I was told at a Davita Center that the patients weren’t allowed to give themselves iron at home. I was wondering if this is a policy of just this one center or if it is the policy for all Davita Centers providing home hemo dialysis.
Hi Marty
I’m looking into the same company. as to what is law or just the company own policy . I can’t depend on company to be honest they are a company. I’ve try to find out over the last month or two but can not any answers. I just posted on path to home. Saw your post. Outside of this page I can see to find much in the real up front answers. And forget about the ESRD network. All I got was the “lets talk”.
bobeleanor :?
Marty, my best guess is that it depends on the type of IV iron centers are using. I am not claiming to be an expert on this and haven’t recently read the new KDOQI Anemia guidelines, but I know that older forms of iron were highly allergenic, and could cause anaphylactic (life threatening) reactions–even in people who’d had IV iron many times before with no problems.
I believe that newer forms of iron are less likely to cause this problem, so that may be what you’re running into. It’s a safety issue. If they are using the allergenic iron, it needs to be given with medical supervision so that if there is a reaction, it can be treated right away.
There are many drugs for iron supplementation. Some are given orally while others are given by IV. These are the iron products for anti-anemia according to MedlinePlus: Ferrous Fumarate ; Ferrous Gluconate; Ferrous Sulfate; Iron Dextran; Iron-Polysaccharide; Iron Sorbitol; Iron Sucrose ; Sodium Ferric Gluconate. You can see brand names and read more about iron supplementation here:
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202305.html
Most IV iron products have FDA approved label warnings about the potential for anaphylaxis (stopping breathing) and require that these drugs be given where there is equipment to resuscitate the patient. It’s not to inconvenience patients but for their safety. I contacted one of the manufacturers of a couple of these products and was told that they don’t recommend that CKD or ESRD patients self-administer the drugs.
I remember reading that Pierre self-administered IV iron but in Canada things may be different. I’m pretty sure I’ve read messages where patients on this board who live in the U.S. self-administer their IV iron. Some dialysis companies and physicians may allow patients to self-administer because they’re willing to assume the risk while others are not.
If home patients can’t self-administer, I’d suggest that you ask where you can get your IV iron if needed close to your home on your insurance plan. Medicare Part B will pay for IV iron if the drug is medically necessary and given by a doctor or dialysis clinic. Most Medicare Part D plans will not cover oral or IV iron supplements because they are minerals and as such excluded drugs.
My clinic also requires I.V. iron to be given at the clinic, but I don’t use I.V. iron anymore, I decided to go oral iron and so far it has worked great that way…
Here is the real deal. I was approached by a patient about doing home hemo. He had found a Davita unit 1 1/2 hrs. from his home. My first reaction was to say go for it. Because after training it is only once a month clinic visit. Then it dawned on me, we have had alot of discussions on this board as to who does home IV iron administration. So instead I asked him what the policy was for IV iron. He was told he would have to go in-center. So my answer then went from go for it too think about it. If you need IV iron frequently and have to go in-center that drive could get very tiring. Maybe you would be better off finding a unit further away which allows patients to do IV iron at home.
My second thought was if it wasn’t a Davita Company Policy for IV iron at home then maybe the center would change their mind. I only think this because I have been doing IV iron at home for years and I know there are other posters on this board in the states that also said they did IV iron at home. So the question still remains is it a Davita policy or a center policy.
What form of IV iron are you administering? Is your supervising dialysis clinic part of a corporation or independently owned? The deeper pockets, the more worry there may be by lawyers and risk management people.
The other thing to advise the patient is to ask where he/she can get IV iron other than at the dialysis clinic, e.g. local hospital outpatient department. Also, if the patient doesn’t take IV iron at all or seldom takes it or can take oral iron effectively instead, it may be a moot point.
Thanks for the tips Beth. I really don’t know this patient all that well so I don’t know his iron requirement. But I will mention the possibility of oral iron or having it done at a hospital if Iron is an issue. I have given both ferrlicet and venofer excuse the spellings (just to lazy to go look them up). We are with an independent dialysis center.
Is there a Billing issue too. I thought I heard VA home dialyzors can give themselves iron at home but Medicare (and insurers that follow Medicare’s lead) don’t reimburse iron given at home. Anyone here insured through the VA (and have a provider up on VA rules)?
Why couldn’t I give myself the test dose and monitor myself for symptoms? Is administering iron more risky than giving oneself dialysis?
I really don’t know the rules of IV Iron being paid for by Medicare. But I do know patients who have Medicaid used to get the Iron paid for through them and I think they still do. Most of the patients in our program are through Medicare and Medicaid and I haven’t heard of anyone going back in-center for Iron because it was no longer paid for. But just because I haven’t heard of it doesn’t make it true. It’s been a while since dad has needed an iron prescription it will be interesting to see what I run into when this happens.
The patient asking about home hemo has decided to wait and try and find a unit that allows IV Iron at home. He hasn’t had good luck with oral iron in the past and doesn’t want the hassle of getting scripts and running to the hospital for iron even if it is possible. His purpose for wanting home dialysis was to quit the running to treatments and he doesn’t see where the benefit is; if he exchanges treatment runs for iron runs. He realizes the health benefits of more dialysis and hasn’t given up the idea of home hemo. He is just electing to find another center for home hemo rather than find a hospital for the IV iron.
I wouldn’t think giving IV iron wouldn’t be anymore risky than doing dialysis. I would even go for the first couple of Iron treatment being done in-center if no problem then allow the patient to do it at home. I find it confusing that it is to risky for some centers to permit but not to risky for others. Unless it has more to do with the money issue and some centers are just more afraid of being sued than others. It seems to me dialysis patients are often governed by the “fears” of others not what is real.
If the patient hasn’t tried different kinds of oral iron, that might be a first step. I’ve talked with people that had to try several brands of iron before one worked for him/her. If the patient did more frequent home hemo it’s also possible that his/her EPO and IV iron needs would be less because there would be less toxins in the blood to contribute to the problem of anemia of kidney failure…
That’s true Beth, I myself had to try a few brands before finding the one that worked for me…not all oral iron pills are the same…
Some folks have had luck with iron elixer, too, which is a liquid and possibly better absorbed for that reason.
Some patients get great results with this brand iron…
Bill wrote"
Is there a Billing issue too. I thought I heard VA home dialyzors can give themselves iron at home but Medicare (and insurers that follow Medicare’s lead) don’t reimburse iron given at home.
In our unit’s program epo can not be given IV and neither can iron. We were told that it has to do with Medicare or Medicaid ( not sure which) and billing. No one explained “why” Med/Med will not pay for meds given IV except that it is “just their policy”. So is this a $$$ thing?
Hi Folks
So to get back to Marty question and mine. Who makes the rules and what is the law?
I’ve been looking and emailing around and can not find a yes or no answer on things. I called network 4 people and it seem like they just want to let you talk the problem out your system. I even email them to try and get a yes or no answer on company rules and what the law is with issues. And got no where, I have the emil saved.
I do not trust a company, they are out to make as much $ as they can, and there is nothing wrong with that, as long they tell you up front what are company rules and what the laws are on these issues.
Like was posted here somewhere that most pts are not given all the facts about dialysis, even from the doctor.
bobeleanor :?:
Hi Folks
Let me add this to my post above…
Can I now that I’m home if I want to go to a center ,no matter who runs it as long as I get my insurance company Ok, I can to joe’s dialysis next door or for that matter even if I’m in center and want out of the center and into a center run by someone else as long as I get the $$$ to the company doing the work?
You understand my first trip into a center and the dialysis world was not a good one, I was lied to by both workers and doctors. I’ve been in the medical world all my life knew what dialysis was and is but was not aware of the centers.
bobeleanor 
As a nurse it really bothers me when patients feel that dialysis professionals are “trying to keep things from them and the only thing we care about is $$$$” This can’t be further from the truth for me and many other professional nurses who have dedicated their lives to caring for people with kidney disease. I have been in dialysis for 21 years and I know that there are people out there who only care about the $$$, but that is not the majority. As a nurse I can work in any field I choose, but I love dialysis. The reason for that is I know it could happen to anyone. That includes myself or people that I love.
When your clinic makes a decision not to administer IV iron it’s not just because of $$. It’s about safety. If the clinics were to relax there policy about giving IV iron and someone has a bad experience or even worst DIES, not only will they be liable, but the worst part is the lost of that persons life. For me the $$ is not the issue. It’s patient safety. I know it seems that we sometimes go overboard with our policies and procedures, but PLEASE, PLEASE know that for most of us, it for your SAFETY FIRST, not money.
Your Dedicated Nurse for Life