Most home dialysis patients are Medicare Method I patients. In this case, the dialysis clinic orders the machine and supplies for the patient. It orders from companies that it has contracts with. The patient does not typically sign up with a company unless the patient is a Medicare Method II patient. Even in that case, the patient uses a machine that the dialysis clinic staff know and can train the patient on. Contracting is done at a facility or corporate level, but I have heard that patients have influenced clinics to consider one machine or another.
So far as machine maintenance is concerned, several people have discussed this in several threads. One thing that isn’t discussed as much is the obligation that the clinic has to provide backup dialysis for home patients that need it. This is a requirement of Medicare certification for a home dialysis program. When I worked in dialysis, our patients who had machine problems that made it impossible for them to do dialysis came into our clinic for one or more backup dialysis treatments. It wasn’t always easy to fit people in, but we did it because we didn’t want any of our patients to miss a treatment.
It’s great that the NxStage machine is transportable and the company is willing to ship out a different machine in trade. However, if someone was planning to do dialysis one day and found that his/her machine was not working, wouldn’t it be at least the next morning before the working NxStage could arrive by FedEx or other overnight shipping service? If so, wouldn’t that person miss a dialysis treatment too? Maybe the person could do dialysis right away if he/she was home all day, but wouldn’t the working patient have to wait to do dialysis until the next evening? Unfortunately, if a machine problem can’t be fixed by the patient, it usually means some disruption in the normal dialysis schedule.
Doing dialysis frequently certainly seems to improve outcomes. I am very glad that all of you are conscientious about your treatments. I’m sure it’s going to serve you well. However, it makes me wonder if clinics are less likely to offer backup dialysis if a machine problem causes someone on frequent dialysis to miss an occasional treatment compared to how quickly that same clinic would offer backup dialysis to someone doing dialysis 3 times a week. Eston, since Aksys hasn’t had a technician in your area, how long have you had to go without dialysis before your machine was repaired? Did you tell your clinic that your machine not working? Did your clinic suggest that you come in-center for a treatment? For the rest of you, what are clinics offering when you tell them your machine is broken? What do they do if you complain about having to miss a treatment because your machine isn’t working and the technician isn’t local?