[QUOTE=Bill Peckham;11100]I wish I could think/write/discuss this stuff all the time but my day to day commitments have a way of keeping me busy. Maybe I should start a Dialyzor Institute: a CKD5 think tank. That way this thinking/writing/discussing business could be my vocation instead of simply an avocation.
Thanks Bill any time you post I read and follow . Your a role model for the todays dialyzors
It is hard for me to see all the ways the election results changed what is possible and what is likely when thinking about federal dialysis funding but I think if anything some kind of Pay for Performance has become more likely. Senator Baucus introduced a P4P bill in the last Congress and there does seem to be a deal to be made - pay for P4P with the annual update.
The issue will be what measures do you reward - to get an idea of what sort of measures could be used check out what is reported on a Dialysis Facility Report. It would be great if there was some measure, some number that once determined we’d know for sure how good or meritorious, a person’s care really is but there is nothing like that, all we have are kt/v, hgb, k … all the things reported on your monthly labs. But is it really fair to financially reward/punish a dialysis unit based on a dialyzor’s control of phosphorus?
The dialyzor has far more control over phosphorus levels then either the Nephrologist or the unit. The dialyzor is in control of their diet and remembering to take their binders but phosphorus control is important and it would be in Medicare’s interest to see better phosphorus control among their CKD5 beneficiaries. This is where I think Pay Less for Performance could help.
We all (society) will benefit if dialyzors try harder to accommodate their particular CKD5 requirements as measured by known mortality/hospitalization indicators e.g. albumin, phosphorus and if financial incentives work for doctors and clinic administrators then they should work for any human, even those who need dialysis.
As far as Method I v. Method II - I don’t think anyone can answer how Method II would work in a specific situation which is the problem. I would be interested in imagining how the system should work but to do that we should understand where we are.
On this it seems like your right. That it could boil down to the dialyzor and how hard that person is willing to work at finding a good doctor to work with him or her.
Right now dialysis is getting more structured in the US for largely business reasons, standardization saves money. As care delivery becomes ridged I think it becomes more important to offer people a viable opt out/do it yourself option. Right now I don’t know how viable Method II is for someone wanting high dose home hemodialysis. I’d like to know more about how Method II works in practice.[/QUOTE]
Thanks tons Bill,
bobeleanor