I did have a couple of more questions:
Why is the 51% bump just for new patients?
I’m assuming the push into PD for uninsured patients is because it is less expensive and may not take a space in the clinic. Is that correct?
Good info on PD. And thanks for all the help in understanding all this!
[QUOTE=plugger_;20018]I did have a couple of more questions:
Why is the 51% bump just for new patients?
I’m assuming the push into PD for uninsured patients is because it is less expensive and may not take a space in the clinic. Is that correct?
Good info on PD. And thanks for all the help in understanding all this![/QUOTE]
The 51% bump for new patients is because they are more costly to educate and treat. Unfortunately, the mortality rate on dialysis is TWICE as high during the first few months as it is later on. Many people are medically unstable and need a lot of time to manage. About 3/4 of people don’t have their anemia treated before starting dialysis, for example…
The push for PD folks who don’t have insurance is because it only takes a week or so to train someone for PD. That maximizes the number of +51% treatments that will still be left for the clinic after training. Since HHD may take 3-6 weeks, or even longer, to train, it doesn’t leave the clinic with as many of those better paid treatments.
[QUOTE=Dori Schatell;20019]The 51% bump for new patients is because they are more costly to educate and treat. Unfortunately, the mortality rate on dialysis is TWICE as high during the first few months as it is later on. Many people are medically unstable and need a lot of time to manage. About 3/4 of people don’t have their anemia treated before starting dialysis, for example…
The push for PD folks who don’t have insurance is because it only takes a week or so to train someone for PD. That maximizes the number of +51% treatments that will still be left for the clinic after training. Since HHD may take 3-6 weeks, or even longer, to train, it doesn’t leave the clinic with as many of those better paid treatments.[/QUOTE]
I don’t have numbers but I would think people starting dialysis without insurance would as a group be less likely to start dialysis with a fistula. I think in many cases it would be medical best practice to get someone started on PD, establish Medicare Primary, and then get a fistula placed and a transplant work up.
That as opposed to starting dialysis as charity care/self pay, and a catheter.
Absolutely. It’s really a win-win for patients and clinics to get uninsured folks going on PD, unless they REALLY don’t want to. But I’m not sure folks understand the fiscal ramifications of not having any insurance for 3 months of dialysis. It can lead to bankruptcy–and, ironically, one of the reasons people can be involuntarily discharged is non-payment…
[QUOTE=Dori Schatell;20013].
No. Each dialysis treatment used to be paid at a “composite” rate of about $150–with extra money for things like EPO. Now, there is a "bundled’ payment of about $229–with some adjustments for age, comorbidities, etc. But for NEW patients (who are eligible for Medicare), clinics will receive $229 + 51%, or about $345. That’s a big enough difference (x 48 treatments = $5,520) that clinics are likely to urge folks to start PD if they don’t have Medicare. That way, they will immediately become eligible for Medicare–so they pay less out of pocket (even the PD catheter can be backdated so Medicare pays for it), and the clinic will make much more money.[/QUOTE]
Any dialysis access (PD or HD) can be covered by Medicare as a primary or secondary payer if the patient starts a self-dialysis/home training program before the end of the second full month of dialysis (the “qualifying period”) because Medicare can be backdated to the first of the month dialysis starts. As you can see, to get the access covered by Medicare, timing of access placement is key for uninsured/underinsured patients especially. With these patients, the access needs to be placed the same month dialysis starts, even if the access is placed the first of that month and dialysis starts the last day of the month. Then the patient needs to start a self-care/home dialysis training program by the end of the second full month of dialysis. Nephrologists, surgeons, and home training nurses need to be made more aware of this.
Social Security provides annual notice to anyone with a Social Security number whether he/she has enough work credits to qualify for Medicare. Then it’s just up to the clinic to schedule first dialysis the same month as the access was placed, to start home training before the end of the second month of dialysis, and to complete the Medicare form (CMS 2728) that lets Social Security know the patient has started dialysis and begun home training b the deadline to get Medicare backdated. This is not rocket science. Getting 4 months of dialysis covered by Medicare at 151% of the usual rate would seem to be a motivator.
I’ve heard from social workers that surgeons have refused to place an access in an uninsured patient. I wonder if uninsured patients are dying of kidney failure because surgeons don’t know this Medicare incentive for home dialysis.
Let’s see if I’m reading this right. An uninsured person would normally have to wait three months before getting on Medicare and would possibly be risking bankruptcy. One way to avoid the hefty bills would be to get an access and start dialysis during the first month, then get into a Home Dialyis Program during the second month. Medicare would backdate and pay for all or most of the expenses incurred for the first two months of dialysis and thereafter?
I haven’t had much luck with my assumptions, but I’ll try one more! I’m assuming Medicare would be paying the bundled amount plus the 51% bumped up amount for the weeks of home dialysis training, either say a week of PD training or 3-6 weeks of home hemodialysis training?
Exactly! So, getting uninsured folks on PD or home HD is a win-win for clinics AND people on dialysis.
I haven’t had much luck with my assumptions, but I’ll try one more! I’m assuming Medicare would be paying the bundled amount plus the 51% bumped up amount for the weeks of home dialysis training, either say a week of PD training or 3-6 weeks of home hemodialysis training?
They will only pay one or the other–not both at the same time.