, Untanu RV, Gabaldon J, Bhat JG. 35 Targeting Higher TSAT and Ferritin Does Not Reduce Erythropoetin Alfa (EPO) Dose in a Cohort of Hemodialysis Patients with Central Venous Catheters (CVCs). Am J Kidney Dis 2011. [DOI: 10.1053/j.ajkd.2011.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bhat P, Untanu RV, Gabaldon J, Bhat JG. 34 Efficacy of an Anemia Management Strategy Targeting Higher TSAT and Ferritin in Incident Hemodialysis Patients. Am J Kidney Dis 2011. [DOI: 10.1053/j.ajkd.2011.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bhat P, Bhat JG. The 2011 ESRD prospective payment system: perspectives from a for-profit small- to medium-sized dialysis organization. Am J Kidney Dis 2011; 57:556-8. [PMID: 21316132 DOI: 10.1053/j.ajkd.2011.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 01/12/2011] [Indexed: 11/11/2022]
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Bhat P, Sokolowski W, Cundiff W, Bhat JG. Preparing for the bundle: one year later. Nephrol News Issues 2010; 24:30-35. [PMID: 20695320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Premila Bhat
- Atlantic Dialysis Management Services, LLC, Ridgewood, NY, USA
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Bhat JG, Bhat P. The 2009 Proposed Rule for Prospective ESRD Payment: Perspectives From a For-Profit Small Dialysis Organization. Am J Kidney Dis 2010; 55:231-3. [DOI: 10.1053/j.ajkd.2009.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 12/08/2009] [Indexed: 11/11/2022]
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Bhat P, Sokolowski W, Bhat JG. Projected impact of the proposed "bundled" ESRD payment system on a small dialysis organization. Nephrol News Issues 2009; 23:46-52. [PMID: 19585810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Payment for outpatient hemodialysis services is currently made by the Centers for Medicare & Medicaid Services on a per-treatment basis using a partially "bundled" composite rate adjusted for geographic and patient characteristics, plus a separately billable portion for medications and services not included in the bundle. In response to concerns over rising costs of the End-Stage Renal Disease Program, and specifically the increasing use of erythropoiesis-stimulating agents, Congress has mandated a new, more inclusive prospective payment system, in which current composite rate services, separately billable medications, and dialysis-related laboratory services will be included in a single payment. It is expected that the so-called bundle will apply a geographic wage adjuster and patient-specific case-mix factors to a base rate to calculate a per-patient, per treatment payment unit. We have modeled the proposed bundle and entered clinical and financial data for 118 Medicare patients dialyzed at a suburban dialysis center in New York State during 2006. Under the proposed bundled system, we stand to lose as much as $118,000 per year in revenue, and we find the case-mix adjusters appear to be poor predictors of our actual costs. We conclude that the proposed bundle places the small dialysis provider at significant financial risk.
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Affiliation(s)
- Premila Bhat
- Atlantic Dialysis Management Services, LLC, Ridgewood, NY, USA
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Zoneraich S, Bhat P, Bhat JG, Mollura JL. Bedside patient examination originated 6000 years ago in ancient Egypt. Circulation 1996; 94:1792-3. [PMID: 8840886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Asnis DS, Bresciani AR, Ganesh Bhat J. Mycobacterium gordonae: An unusual pathogen causing peritonitis in a patient on chronic ambulatory peritoneal dialysis. ACTA ACUST UNITED AC 1996. [DOI: 10.1016/0196-4399(96)88938-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
OBJECTIVE To report a case of reversible seizures and mental status changes in a dialysis patient given preventive isoniazid therapy. CASE SUMMARY A 66-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) was given isoniazid prophylaxis following a purified protein derivative (PPD) reaction greater than 20 mm in duration. Oral administration of isoniazid 300 mg/d was started and four days later she was admitted to the hospital for confusion, lethargy, and focal seizures that began 24 hours after initiation of therapy. All medications were discontinued with the exception of oral pyridoxine 50 mg/d. Dialysis was withheld to determine if the seizures were medication induced rather than uremia related. Seizures and mental status changes were reversed with pyridoxine. Dialysis was restarted after the symptoms resolved. CONCLUSIONS Preventive therapy against tuberculosis with isoniazid should be stressed throughout the medical community. Isoniazid has adverse effects including hepatitis and peripheral neuropathy (common) and convulsions (rare). Our experience suggests that additional supplementation with pyridoxine 50 mg/d should be given routinely to prevent adverse reactions in uremic patients.
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Affiliation(s)
- D S Asnis
- Department of Internal Medicine, Flushing Hospital Medical Center, NY 11355
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Bhat JG, Kerpen HO, Murthy PS, Horowitz LJ, Valderrama E. Angioimmunoblastic lymphadenopathy, Bence Jones Proteinuria, and acute renal failure. Arch Intern Med 1981; 141:1373-1374. [PMID: 7271411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Bhat JG, Gombos EA, Baldwin DS. Depressed leukocyte migration inhibition in response to streptococcal antigens in poststreptococcal glomerulonephritis. Clin Immunol Immunopathol 1980; 16:48-56. [PMID: 6991180 DOI: 10.1016/0090-1229(80)90165-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Kerpen HO, Bhat JG, Kantor R, Gauthier B, Rai KR, Schacht RG, Baldwin DS. Lymphocyte subpopulations in minimal change nephrotic syndrome. Clin Immunol Immunopathol 1979; 14:130-6. [PMID: 314370 DOI: 10.1016/0090-1229(79)90133-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Kerpen HO, Bhat JG, Feiner HD, Baldwin DS. Membranes nephropathy associated with renal cell carcinoma. Evidence against a role of renal tubular or tumor antibodies in pathogenesis. Am J Med 1978; 64:863-7. [PMID: 645750 DOI: 10.1016/0002-9343(78)90529-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A patient with the nephrotic syndrome due to membranous nephropathy was found to have renal cell carcinoma. Since membranous nephropathy in patients with malignancies has been attributed to a tumor antigen-antibody complex form of glomerulonephritis, an attempt was made to implicate tumor antigens and/or renal tubular epithelial antigens in the pathogenesis of membranous nephropathy in our patient with renal cell carcinoma. Antibodies directed against tumor antigens and renal tubular antigens and renal tubular eipthelial antigens were sought in his serum and in eluates of his glomeruli; no such antibodies were found. The concurrence of the two renal lesions may have been fortuitous in this patient. However, their association temporally suggests that they were related, and our immunologic studies demonstrate that tumor antigen-antibody complexes are not invariably involved in the pathogenesis of malignancy-associated membranous nephropathy.
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Bhat JG, Gombos EA, Baldwin DS. Depressed cellular immune response to streptococcal antigens in poststreptococcal glomerulonephritis. Clin Immunol Immunopathol 1977; 7:230-9. [PMID: 862253 DOI: 10.1016/0090-1229(77)90050-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
One hundred fifty of 490 patients undergoing open heart surgery had renal failure attributable to cardiopulmonary bypass. In 69, serum creatinine concentrations did not exceed 2 mg/dl and returned to normal by the fourth postoperative day. In 60 patients, serum creatinine attained levels between 2 and 5 mg/dl, oliguria did not develop, and recovery of renal function occurred within 4 to 37 days. Serum creatinine increased to levels exceeding 5 mg/dl in 21 patients, 11 of whom were oliguric. Despite dialysis, 14 of these patients died from cardiac causes or sepsis. Prolonged cardiopulmonary bypass time, hypotension, oliguria, low output syndrome, and hemoglobinemia during open heart surgery correlated with the development of renal failure postoperatively. Although severe renal failure was an uncommon complication after open heart surgery, its occurrence carried a grave prognosis.
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Engelman RM, Bhat JG, Glassman E, Spencer FC, Boyd AD, Reed GE, Isom OW, Pasternack BS. The influence of diabetes and hypertension on the results of coronary revascularization. Am J Med Sci 1976; 271:4-12. [PMID: 1258897 DOI: 10.1097/00000441-197601000-00001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The effects of diabetes and hypertension on the early postoperative course of patients undergoing coronary revascularization were studied by reviewing the records of 177 patients operated upon in 1972. There were 121 nondiabetic, nonhypertensive; 32 hypertensive; ten diabetic; and 14 diabetic-hypertensive patients. The incidence of postoperative low cardiac output, renal insufficiency and arrhythmia was significantly higher in the hypertensive patient. Operative mortality ranged from 0 in diabetic patients, to 0.8 per cent in nondiabetic, nonhypertensives, to 7.1 per cent in diabetic-hypertensives and 12.5 per cent in hypertensive patients, suggesting an increased risk for the hypertensive patient. The one- to two-year follow-up results documented symptomatic improvement in 90.7 per cent of patients with little adverse effect apparent from diabetes or hypertension. Pre- and postoperative coronary angiography was carried out in 103 patients between 1968 and 1973 with a mean elapsed time between operation and postoperative angiogram of 9.3 months. The progression of atherosclerosis was graded on a 0-4 basis in both grafted and ungrafted coronary arteries. While hypertension appeared to contribute to disease progression, the incidence of vein graft and internal mammary artery bypass occlusion was not significantly affected by either diabetes or hypertension. This study has shown that while hypertension contributes to increased morbidity and mortality in the early postoperative period and an increased rate of progression of atherosclerosis, neither diabetes nor hypertension appeared to influence the one- to two-year results of coronary revascularization.
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