We have heard of units that have in-center nocturnal programs. Believe it is mostly FMC that is doing this. Most units do not utilize the machines/chairs during the night. If units ran night shifts providing patients with nocturnal txs would this be profitable? It seems it would make them $$$ and provide a better option for patients.
I suspect that Fresenius believes it will be profitable for the corporation or they wouldn’t do this. I suspect they also believe that it will provide better dialysis than 3 days of conventional hemo and will allow more patients to work. Keeping patients working is what drives facility profitability because reportedly Medicare pays less than what it costs a clinic to do dialysis.
In my area, one Fresenius clinic is currently doing nocturnal dialysis treatment 3 nights a week – same nights every week. They have a reduced staff from daytimes because patients allowed to do nocturnal dialysis are stable. If I recall correctly, patients come in at around 8-9 and leave at around 4-5. This gives the staff time to set up for the day shift.
I suspect more clinics will start to do this as time goes by. With growing numbers of patients needing dialysis and having dialysis machines available that could be used overnight may make it possible to postpone having to expand a clinic or build and staff a new one.
I hope that clinics will not rely on in-center nocturnal dialysis and will screen every patient for his/her potential to do home dialysis. I believe strongly that home dialysis offers the best chance for control over one’s illness and a more “normal” life than even in-center nocturnal dialysis.
What about SDD in-center for patients who don’t have a helper at home? It seems even that could be profitable as patients would be healthier, have less hospitalizations and could get back to work. 3x in-center is a ruthless cycle as almost none of the patients feel well and there are constant problems. Seems better txs, whether in-center for those who lack support, or at home for those who are supported would be the best direction to go in.
Heather, the problem with SDD in-center is that it wreaks havoc on scheduling–and the extra treatments are not paid for. The scheduling issue is HUGE. Centers lose money if the chairs are not full for every shift. If you are doing 3 hour treatments, as, sadly, most centers are, for example, you might have a shift that runs from 9am-noon. Each chair is used by one person during that time on MWF and one person on TRS. If you offer 2 hour treatments 6 days a week, you are wasting one hour of that time slot every day.
So, the only way to make this work is to put two 3-hour shifts together–say, 9am-3pm; 6 hours. In a regular center, each chair would now have 2 MWF and 2 TRS folks during that 6 hour period (4 payments). But you’d need to have 3 daily people in that slot. This is very tough to coordinate. Plus, you’d only get payments for 3 people instead of 4–and no payments for the extra 3 shifts each person would use. It’s simply not feasible in-center.
There are a handful of US centers that are offering in-center SDD (in North Carolina, Minnesota, and California, as far as I’m aware), in some cases for the NIH study, which helps support the extra costs. But this still doesn’t solve the very big scheduling hassle.
It is time to make the “dialysis weekend” optional. Units should instead offer “wellness weekends”. Units should offer forth treatments on Sunday (or Saturday, whichever day the unit is now closed). The “magic” of the HemoDialysis Product method of reckoning dialysis dose is that a forth treatment makes every hour on dialysis count for 16 HDP points instead of 9 HDP points.
So that bonus wellness run could be just two hours and still every other hour spent dialyzing would count for 16 HDP points. If dialyzor A is running 4h(ours) 3x(per week) their HDP is 36 because each hour on dialysis is worth 9 points. If dialyzor A added a 2 h wellness run to their schedule then their HDP would be 56. 20 HDP points for a single run. Medicare could buy every incenter dialyzor 20 HDP points by offering reimbursement for the forth treatment.
I believe forth treatments is the clearest path to improving incenter dialysis outcomes. I also think that it is a shorter jump to go from 4x incenter to 5 or 6x high dose home dialysis then it is to go from 3x to 5 or 6x. So wellness weekends could help people make the jump to home high dose hemodialysis.
I’d be interested to know if dialyzors are more likely to go home after trying nocturnal incenter. I like the incenter nocturnal option it would be what I would want if I had to dialyze incenter.
Bill wrote:
I believe forth treatments is the clearest path to improving incenter dialysis outcomes. I also think that it is a shorter jump to go from 4x incenter to 5 or 6x high dose home dialysis then it is to go from 3x to 5 or 6x. So wellness weekends could help people make the jump to home high dose hemodialysis.
I’d be interested to know if dialyzors are more likely to go home after trying nocturnal incenter. I like the incenter nocturnal option it would be what I would want if I had to dialyze incenter
My family member on dialysis initially chose 3x week hemo over pd (only choices given) as that meant 4 days a week to be free. But what was learned was those 4 days are not really free as what good is being free if one doesn’t feel well off and on due to uncomfortable unit txs and insufficient dialysis? Similarly, a 4th day of typical in-center dialysis wouldn’t be appealing as now half of the weekend is gone.
From what we’ve read of the units that offer 6x in-center SDD txs, this sounds like a better fit. The txs are quick and there’s a big pay-off in health benefits. The patients come running for their txs and don’t miss, because they feel so much better minus the fluid and toxins and can have a more liberal diet.
But what would prepare patients to make the transition into home txs? I think the biggest hindrance is the way doctors and dialysis staff make patients feel dependent. In many instances, they don’t shoot straight with patients giving them all their options thus they make them feel fearful that they couldn’t possibly handle their own txs either alone or with family support.
This subject has been discussed before. Just give patients the tools to care for themselves and many could fly the coop.