Can we tallk about?

Hi Folks

Beth and Dori

Has it been talked about already not in center issues, but the way centers are set up . I saw Bill film on home hemo, and looked up NKC. That group looks like a model group. I was wondering about the way centers are set up. And Bill you are a big fan of the center. and it looks and sounds at least from what I seen on net that you should. I’m not mad or anything at any one company but not being able to travel to really see #'s of centers. If you only are able to see one center or two due to any # of reasons it would be nice to hear how other centers are set up. I’ve only seen three Davita centers each was set up different . It too hard to get a real idea on a company if the view is blocked.

I let it up to folks who run this page to make the call on this subject
bobeleanor :smiley:

I just wrote this huge reply to this and lost it… ARGH! I will not retype it, but I will say. It is not about how a clinic is set up. They are mostly the same in that fashion. It is about the staff of the clinic. There is no real way to know what you are getting into with a clinic untill you are there. I have been to many clinics in my 13 years on dialysis. I was called non-compliant and still am probably called that. Not because I was out partying or not doing my dialysis or any of the things that come to mind when you hear non-compliant. I was called that because I asked questions and demanded answers. I demand to be treated with respect and as soon as a person crosses that line with me I want them out of the sight of my care. Even if that means I have to leave a clinic and go to a new one. I have had many horrible things happen to me at the hands of people who couldn’t care any less then they do. I have seen nightmare things happen to others at he hands of these same people. So I would not say that there is anything about the set-up of a clinic that is all that important. It is about the people working there. I have been to clinic with tiny uncomfortable waiting areas and the most terrific people working there. I have been to clinics with huge beautifull waiting areas complete with 200 gallon salt water aquariums and seen the worst staffing issues around. Also you can go by a clinics score card. They do all they can to skew those numbers. One time I found that if the clinic I was at lost me as a patient that they would have a terrible rating. My long time on dialysis and long term stay at their clinic made them real good on paper. Yet I was afraid for life at that point. Often they would hook us all up in the morning with only one nurse and two techs on the floor. That is against the law and very dangerous for our safety. So setup is only a cosmetic issue. What realy matters is people, are they ready to work with you? Do they care about you? those types of questions need to be answered. Dialysis is an industry that is overloaded with patients and you make no difference what so ever to the industry. You can die today and they will still be drawing fat checks and laughing all the way to the bank. Because you dieing just opens up another chair for someone else to take your place. I hate the industry more then the disease…
Sorry, hope this helps in someway, maybe I am totaly off topic,

I completely agree with you on that matter…its actually the type of people they have working there. They usually have the wrong people working for this industry and mostly under trained or not certified at all! Alot of the times when we patients try to correct things there face to face they’d give us the look and merely don’t want no one telling them how to do their job. Most of the time its bad management, simply put.

If you think that this problem can be solved? Maybe not, it will always be around till the patient open up their eyes and do something about it. I think that’s why clinics fail, all because of poor management…

Our center is excellent and it starts at the top and works it way down. The focus is first on patients then the rest falls into place. It’s also independent.

LSB, Your next to the last sentence was a million dollar sentence and I’m sure something that is shared with most dialysis patients.

Hi Folks

Thanks for input.

What I meant was like if you go into chain store or chain food eater , they is a look and feel to them. Even the ones that are not a part of big chain still have a feel and look to them. In my tiny trips to three centers all a part of the same company if the name was not the same you might not know they were of the same company. I know that the person who is in charge has a say in the way things are done ,but should one not get the same feeling , the only real change might be the people. In certain rules Etc Some centers let pts eat or drink while on machine while other certers will not let you eat or drink.

bobeleanor :?:

Bobealeanor, I think some good points were made on this thread about what’s really important for good care and good outcomes–and it isn’t how a center is set up or whether it “looks like” or “feels like” another center by the same company. Policies (e.g., can you eat? bring a cell phone or laptop? cannulate yourself? have a visitor?) are more important than appearances, and who the staff is and how they treat people is probably most important of all.

It’s not surprising that centers don’t “look alike” even if they’re from the same company because they weren’t all built at the same time or for that company. A good analogy is hotel chains. In some cases, like La Quinta, for example, every hotel in the chain is the same. They were all built to be La Quinta’s, and if you stay at one, you’ve stayed at them all. But Holiday Inns are not consistent–a particular hotel may have been a Ramada, an independent, or who knows what, and it may be very nice, or it may be a rundown pit that you wouldn’t want to trust your life to.

There has been a tremendous amount of buy-outs and consolidation in the dialysis industry over the past 20 years. So, Fresenius or DaVita, for example, may have just built a center last week–or may have bought one that was built in 1985 and hasn’t been updated since. They’re not “chains” in the sense that each site is consistent. It just doesn’t work that way.

Dori has a good point here. I was at one center that went through three diferent owners/companies while I was there. The building stayed the same and even the staff for the most part. It didn’t realy have much to do with what company owned the place.
As for rules like not being able to eat/drink on the machine. Is this realy a rule at any clinic? I have not seen such, but I guess people could be that crazy. That is a insane rule and no one should ever go to a clinic like that. I have to drink and eat while I am on the machine. If I don’t I feel horrible after my run. A rule like that would be a deal breaker for me.
As for self cannulation, buttonholes, etc…, these should be some of the guidelines to ask when inquiring about a new clinic. These techniques are on the forfront and are widely becoming the best way to care for yourself.
I have to go back to your post. You mention not being able to travel to see other clinics. It wouldn’t matter much if you could travel. Most clinics will not let you in the front door unless your are allready their patient. These clinics are very secure. They have a lot to worry about. I was at a clinic that often would have blood on the walls in the back hallway to the garage. I came in one day with a camera and was going to take pictures of it. They blocked access to the back hallway when they saw me with a camera. This leads us back to the problem with the industry. As long as it is an industry there will allways be bad practices. Untill it becomes about human live and not the all mighty dollar. It will be this way.

Hi Folks

Can you answer this then , if company has 1200 centers will each center keep all the $ that the center makes,or do they have to pay corp hq. some % of intake?

Also at the start I was in a center of 32 pt a shift, chairs and machines were and still are on top of one another, each chair /pt have a big I mean big tv. The noise level was that of a race track or a bar. I was so close to other pt I could not put wings up on chair , I could not even put my arm on the arm of chair without being in contact with other pt. The reason I brought this up the other two centers were much better. The center I just saw, if I had been in there Im still would want to come home but I would have taken more time. I’m still new and I’m finding it hard that there is no law that says each pt chair and machine should have space plus the small tv head phones. So if it means instead of 32 chairs they cut back to 28 or 25 chairs. So the set up is a key to pt care. If a pt feels safe and get answers that make sense , Dori ask yourself one question , What would you do about a center like the one I was in and you not the person calling the shots? And let me say I’ve been in contact with both the esrd4 and state dept of heallth. I just want to try and make sense of a medical set up that seems to not make sense. most of the people who worked in the center were just like most people working to make ends meets. The idea that came across was that there hands were tied. If they did not like it they could leave.
bobeleanor :smiley:

So far as the money is concerned, as far as I know, unless a dialysis clinic is privately owned, a corporation usually does the billing for it. I believe that the corporation collects the money for all the clinics and, with the administrator of the clinic, sets a budget for each clinic to operate within. Promotions and bonuses are awarded based on both how cost effectively clinics operate and how good their patient outcomes are.

So far as the dialysis environment is concerned, Medicare surveyors are supposed to survey dialysis clinics to make sure that they are in compliance with the Conditions for Coverage for Suppliers of End-Stage Renal Disease Services (the ESRD regulation). In the current Conditions there is a standard related to environment that states:

i Standard: favorable environment for patients. The facility is maintained and equipped to provide a functional sanitary, and comfortable environment with an adequate amount of well-lighted space for the service provided.
(1) There are written policies and procedures in effect for preventing and controlling hepatitis and other infections. These policies include, but are not limited to, appropriate procedures for surveillance and reporting of infections, housekeeping, handling and disposal of waste and contaminants, and sterilization and disinfection, including the sterilization and maintenance of equipment where dialysis supplies are reused, there are written policies and procedures covering the rinsing, cleaning, disinfection, preparation and storage of reused items which conform to requirements for reuse in § 405.2150.
(2) Treatment areas are designed and equipped to provide adequate and safe dialysis therapy, as well as privacy and comfort for patients. The space for treating each patient is sufficient to accomodate medically needed emergency equipment and staff and to ensure that such equipment and staff can reach the patient in an emergency. There is sufficient space in units for safe storage of self-dialysis supplies.
(3) There is a nursing/monitoring station from which adequate surveillance of patients receiving dialysis services can be made.
(4) Heating and ventilation systems are capable of maintaining adequate and comfortable temperatures.
(5) Each ESRD facility utilizing a central-batch delivery system provides, either on the premises or through affiliation agreement or arrangement (see § 405.2160) sufficient individual delivery systems for the treatment of any patient requiring special dialysis solutions.[/i]

As you see, this doesn’t specify how much space is allotted to each dialysis station. Some states regulate space for each station. Many dialysis clinics require patients using TVs or other noisy devices to use earphones so as not to disturb other patients.

Hi y’all,

Bobeleanor wrote:

Dori ask yourself one question , What would you do about a center like the one I was in and you not the person calling the shots?

Y’all can probably tell that if my kidneys were to fail, you wouldn’t find me IN a center–I’d be home. But as far as your options, they would include:
– Finding a different center (if there is one in your area that your insurance plan covers)
– Training for home to get out of the center

As Beth has pointed out, there don’t seem to be specific requirements related to space allotment per chair, so I’m not suggesting that you file a complaint, because unfortunately there isn’t a basis for one.

PICK YOUR BATTLES. I’ve talked with too many patients who have complained so much about even minor things that their complaints appear to be ignored by everyone – state survey agencies and ESRD Networks. This means that when a serious violation occurs, they will likely not be listened to. I’ve also talked with patients who have been the advocates for all the patients with complaints at their clinic, including those that were too afraid to speak out. Some have been appointed to patient advisory committees at clinics, but too many others have been ignored at best and at worst terminated as troublemakers.

If the space is so tight between dialysis chairs in your clinic that the wings on the chair cannot be raised without touching the chair beside, this would indicate to me that there isn’t enough room between chairs in case of an emergency. Hopefully the state surveyor will see this and write a standard level citation requiring the clinic to develop a plan of correction. If the state surveyor talks with you or any of your fellow patients when he/she comes in (and they do talk with patients), if the environment is not as required by the ESRD regulation, let the surveyor know.

And like Dori says, don’t stay where you feel uncomfortable. Look at other alternatives.

Hi Folks

Thanks to Beth and Dori

I hope I’m not to big a pain in the backside.

I understand what you are saying but centers in this area (SE PA) for the most are Davita, I’ve seen a few that are FMC but my understanding of them is there are basic the same. As for real fights and centers being written up , the centers know that it just a paper. No fine of real cost to get the message across loud and clear. Companies only understand $$

As for home programs the only center I found was a Davita at 6th and chestnut in phila. The home team seems to be ok outside of wanting me to travel 50 miles one to go over labs that my doctor reads to me the day before. I really don’t mind going to see my nurse she is funny and outside of company stuff we get along fine. I just don’t see the need to see three people over two days to hear the same things. But I’ll do my best and( “play by the rules” esrd 4 words not mine)

If you know of a center in this area that offers home programs. but I have look at your site to get the info on centers. I always take you comments with a grain of salt and pepper. But if you know where I can look and I’m in chester /lancaster county pa
bobeleanor :smiley:

I think Davita has some not so patient oriented rules which I can’t see the value in either. Why 2 trips back to the clinic a month? Most other home programs that I know get it all done in 1 trip. Nephrologist, Nurse, SS, Dietitian.

Who knows Marty. I’ve been emailing both the state of PA health dept and esrd 4 and feel more confuse now than before. The way I look at dialysis companies is that they are a service . Just like any medical supply company. I have to self cath every day and get my caths, Ups every three months. When the company calls they ask basic quections then ship my things. Since I’m not in center why go the center 50 miles away when they is a davita 25 miles away with my doctor.
bobeleanor :smiley:

It may only look like paper, but when a surveyor writes a citation, the clinic must write a plan of correction and the reason for the citation must be corrected by a certain date. Surveyors will return to see if the citation(s) has been resolved. If patients health or safety is at risk, the surveyor can write an immediate jeopardy citation. An IJ citation can stop Medicare payment or cause Medicare to shut the clinic down. When you say “companies only understand $$,” this is the big one that can be very costly to a dialysis clinic. I’ve heard of clinics that were shut down never to reopen and patients had to be immediately transferred to other clinics.

I don’t know where you live in Chester/Lancaster county, but if you haven’t tried sorting the 38 PA clinics that offer some for of home hemo (click on city at the top) in our database by city, you might do that to see if one is closer to you than the clinic in Philadelphia. I’d also encourage you to check in bordering states in case a clinic in one of those states would be closer.

I am, of course, very proud of the Northwest Kidney Centers (next year I will be the first Dialyzor Board Chair in its 45 year history). I’m proud of the service they provide in my community because I have seen what it can be like and is like, it just depends on your zip code. But even at NKC, with our raised expectations and long history it takes constant effort and as with all endeavors involving humans there will be challenges.

One thing we here on HDC could flesh out is what a truly dialyzor-centric Method II program would look like.

Hey Bill

What is the dialyzor-centric MethodII program???
bobeleanor :smiley: