Money and the NxStage

I am very interested in the Nxstage machine but it seems that there might be an issue since I will be going to Medicare (reaching the 30 month time) in August of this year. For those of you that have Medicare as your primary how are you doing this? Is your unit obsorbing the costs? Or are you paying out of pocket? Also, if you are in a study that is paying would you share the name so I could check into that? Has anyone went out of state to get the training and then did the monthly checkup out of state also? Looking for a way to make this work and hoping to find some answers here, thanks, AZgloria

  1. Visit the NxStage website. Call NxStage and ask for the sales department. Ask if NxStage has contacted a clinic in your market. If not, ask NxStage to do so.

  2. If NxStage has approached a clinic in your area, call the clinic and express your interest in using the modality.

  3. Talk to your nephrologist to see if there are any LEGITIMATE reasons why you can’t dialyze daily at home. You will need a committed partner.

  4. Your costs, if any, will be determined by your insurance company or Medicare HMO. Talk to the clinic about expenses, if any. The NxStage System One doesn’t use water but does use about $1 of electricity per month. It plugs into a regular outlet.

Good luck.

Basically Medicare will pay the same no matter which machine you use, really it is up to the provider to decide what machine to offer. Have you been told that your machine options will change once your insurance changes?

Commercial insurance may pay for every dialysis treatment provided or not, depending on how contracts are written and coverage provided. It’s always a good idea for dialysis providers to bill for the services they provide, whether they’re billing a commercial insurance or Medicare. Medicare routinely pays for 3 dialysis treatments a week. However, if someone has a legitimate medical reason why more frequent dialysis would be better, his/her doctor can write the Medicare fiscal intermediary (the Medicare contracted insurance company that pays Medicare claims) and offer medical justification for additional treatments. The doctor should provide a patient-specific medical report and cite or copy research studies that show the benefits of more frequent dialysis for that condition. There is no assurance that claims for extra days will be approved. However, there is an appeal process when a FI denies a Medicare claim. For Medicare claims filed in 1997 (not necessarily additional treatments), only 3% of denied claims were appealed but 44% of them were approved on appeal (Amgen Guide to Medicare Reimbursement). The worst Medicare can say is no and there is a possibility that Medicare will pay for one or more additional treatments a week.

But if Medicare will only pay for three (or maybe four) treatments a week, does that mean that patients who are Medicare primary aren’t considered for daily programs like NXstage? Or are there clinics that write off the treatments that refuses to reimburse them for? It seems like that would create a financial hardship for the clinic unless the supplies associated with the NXstage are cheaper than other machines. But maybe I don’t get it.

Just wondering…

Clinics and/or dialysis corporations negotiate contracts with the companies that manufacture the machines and supplies. The goal for the clinic is to get the contracted price to a point where the clinic would not lose money on patients who have Medicare and a supplement and who want to do more treatments a week. I have known patients who have Medicare and a supplement that are doing daily and nocturnal home hemodialysis.

I’ve heard administrators from clinics that offer the newer therapies say that they offer these treatments because “it’s the right thing to do” and because patients on these therapies do have better clinical and quality of life outcomes that reduce costs for the clinic in other areas. For instance, studies show that patients on daily and nocturnal home hemo have better control of blood pressure, anemia, and bone disease with fewer medicines, fewer hospitalizations, better survival even if they other serious health conditions. Using fewer medicines and being able to bill for patients’ home treatments vs. having them in the hospital where the hospital bills is another way to generate revenue (or cost savings) for the clinic.

Clinics should do all they can to keep more patients working, including offering daily and nocturnal dialysis. Working patients are more likely to have commercial insurance for the first 30 months. When patients have medical reasons why additional treatments could be justified, clinics should bill Medicare and provide medical justification for extra treatments. If a clinic has a good mix of patients, some of whom have been approved for extra treatments and some with commercial insurance, the clinic should be able to offer these newer therapies to any patients that want them.

Great answer, Beth.

It’s interesting, but during the period when my group insurance was still primary for my husband, one of the nurses at our unit regularly joked about giving him whatever he wanted because he was “worth” three Medicare patients. Then after the 30-month switcharoo, this same nurse joked that he shouldn’t expect any more special treatment (not that he did anyway). It really bothered me. Especially when we began asking about home hemo and the general attitude was that we were being unreasonably demanding that we were not happy with in-center hemo. Where the concept of putting the patient first fit in with that kind of an attitude?

(Not to mention the fact that the whole situation is patently unfair considering that despite the fact that my dependent coverage now functions only as a Medicare supplement, I still pay full dependent coverage at a rate of over $500 a month–more than I was even paying when my group insurance was primary. But then, who ever said life was fair!)

The other I have is, if a unit has begun a home program using a particular machine, what motivation do they have to switch machines? Don’t they have a huge financial investment in those original machines? And if they did decide to add a second machine as an option, would patients have the right to switch at their will or would it be the unit’s decision?

My final question would be, can a unit choose to offer one type of home modality to one class of patients and not another based on their insurance coverage? For example, let’s say, a patient with Medicare primary with Medicare supplement is only offered every other day nocturnal on a Fresenius Baby K while a commercial insurance patients is offered the option of being on the NxStage for daily dialysis? If that’s the case, would a patient have the option of paying more to choose their particular modality? Or would Medicare frown on this?

Thanks again for your insightful answers,

Deborah (Formerly Wwdebebb)

Hi Debby, I contacted NxStage and they told me they are negotiating a contract with the unit I am connected with right now. I am doing home hemo with my present unit on a baby K machine. My neph has already said I could switch to a NxStage. Debby, are you using the NxStage now? Do you have private insurance as your primary? When you switch over to Medicare as your primary do you anticipate any problems? Thanks for your help and thank God for home hemo.

Hi Deborah, I am curious to find the answers to your questions also. I also wonder if each unit has it’s own discreation on how it works. From what Beth wrote it seems that this might be the case. I do hope we get the opportunity to use the Nxstage. Hugs to Michael, Love, gloria

So glad that NxStage is in your area. I was previously disabled so I was covered by a Medicare HMO when I was diagnosed with PKD. I can’t change insurance carriers unless mine goes out of business or leaves the area.

I was in a clinic initially. I then went home with the Aksys PHD for 20 months. It was very annoying, although it did allow me to dialyze at home until NxStage became available.

One of the happiest days of my life was the day the Aksys technician came to remove the PHD from my home. A few days later, the NxStage System One was delivered. I haven’t stopped smiling since.

Don’t listen to some of the posters on this website. Some of them have a financial or other interest in Aksys and are biased. I am the only person in the U.S. who has used both systems at home. I feel better using NxStage. I would never allow the PHD in my home again, under any circumstances.

That’s a serious charge Debby. Who are you talking about and based on what information?

I would like to ask posters to the Home Dialysis Central message boards to please be respectful each other’s opinions. Suggesting that people only read posts with which they agree and charging that someone with a different opinion must have a financial interest in one company or another are both inappropriate.

I don’t have a financial interest in either Aksys or NxStage and hope that both companies do well. In fact, I’d like to see even more machines come on the market to increase the choices. The more choices there are, the better off patients will be.

Personally, I wish there would be less equipment boosterism and more discussion about the actual dialysis and its advantages.

I didn’t make the switch to daily home hemo in order to use a specific machine. I would have used whatever machine the home dialysis unit was offering. I don’t care at all about the machine. It reminds me of photography forums I used to participate in, where discussions inevitably went down to what equipment people were using, and boosterism for specific brands and for the latest models.

What I care about are the health advantages of daily hemodialysis. What I want is to remain as healthy as possible until I can get a kidney transplant (and I want to be as informed and as involved and independent as I can possibly be about my dialysis in the meantime). I believe, based on the available evidence, that daily home hemodialysis offers me the best possible treatment short of a transplant, and the most independence. There’s so little a person on regular thrice-weekly dialysis can eat that it’s virtually impossible to avoid malnutrition to some degree, and it’s also impossible to avoid alternating every day between being dehydrated and volume overloaded. People are doing half the job that dialysis itself should be doing by not eating and not drinking.

What I don’t want to see are people scared away from daily home hemodialysis just because they’ve “heard” that the machines are too difficult to use.

When they come up with a real, tangible improvement over hemodialysis like a wearable artificial kidney, for example, then I’ll be interested in the equipment. Right now, whatever the make of machine, it’s still just a minor variation on what is basically a 50 year old technology. Personally, I would rather that money, investment and effort be concentrated on developing better treatments for kidney failure, rather than new makes of hemodialysis machines that offer only incremental improvements in convenience.


Pierre, Your point is a good one and I think it should be the top priority. But I can’t get away from wanting information on the different machines. If the NxStage were available for nocturnal, I would change in a minute. I would love to eliminate the time I spend setting up, tearing down, cleaning, making bicarb and the RO cleaning. It’s just human nature to want life to be as easy as possible as well as get the best treatments.

Shadenfraude in regard to photography equipment is one thing but shadenfraude in regard to dialysis? I find that disturbing.


I too like to read information about other machines. If there’s a better way of doing it, sure, I want to hear about it, and I like to see the comparisons. What I’m not particularly interested in is the my machine is better than your machine kind of stuff. Anyway, sorry I brought it up.


Pierre I wasn’t saying that your posts indicate a shadenfraude about various machines, I agree completely with your approach. I was echoing Beth’s post that “The more choices there are, the better off patients will be.” Shadenfraude is one of those words without an English equivalent. Shadenfraude is a German word for taking pleasure in the misfortune of others i.e. hoping for or celebrating bad news so that one’s point of view is reinforced or proven correct.

I too don’t want to discourage people from home dialysis, however, the reality is that the easier the machines are, the more people will be interested. It has dawned on me that I never get a vacation, there is never a time that I don’t have to spend 6 days a week doing dialysis. This is a reality, but it can also sometimes be depressing. Anything I can do to make it easier is important.

Having a machine that will travel with me and require little time to set up and clean up would really improve home dialysis for me. Right now I am too large a patient for the nxstage, if I can lose weight then it would be okay for me. I do think that my quality of life would be better on the NxStage as it would reduce my total daily time spent dealing with dialysis significantly.

Does this mean I will give up on home dialysis, no, because the primary reason I chose home dialysis is to hopefully provide a better quality of life and a longer life so I will be here to see my son graduate from high school, college and maybe even become a grandma!!

But I still want to hear about new machines and machines that will make home dialysis easier and maybe allow us to travel with our machines, so no, I do not want companies to quit looking for better machines and better dialyzers to give us more options and also to continue to improve our health.

You make good points, Cathy!

We too would love to have a machine that would allow us to go on vacation and enjoy life a little more easily. Just yesterday, I called the Davita “helpline” trying to arrange dialysis for a short vacaton we’re planning, and the “helpful” person on the other end of the line informed me that it’s very difficult to schedule dialysis for vacationing home hemo patients because most clinics don’t want to take them! I was absolutely horrified. Has anyone else heard anything like this? If so, why in the world would this be true? It’s not like we’re asking to do nine-hour runs!

Regardless the disadvantages, we too are willing to do whatever it takes to continue doing dialysis at home. The improvement in Michael’s health has just been incredible! But that doesn’t mean we’re not looking for ways to make life as good a possible–including new machines if they become available.

Which leads me to… Was anyone able to answer whether a clinic can offer one machine to one patient and not another based on whether they have commercial insurance or medicare?


I dialize six days a week and go on vacations frequently, I have not had any problems scheduling treatments at other centers. I do go back to 3 times a week dialysis while on vacation though. Daily home hemo has been very very good to me.
John L