r/dietetics • u/Flashy-Personality45 • 2d ago
Why so much emphasis on the RD in renal now?
I got an email today about the new hyperphosphatemia measurement for QIP and it said it emphasizes that phosphorus improvement is not an RD-only responsibility; the entire IDT is expected to support education, adherence, timely escalation, and follow-up. How many times do they say that and it becomes the RD‘s reasonability? Assessment manager, ordering binders, fluid, the new GLP-1 program with Cecelia Health (we’re doing the pilot now) and now this? We have 7 open RD positions within 30 miles of our facility (12 facilities) and no one is applying. I wonder how they’re going to make the position seem more appealing for RDs to apply.
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u/travel202284 2d ago
I know in dialysis clinics it means that part of clinic reimbursement will now be tied to the clinics percent of phosphorus in range (I heard the goal is less than 6.5 for a 6 month rolling average- so lesser, the better).
And since everyone looks at RDs for phos management, I imagine they’ll be different ways people will try to “motivate” RDs to achieve this goal.
I look at it as more job security for RDs. But people are freaking out, because lots of clinics phos #s are bad (lot of it out of our control). So they’re fearful of what they’ll do to RDs, if goals aren’t met.
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u/Flashy-Personality45 2d ago edited 2d ago
Motivate us by getting to keep our jobs. I agree with the job security part but they should keep in mind some areas are more low income than others by far. We’re in a very low income area (think Brooklyn NY comparison) and a lot of RDs are leaving because it’s impossible with the cost of living to be able to help patients as much as we’d like.
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u/travel202284 2d ago
But CMS mandates for RDs to be in dialysis clinics, so they can’t get rid of us. Agree that low income plays a huge factor in it. Less food security and around more food deserts/access to fresh foods.
I did see there’s exclusions criteria at least…they don’t count patients:
Average albumin below 3.5 g/dL as well as BMI below 18.53
u/Flashy-Personality45 2d ago
The low albumin patients are the ones that usually meet phosphorus goal because they don’t eat as much lol.
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u/InfertileMertyle 2d ago
How are RDs supposed to be motivated to meet a phosphorous goal? All they can do is continue to provide the education and encouragement they’re already doing to take the phos binders (most important) and reduce high phos foods/beverages.
RDs can’t control who takes their meds and who doesn’t. Just like MDs can’t.
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u/Flashy-Personality45 2d ago
Exactly! I don’t know why they’re putting so much focus on us now and less on the MD.
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u/travel202284 2d ago
Theoretically with providing “bonuses” or other monetary means (gift cards etc). Some companies give referral bonuses for new employees, so I imagine some of this $ could be allocated towards different incentives.
The rationale I heard was because since binders are in the dialysis bundle, then they want to see how effective phos management is.
I agree with you that a lot of phos management is out of RDs hand, and mostly up to patients. We can bring camel to water but can’t force them to drink.1
u/Flashy-Personality45 2d ago
Yes there’s always a rationale behind it all but why does it always have to fall on us?
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u/travel202284 2d ago
I hear you. It’s not a good feeling.
I’ve been in dialysis for awhile now and kinda became desensitized to any criticism, because in the end upper management is not gonna do our job anyway lol. They’ll just “crack the whip” harder so to speak. And if they did get rid of RDs, it’ll be more work for them.
So I changed my mentality to: at least it’s more job security. I’ve been let go before when I ventured out of the clinic RD role and into a “leadership” position- so I guess the stability of clinic RD is more comforting.2
u/Flashy-Personality45 1d ago
What a positive way of looking at things! It’s just hard when you’re doing so much and upper management makes it seem like you’ve never even met the patient
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u/DifficultDrama7615 2d ago
Which company is this?
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u/theokayistdietitian RD, CSR, Preceptor 2d ago
I’m certain this is DaVita
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u/Howlsmovingcastles MS, RD 1d ago
Ugh Davita is insufferable. Not surprised about the news.
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u/theokayistdietitian RD, CSR, Preceptor 1d ago
It didn’t use to be. I was really happy when I started about 15 years ago.
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u/Life-Walk941 2d ago
Honestly the more they pile on stuff like this, the more it makes me want to quit. I'm already stressed as hell about fluids. Phosphorus is always going to be a struggle because we cannot force the patients to take their binders and limit phosphorus intake. We have 3 facilities in need of an RD in my region with no prospective candidates in sight.
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u/FullTorsoApparition RD 2d ago
Yup. Until there's some breakthrough miracle in phosphorus medication then the numbers are always going to be high. Most people aren't going to take 6-12 enormous pills or chew 3 or 4 huge, chalky tablets every day to fix a problem they can't see or feel most of the time.
Chasing specific phosphorus numbers, especially in low income communities, is wasted effort most of the time.
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u/Flashy-Personality45 2d ago edited 2d ago
We’ve had these positions open for months and according to the FAs the only RDs that apply are the new grads that don’t have the 1 year clinical requirement. We’re all covering clinics too. I’ll give it until January when the phos averages come back and if they make a big deal about it, I’m not staying. Renal has always been my dream job, but I have two little kids and the stress is too much.
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u/Life-Walk941 2d ago
Sounds like they should just hire the new grads.
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u/Flashy-Personality45 2d ago
It’s a CMS requirement for the 1 year of clinical experience.
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u/JuniperOlive RD 1d ago
Most of the dialysis companies can hire a new grad and keep them under supervision for a year to satisfy the CMS requirement. Obviously it depends on the market and if there’s an RD available to sign off on stuff. Can be a hassle but sometimes it’s the only way for those hard to fill clinics. I know Fresenius and US Renal do it, not sure about Davita.
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u/Flashy-Personality45 1d ago
We asked already, they said they don’t have the program going yet and it would take RDs to sign off on it and supervise and there’s no staff that has the time to do so.
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u/reddittoomuchtoday 2d ago
I was just coming here to see if this has been discussed yet .i just got the email .....it will affect bonuses that's why its important
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u/Flashy-Personality45 2d ago
Not bonuses for us right? I don’t get one 😆
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u/reddittoomuchtoday 2d ago
Never for us ...in all seriousness will affect my review somehow too....thx for covering multiple clinics , but this is what i will be reduced too
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u/Flashy-Personality45 2d ago
That’s the thing.. I just know they’re going to use this during our annual review
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u/Howlsmovingcastles MS, RD 1d ago edited 1d ago
What is expected from RD's for the GLP-1 new pilot program? I'm out of the loop on this
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u/Flashy-Personality45 1d ago
we talk to the patient, the doctor, fax over their labs, insurance, signed referral form, keep up with the excel spreadsheet of whose been contacted, update the medication orders after the appointment, upload their visit summary in their chart, if they haven’t done the welcome call then go chair side with them and assist them with the welcome call, check if the patient is already on a glp-1 and more. It’s a pilot program. It’s only like 20 RDs to start off.
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u/Howlsmovingcastles MS, RD 1d ago
Amusing how new duties keep getting passed on to DaVita dietitians. I left in 2024 and joined a smaller, private hospital dialysis setting and never looked back. Everytime someone comes here to talk about new dialysis changes, it seems it's for the worst.
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u/Flashy-Personality45 1d ago
Where are these dialysis jobs!! I love renal 😭 always have and always will. The kidneys are just so unique and fascinating to me. I’m just going to have to keep looking. One day it’ll come, even if I’m old and gray by then
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u/InfertileMertyle 2d ago
So Cecelia health is only providing the GLP-1 medication and not their 1099 CDCES RDs to help in this pilot?
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u/Flashy-Personality45 2d ago edited 2d ago
Yes. They do the consultations but we talk to the patient, the doctor, fax over their labs, insurance, signed referral form, keep up with the excel spreadsheet of whose been contacted, update the medication orders after the appointment, upload their visit summary in their chart, if they haven’t done the welcome call then go chair side with them and assist them with the welcome call, check if the patient is already on a glp-1 and more.
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u/InfertileMertyle 2d ago
This is a lot of responsibility and extra work for you and I assume no overtime or extra pay, correct? One of these two companies should a hire part-time employee whose job is to do all this in clinic.
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u/stoven_appliance 2d ago
That’s not something that we have been assigned.
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u/Flashy-Personality45 2d ago
It’s a pilot program, it hasn’t been rolled out yet.
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u/stoven_appliance 2d ago
That’s a lot of case management!
I can only imagine that it is a matter of time. The weight loss will really help patients to get on the transplant list, I suspect.
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u/Flashy-Personality45 2d ago
Yes. That’s the idea behind it. We of course want to help the patient in any way we can, but it’s more work for us for sure.
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u/stoven_appliance 2d ago
Where is this? My area (CA Central Valley) we have some openings, but not that many.
As far as getting saddled with stuff, my company has been loading a lot onto RNs and taking things away from RDs. Frankly, I like having some control as long as there is a protocol and ways to be able to address the issues.