Are you going to start p4p/p4lp?

[QUOTE=Bill Peckham;11013]I think I’ll start a P4P/P4LP thread when I get back. The trip went well, I am between flights in Denver (6AM departure from Orlando) all my treatments on the System One were uneventfull , I should be at my desk by 1PM west coast time.

Spontanious trips are dancing in my head - skiing at Whistler in February, a bare bones boat charter in the San Juans in May, these trips seemed out of reach and now they seen very doable. Not that I have given up incenter travel - I’ll try for incenter nocturnal for Christmas in Chicago and then New Years in Santiago? Iguazu Falls? Panama? I do love to travel.[/QUOTE]

Hey Bill
If you start the this ,will you talk on payment types? Methiod 1 vs 2. I want to know if 2 will free me up to go to a center near by, if they still have a home program? I read that 2 you the consumer get your supplies from company and help on machine problems? You just need a doctor who will work with you and a center for back up? But it the center that trained you is to far to travel to then you can go center where your doctor is at, is this wrong?
bobeleanor

I’m not Bill but I can give you some insight into your questions. There isn’t a complete right or wrong in any dialysis question. What you can or cannot due will depend entirely on what the unit that trains you is willing to agree with and what the nephrologist in charge of the home program is willing to agree too. How they make their decisions will come into play with what the state regulations are for home dialysis and how comfortable they feel with what you want to do. The equipment companies only sell to dialysis clinics and the technical support is furnished to you through the dialysis clinic.

How about if he becomes his own Medicare provider like George Harper did?

Hey Country Girl
How you doing?

In one of my other post I think I posted that come 1/11/07 I will head back to my old doctors. These people have know me for some 30 years.*This 1 or 2 payment seems a bit like mumbo jumbo. Like you said it seems like they is no real laws just rules. I don’t understand why a medical supply company(dialysis company) seems to have more power over the consumer than the doctor. Right now my doctor and I are talking and seem to understand one other. But the dialysis company seems to think that they can over rule the doctors orders. It’s like the dialysis company has the machine or (ball) and since they have the ball they make the rules and can over ride the doctors orders. Or the dialysis company will take the ball back. The problem I have with my doctor is that he is a company doctor, who is in a group and the newest member.

It seems like most folks in dialysis both home and in center are very happy with the status quo. The who are making the rules seem to want to treat consumers on dialysis like we can’t follow tx, we can’t do anything without the dialysis company. Like we are disabled. ( some folks are and in need of center care or help at home) I’ve been in dialysis a year now and I find very easy. Look, the consumer is going to follow the what best for the consumer or the consumer will not. The consumer that follows the tx’s, foods, etc will do it for themselves not for the dialysis company. and please don’t take this as if I’m upset or angry. I just want some with out ties to dialysis to give the break down.

I also looked up the $ on dialysis companies stocks. All of them seem to be doing very well. And I don’t have any problem with that that is name of the game keeping your shareholders happy.
bobeleanor

The reason the clinics have power over the doctors is because the clinic doesn’t have to take you as a patient unless they want too and the Dr. doesn’t have any control over that unless he owns the clinic.

Hey Country Girl

I’m not going into this , I just hope you really don’t think that a company has that much power.

My hope was to get people who the payment plans 1 and 2 could talk in lay mans terms as to what they really mean. And have Bill open things since he seems to be on front line of these questions and answer.
bobeleanor

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.

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.

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=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

Hi Folks

I’m not sure where the new congress will go??? Right now this country has so many issues. And I’m not convince that this congress will be any different than the last 10 congresses. (what has congress done for us lately)

As for dialysis it seems like they (cms, esrd, the companies) just like other areas of life make you work hard to get the needed information. Or changeing payment plans. Maybe in working so hard for change ,if you get to where you want to be you have a feeling of satisfaction?
bobeleanor
PS thanks once more to all the people who run this borad and to the people who are home doing what needs to be done.

I don’t think the companies or for that matter the non-profits have that much power. It’s just a fact.

Hi Country Girl

Sorry if I said anything that out of line.

bobeleanor

Bobeleanor you didn’t say anything out of line.