Can a doctor

Hi Folks

Beth talk on if a doctor wanted to write a script for iron so that a consumer could self dose after proper training. The doctor could do so if he wanted to take the risk. In the same thinking could a doctor write a script for a consumer to do his /her tx and just report to him? The flow and lab work could still go a dialysis company and the company could still bill for lab work and paper work? Everybody wins. The consumer just has to see the doctor, the dialysis still gets a cut of action.

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                             Beth Witten MSW ACSW LSCSW

Medical Education Institute, Inc.
As some of you have found, doctors can (and some do) prescribe IV iron for patient self-administration. Medicare Part B will only pay for IV iron given in a dialysis clinic, not at home. If a doctor is willing to write a prescription for a patient to take it at home (and accept the liability if the patient has a problem with it which is low risk from what I understand) AND the patient has been trained how to self-administer to limit the risks of adverse events AND the patient can afford to pay for the IV iron or has insurance that will pay for it other than Medicare, then he/she could purchase it at the pharmacy and self-administer.

So far as Medicare coverage is concerned, currently IV iron is excluded from Medicare Part D coverage in the standard Part D plan because it is considered a vitamin or mineral and the law that created Part D excluded these drugs. The renal community has been advocating for coverage of renal vitamins, iron, etc. to be covered as essential for the health of people with kidney disease. I have not heard that this has happened yet, but hopefully IV iron companies and renal organizations will be successful in getting these classes of drugs covered just like prenatal vitamins are covered for pregnant women. I suspect it wouldn’t hurt to have patients advocating with their elected officials for this legislative change.

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I think it could be done but I don’t think the world of dialysis is anywhere near excepting we could become even more independent. Remember we haven’t even gotten all doctors to accept they don’t have to be afraid about patients doing their own home treatments. I do think a doctor could write you a script for a dialysis machine. I also think he could order your labs done get the results himself and tell you what you needed. The question is who would be responsible for “backup” treatments. Now that NxStage is out backup wouldn’t be as much of a problem in the area of machines but if you were ill and needed to go in-center where would the backup be? Also without a lot of extra work I don’t know who would put up the supplies for you 2x2’s, alchohol prep pads etc. I think you would also need to have someone on call in the event you had a problem during treatment. I know when patients who first go home on the Fresenius the nurse gets called alot if by chance air gets in the system or a transducer needs changed or if a patient just can’t figured out what is causing their alarm. I don’t think you could get a center to support you in just the time of need. I know when we switched to home hemo our nephrologist agreed to follow us at home because we were so far from the home dialysis center. But the dialysis center we were in REFUSED to let us come in for a treatment, should we have a problem on home hemo. Therefore I had to change to another nephrologist closer to home and another center backed us at home. I don’t think the idea is impossible, but I think were ahead of the times.

Hi is that you Marty?

Back up at hosiptal, my center is only open monday to saturday 6 to6. And we all know back up happens during normal working hours LoL
What do you mean by 2x2 etc? I have all my things here. Baxter ships my 2x2 saline,gloves Etc. Nxstage ships me soultion and cartridges. All of this is call in by me and shiped UPS or other carrier to me, not to company.
If I get sick other than dialysis sick I would go to doctor or get to hospital.

I will be going back to doctors that knew me in the 70’s and 80’s . My medical history is too much for these people. They don’t care any thing but kidney/dialysis anyway. I have to self cath still, and still get infections and the implants I have that control my urine still go bad. I need a doctor who I have trust in to handle and can control all parts of me. Plus Marty, for me these doctors know my mind. For the outside part is a cake walk. It is in my head that these doctor know that is most important. They first time they saw me was in 73 and they follow me till 2000. When I got full of myself and wanted to break away. Oh well we learn as we get older.
bobeleanor

Yes, Country Girl is me Marty. When I use the name Marty1 as I used too; I got a message saying I had to have a least 8 characters. So until my registration is approved as Marty Ann. I have been using Country Girl. Well, Bob you have informed me of another thing I didn’t know. I didn’t know gloves etc. were shipped by Baxter. We have to pick ours up at our once a month clinic visit. When I spoke of having a backup, I was thinking of a scenario where maybe you broke a leg or something and it wasn’t that you would need medical attention as you many not physically at 1st be able to set
up the machine. I don’t think this would be near the problem with NxStage as it would be with Fresenius. Have your doctors given you any input into what they think would be do able. Unless every problem is addressed separately it’s hard to know what can be accomplished. It’s hard to get to the bottom of issues to find out if they are for safety, for convenience or for payment reasons. Any patients I have heard of that have stepped out of the box have had to put alot of effort into getting where they wanted to be and they all had very very supportive nephrologist.