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  1. #21
    Country Girl Guest

    Default Independence

    Traveler, George Harper was successful in becoming a DME (Durable Medical Equipment Supplier.

    I think this is how it works.

    You establish a business mine would be called "Dialysis Consultant" then I apply to Medicare for a DME #.

    Medicare approves the paperwork and gives me my DME #.

    My DME company buys a dialysis machine.

    My nephrologist writes me a prescription for the dialysis machine and supplies.

    My DME company fills the prescription.

    I now have the dialysis machine for treatments.

    My DME company bills Medicare for my machine.

    None of this would change the way I have been being treated by my nephrologist.

    You may have to be a Method II patient, I'm not sure.

    Don't take this as I know what I am talking about but this is how I see it working.

  2. #22
    Join Date
    02-13-06
    Posts
    541

    Default

    Hi Folks

    You all seem to be on the right track........

    Best Of Luck

    Bobeleanor

  3. #23
    Join Date
    06-25-04
    Location
    Kansas
    Posts
    1,782

    Default

    You do have to be a Method II patient to contract with a DME. I don't think this is as "simple" as people think or more people would do it.
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

  4. #24
    Country Girl Guest

    Default Simple

    I don't know of anyone who said they thought it was simple. Even though I have laid out the steps as to how I think it would work, I didn't mean to imply it was simple. I don't know. I'd have to do a lot more investigating into how DME's and the machine suppliers set up agreements. Is it just for the machine or machine and service too? Then you have to have a nephrologist who really trusted you, and thought that what you wanted to achieve by doing it was important enough to work with you. Obviously, George's nephrologist didn't want him to have to give up his lifestyle either. Then you'd have to learn the proper way to bill medicare. George didn't set out doing this because he wanted too, he was forced into a situation of give up his love of travel and lifestyle or tackle the difficult. I wouldn't even consider this unless someone was going to pull our ability of doing home hemo out from underneath us. Thank God more programs are being started and not closing this gives some comfort. However, it would also be comforting to understand this just in-case the situation was such that you really felt it was your only option to live the life you want or the dialysis prescription you needed. Maybe being prepared a head of time of knowing what you had to do would make the difficult a little less hard to confront when your left with no other options. I don't think anyone here is even up to the challenge of learning how it would work much less doing it.

    Marty

  5. #25
    Join Date
    07-02-04
    Location
    Seattle, WA
    Posts
    1,153

    Default

    Quote Originally Posted by Country Girl View Post
    Thank God more programs are being started and not closing this gives some comfort. However, it would also be comforting to understand this just in-case the situation was such that you really felt it was your only option to live the life you want or the dialysis prescription you needed. Maybe being prepared a head of time of knowing what you had to do would make the difficult a little less hard to confront when your left with no other options.
    I agree with you Marty; my thinking has been around the money and what role CMS should play to ensure that Method II is viable.

    For instance why isnt Method II case mix adjusted? Marty do you know what your Dads case mix adjusted composite rate is currently? I bet his is about $150 so 13 x $150 - just for the sake of parity the Method II allowable rate should be around $2,000. I think Beth put her finger on it - CMS would like Method II to die on the vine. Sounds like a job for advocacy.

    Quote Originally Posted by Country Girl View Post
    I don't think anyone here is even up to the challenge of learning how it would work much less doing it.
    I have to disagree with you here, where is this coming from? It should be spelled out more clearly but if we had to wed learn while doing, as always.
    [FONT=Times New Roman]
    [/FONT][FONT=Times New Roman]Dialysis from the sharp end of the needle
    tracking industry news and trends, in advocacy, reimbursement, politics and the provision of dialysis
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    [/FONT][FONT=Times New Roman]2days on/1day off, 30 Liters @ 250Qb ~ 8 hour per treatment FF28[/FONT][FONT=Times New Roman]
    Incenter Hemodialysis: 1990 - 2001
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  6. #26
    Country Girl Guest

    Default

    Bill, If we had too we would learn. I just meant that without having the need, I don't think were facing the challenge of getting all the information required to understand it completely. I know I am being lazy. I really would need to connect with someone who does actual billing to ask for the details. I'd need to talk with DME suppliers and I need to find out just how much a machine would cost.

    I don't understand how anyone knows method II isn't viable. I did read under method II CMS would pay 1490.00 per month for the dialysis machine and supplies. I don't have any proof this isn't viable. (I don't know if this meant the centers couldn't charge for other things if that's the case it may not be viable.) But if this is what they can charge for the machine and machine supplies and separately bill for the treatments then I think it is viable). My guess is the reason Method II is under utilized is because Method I pays more and once the center has paid for the cost of the machine, the machine is then generating a profit for them. If they used Method II the DME would see the profit of the machine once it was paid for.

    I also thought Patients had a choice if they wanted to be Method I or Method II. If they do, we certainly don't get enough information to make an informed decision or at least I didn't. Unless I just wasn't listening.

    These thoughts come from just things that have been said to me that I have made opinions from and my opinions could be right or wrong.

  7. #27
    Join Date
    06-25-04
    Location
    Kansas
    Posts
    1,782

    Default

    Right now, most of the services provided by a dialysis clinic are under a bundled rate called the composite rate. At this point drugs are separately billable. Even certain lab tests are covered under the composite rate.

    A dialysis facility cannot be a Method II provider. I've spoken to people that work in CMS survey and certification section about how about Method II is regulated. As I recall, it is regulated under the DME section of CMS, not the ESRD section. However, the dialysis facility that the DME must have an agreement with to provide support services and backup dialysis is regulated by the ESRD regulations. It may be that having two different sections of CMS that are charged with assuring quality of care increases the hassle factor. I talked with a Method II DME in GA nearly a year ago. It had a contract with a dialysis provider to provide staff-assisted home dialysis. When the dialysis provider was sold and the DME tried to establish a contract with the new provider, the new provider only established a short-term contract to transition the patients. I haven't talked with the DME since then so I don't know if the company was able to prove that it was providing a valuable service or if the large dialysis provider made those patients previously receiving staff-assisted home hemo come in-center.

    After a Method I patient has been on dialysis a couple of years, the dialysis provider with a clinic large enough to warrant having a full-time nurse in home training can start to make more than it is spending every month for dialysis and water treatment equipment, dialysis and all ancillary supplies supplies, labor costs for a home training nurse, part of the salary of the dietitian and social worker, costs for labs that are not separately billable, items like dialysis chairs, blood pressure monitoring equipment, etc. Under Method II, the dialysis facility only gets payment for support services. I cannot figure out how the clinic could ever recoup the cost of training at reimbursement of $1490 per month.
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

  8. #28
    Country Girl Guest

    Default Confused

    When I was frantically searching for a home hemo program, and was writing every government official I got the name of complaining because home hemo wasn't available, I remember distinctly getting an e-mail from either the network or someone in the government in CMS telling me point blank they encouraged home hemo and that they paid so much per hour for the cost of home training nurses. Maybe this amount was thrown into the support payment I don't know but they seemed to think they were taking care of it.

    I think in order to base a judgement on whether or not the payment is sufficient, I would really have to dig into things. I have experienced some things that would knock your socks off. Like seeing a Medicare payment for 850.00 for a medication it took less than 1/2 hr. to administer, plus the usual gauze pads, alcohol wipes, masks, gloves and medicine. The same medication purchased at a pharmacy and done at home $50.00.

    I thought the 1490 a month was the amount the DME could bill for. I didn't know this was the support payment under method II.

  9. #29
    Country Girl Guest

    Default Solving the problem

    I think dialysis patients should advocate for CMS to provide a clause that states dialysis patients have the right to choose the modality of their choice and the machine of the choice. Maybe there shouldn't be so many restrictions on what a home programs has to be. I can see insisting on a Training Nurse but after that they should be able to handle their home patients as they need. If the control, of patients, weren't still totally in the hands of the centers, we wouldn't have to be looking for away around the current systems. All patients should have the priviledge of choosing their machine and modality. After all the patients know what they can and want to do. In-center is great for some, home hemo for others, some need to do night time do to working conditions in the family, some prefer night time. Some prefer daytime and aren't comfortable sleeping on the machine. It's not like dialysis is a temporary condition. Patients live with this for years, so why aren't there needs taken more seriously.

    Marty

  10. #30
    Join Date
    06-25-04
    Location
    Kansas
    Posts
    1,782

    Default

    Quote Originally Posted by Beth Witten MSW ACSW View Post
    I cannot figure out how the clinic could ever recoup the cost of training at reimbursement of $1490 per month.
    Sorry I was typing this late at night after being in mentally draining meetings all day. My fingers were typing faster than my brain cells were working. The $1490 is what the DME is paid for home hemo. What I should have said is that when a patient is Method II, once the patient is home, the clinic only gets the support service fee which is $121.15 a month no matter how times the patient calls or comes to the clinic.

    The dialysis clinic that trains the patient gets the usual composite rate for each dialysis session plus $20 for up to 25 treatments. The nurse doing the training is using a machine, supplies, and utilities just like they do in-center. By regulation, the nurse in charge of home training must be an RN instead of a technician like many staff doing patient care for in-center patients. In addition, the nurse to patient ratio is much higher for home training patients - usually 1 to 1 vs. 4-6 to 1. Training sessions usually last 5 hours or more each training day. Therefore, the clinic is paid its usual rate for equipment, supplies and utilities but only a maximum of $500 ($20 x 25) for more qualified staff, a better nursing ratio for longer, and comprehensive training materials that the patient can use at the clinic and take home with him/her. The training rate should be one of the first targets for advocacy no matter whether the patient is Method I or II, in my opinion. I suspect this is a barrier to clinics offering home hemodialysis.
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

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