For the past few weeks I have been attempting to get a response to some questions I posted on the Optimal-Health Dialysis Care forum from one of the posters and the Editor of Renalweb. There has been no response from either so I thought I would put it out here to see if anyone can enlighten me.
My posting was a resposne to a nurse who said her husband was on HHD and benefited from more frequent treatments, longer treatment times and patient-centered care.
Here were my questions:
Patient centered care, a few extra treatments and longer dialysis times in your experience made a big difference. I can see where those can be very positive but I can also see where they may be more readily implemented into HHD than into a traditional chronic dialysis where the vast majority of patients receive treatment.
Since patient centered care can be a rather broad concept, what specific aspects did you find most beneficial and how can we translate them into a chronic facility setting?
How do we implement extra treatments and longer treatment times into traditional chronic facilities? Extra treatments and longer treatment times do not come without extra costs? With the realities of the current financial situation and the fact that ESRD patients make up less than one percent of the Medicare population but use over six percent of the Medicare budget, how do we deal with those financial issues?
Trying to follow up on my questions from three weeks ago.
Dez, just wondering if you had any specific information you can share with us on "patient centered care"
Editor, I know you are an advocate of longer and more frequent treatments so I was wondering if you could take a shot at my funding question (see above)?
Or are these questions the proverbial elephant in the room?
I'll take a quick stab at answering your questions. I do want to say upfront, I'm an equipment tech, not a RN or mgnt... just on the outside looking in.
From what I've read and understand, the current 'optimal' dialysis is primarily based on a Kt/V value that originally was thought to be a good goal, or at least one that was easily measured. If this goal was met, Medicare would reimburse at a given rate to the provider. What is and has become clear is a simple Kt/V value is not enough to define 'optimal'. And in the long run isn't beneficial for the pt. I'm not saying that this is all dialysis providers look at, but it's one of the main reimbursement markers, that they get paid by. If we used truly pt centered markers or goals, we would be doing longer, more frequent treatments... and would be reimbursed accourdingly. Plenly of literature shows the benefits of longer/ more frequent treatments and I think what the editor is trying to accomplish is getting the word out to people in positions who can make/push for changes in the reimbursement structure. Maybe it's a pipe dream, but it's a worthy goal.
You make a good point about 'extra costs' that I don't think anyone has a good answer to. Even if the reimbursement structure does change, the money still has to come from somewhere.
Sorry, don't know if this helps, but thought I'd give my two cents.
have u looked into noctural dialysis since the treatment would be 8hrs that could take care of the longer treatment i to am just an equipment tech i think u should consult with a social worker or your md
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