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Kidney News : Home Hemodialysis Comes Full Circle: Editorial
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From: bighoobajooba (Original Message) Sent: 6/20/2006 2:39 PM
By Rich Green

Hemodialysis, in the USA, began at home. It fell out of favor in the 80’s and 90’s, owing to the fact that it became too convenient to dialyze in center. This was a tradgic move, which promoted dependence and non-compliance. Patients simply began walking or rolling into clinics and, for three or four hours, handing their lives over to dialysis nurses and technicians.
Now, home hemodialysis is coming back into vogue, once again, thanks to the innovations of various companies, such as Renal Solutions, NxStage and Aksys. A nurse or technician may favor one of these machines over the other, but, no matter which one is used, it’s an improvement over what was available in the past.
New changes are going to be occuring, within the next few years, concerning Medicare reimbursement for dialysis. All services will, eventually, be bundled. This means that the treatment, all disposables, staff time, dialysis access disposables, labs and drugs, will all come out of one bundled payment. When this happens, and it will, home dialysis will become the savior of the ESRD program. How? By reducing the need for staff. This is the only area where providers are going to be able to make the cuts required to stay afloat.
According to Joe Atkins, one RN can cover 30 home hemodialysis patients, overseeing their care. This is a vast savings when you compare the staffing required to carry out in-center hemodialysis. This is the last, and only, place that providers can cut their overhead.
In light of the economic benefits home dialysis can bring to the bottom line, it only makes sense for providers to begin moving in this direction. It’s my understanding that DaVita is already looking, seriously, at home hemodialysis. Not saying they are considering cutting staff, but they are working with NxStage.
The tax dollars available to support an every expanding ESRD program are dwendling and will continue to do so. This means that independent providers had better jump on the home hemodialysis band wagon as quickly as possible. This is one case where “waiting to see what the big boys are going to do” will be too little, too late. In my opinion, anyone who has a small independent facility and is not looking into home hemodialysis is asking to become extinct.
Irregarless of whether you are a small, medium or large dialysis chain, hospital based, or small independent, it would be wise to take the time and money required to invest in the creation of a home hemodialysis program. Financially, it’s the responsible thing to do.

Rich Green

2

A banal unspellchecked waste of bandwidth. Then after slogging through you come to “Irregarless” and it’s clear this is that old Brumley poster of many names.

Irregardless is a word that many mistakenly believe to be correct usage in formal style, when in fact it is used chiefly in nonstandard speech or casual writing.

Irregardless has met with a blizzard of condemnation for being an improper yoking of irrespective and regardless and for the logical absurdity of combining the negative ir– prefix and –less suffix in a single term. Although one might reasonably argue that it is no different from words with redundant affixes like debone and unravel, it has been considered a blunder for decades and will probably continue to be so. So yes, it is a pet peave.

More substantively the “editorial” takes no notice of the 2 to 7 percent yearly increase in the ESRD population.

3

The only thing I find objectionable about this is statements to the effect that if you dialyze in-centre, you’re just a lump or a vegetable who gets rolled in there to give your life over to nurses and techs. Don’t get me wrong, you know I think daily nocturnal hemo is terrific, but there are many legitimate reasons for intelligent people to be dialyzed in-centre, and people writing about it who have never been on dialysis just don’t know what they’re talking about.

Pierre

4

It is about options; every option should be available, and the care of highest quality. As dialysis consumers we need options. The person who wrote this article would be whining and crying if he went to the market and there was only fish, or went to the car dealer and wanted an SUV and could only buy a sedan. Consumers want and deserve choices, and having them serves everyone; it also makes for good competition. When it comes to dialysis people need choice too. For instance someone may start on pd to later switch to hd incenter or at home. Someone may move and choose home hemo because it’s too far to travel to a unit ect… Lin.