Do clinics need special certification?

I was told today by Lifeline clinic in Davie, Fla. that it cannot offer home hemodialysis (other than staff-assisted) because it does not have certification from the Center for Medicare Services (CMS). The clinic claims it needs this certification to train family members to assist with home hemodialysis.

If this is true, Orion Medical Enterprises of North Miami Beach, Fla. is the only clinic which offers home hemodialysis for patients who want to be assisted by a family member. This is in a major metropolitan district of the nation, one that is home to about five million people, including about 6,000 ESRD patients.

The lack of participating clinics is a major impediment to the growth of home hemodialysis, particulaly home hemo which isn’t staff-assisted. My calls to Frescenius fell on deaf ears. Apparently, some of these manufacturers aren’t interesting in really promoting home hemo, even though they sponsor this website!

I would be interested in any information which confirms Lifeline’s claim about certification. Maybe could put more effort into educating clinics and insurance companies, including Medicare HMOs, about home hemodialysis. The goal should be to encourage clinics to offer home hemo and insurance companies to aggressively fund it. Patients know the benefits of home dialysis, but the same cannot be said for the clinics and insurers. Medicare hasn’t taken any positive steps to encourage home hemo. This is one of the major reasons that 99% of hemo patients are dialyzing in-center.

It is great to encourage patients to dialyze at home. But as I have learned, the insurance companies and clinics have much to say about whether you can dialyze at home.

Mmiller, certification IS required for a center to offer (and train people for) home dialysis–PD or home hemo. To make this process easier and encourage more centers to jump through the needed hoops, we built a whole new section of this site that premiered earlier this year, called Start a Program.. ( In this section, we:
• Introduce folks to several consultants who will answer a question for dialysis centers for free
• Share stories of how centers have successfully started new home programs
• Offer a step-by-step plan for how centers can fill out the Medicare forms and get the inspections they need
• Include our Medicare FAQs to shed some light on the complexities

Plus, our Find a Center database ( is a source for centers to find each other and ask questions to help themselves get started.

We have documented growth in home hemo programs that is pretty impressive. Home Dialysis Central launched on July 1, 2004. In September, 2004 there were:
1460 clinics with CAPD. Now there are 1561: 6.9% growth
1428 clinics with CCPD. Now there are 1535: 7.5% growth
294 clinics with 3x/wk home hemo. Now there are 373: 26.8% growth
73 clinics with nocturnal home hemo. Now there are 131: 79.4% growth
37 clinics with daily home hemo. Now there are 144: 289% growth

At the Annual Dialysis Conference next February, there will be a full-day session on “How to Start a Home Hemo Program.” Increasing the numbers of programs is something that the industry is doing. DaVita started a new division called DaVita at Home. Fresenius has committed on a corporate level to grow their home programs. This does not, of course, mean that the center you want will open where you want it, when you want it to.

So, okay, let’s look at the rest of Florida. 22 miles away from Miami, in Davie, there is a center that offers daily home hemo. This is about 30 minutes away–we know folks who drive 200 or more miles to train for and be followed for home hemo. The center is LifeLine HealthCare Services, 3731 SW 47th Ave. Davie, FL, 33314. 954-689-8377. So, you might try there.

p.s. 91.3% of US patients are in-center, not quite 99%–but far too many.