To Guest: You just pointed out the problem. In our capitalist system, there will not be more dialysis until there is more money. As it is the companies have cut everything back to nothing and depend on the dedication of staff to keep patients going. Staff who care try to make up for what has been cut until they burn out and leave. We all need to put our votes where our hearts are and begin to take care of each other with our tax money instead of Merrill-Lynch.
Lenore, what the heck do you think the ESRD program is? Capitalism? You have been listening to too much Fox news. Take a look at healthcare spending vs. results under our system and compare it to all the other industrialized nations (all of which are socialized). How can removing 15% of the total resources (profit) right off the top be efficient? Decisions get made for money, not for patient care results.
Then again, maybe you are right. Look at what capitalism has done for our banking, housing, and credit industries. A real success story there.
I have been doing nocturnal dialysis, for 8 years now, in center. Nocturnal programs are on the rise in units now. There are ways you can look at the benefits from it. Better quality of life, less hospitalizations. And I have been a patient for 34 years, since age 11. I have returned to the work place. I accredit my longevity to the 8 hour treatments 3 nights a week. Kt/v runs 3.65 up to 3.9. For me it considered optimal dialysis, not just adequate.To answer guest, yes it does, although, i am sure there are cuts somewhere.
Where did you get the information that Medicare pays more for nocturnal or extended treatments? A facility has to jump through hoops to get paid for more than 13 treatments/month, Medicare dosn't pay more for "non-standard" treatments.
DISCLAIMER : My opinions and views are mine and may not be the same as my employer.
Posts: 1799 | Location: Baltimore, MD USA | Registered: 24 October 2001
No, your right Chuck, no it doesn't pay more. My apologies, the units recieve the same amount of money for patients running nocturnal as a patient running conventional treatments. The cost most likely is 'eaten' by the providers. But you can look at a lot of benefits to the system. The patients are getting a 'better quality of life'. Less hospitalizations. Return to work. Its considered an optimal treatment, not an adequate treatment. In the long run does it benefit everyone all around? Financially and physically. The staffing requirements are not as strict as during the conventional.
I agree that the benefits are many and any decent society would not put profits over quality of life of the critically ill. Too bad we are not living in one of those societies. Nocturnal, whether home or Incenter, seems to put more strain on the local staff in order to minimize the money lost for wall street. If we did the "right thing", all patients would get daily treatmennts if they wished and actually feel pretty decent again. Staff woud feel better about their careers, and I bet the big wigs would still manage to make a little money, just not enough.
Generally nocturnal incenter can pay its way because you can safely operate with a higher patient/staff ratios and if you consider only the marginal costs. So long as revenue exceeds the marginal costs and contributes something towards fixed costs it is an economic winner.
Fixed costs should already be covered by day time operations so you can rationalize not assigning a quarter portion of fixed costs to the nocturnal shift (they're already covered).
Probably the hardest part is staffing the shift and getting enough patients to select the modality. You'd have to have at least two staff so you'd need at least 8 patients for it to even begin to work.
Posts: 2 | Location: Seattle, Washington | Registered: 22 January 2009