To read some of the posts on this page , one might get idea that getting a new doctor and getting into a new center was like going to store. The thing that I have found is that you go to the center the doctor is in with. The doctor is with a group of doctors that covers x miles around your area. So your doctor wants to make all the calls. The center wants to make all the calls. The idea that the esrd gives is that you have input is crap. You must work very hard at getting a new doctor and even if you do, they go along with the doctor you left. I just met my new new doctor on 6/01/06 ( it only took since dec). same company owns my life.
This may be your experience, but this is not the experience of every patient.
I’ve worked with doctors in three multi-doctor practices. Every doctor has his/her on style and personality as well as level of expertise. Some doctors and patients get along great and sometimes the same doctor totally rubs another patient the wrong way.
I’ve known patients who changed doctors within a practice or they changed to doctors in other practices. Going outside a practice usually means changing clinics. For some the change worked out great. Others were unhappy with their new doctor and clinic too.
My advice is to find out what doctors are on your insurance and interview them. Visit dialysis clinics that are on the preferred list for your insurance so you get the best coverage. See what the atmosphere is like…how patients and staff get along, the “look” and “feel” of the clinic. Check out outcomes on the Dialysis Facility Compare database keeping in mind that the data is a couple of years old. Ask questions. It’s your body and your life and it may take effort, but you wouldn’t want to put your life into the hands of people you don’t trust or feel comfortable asking questions.
In our area you can even get an appointment with a Nephrologist without a physicians referral so much for interviewing the Dr. I’d like to see the precentages on those patients able to change as compared to those patients who can’t.
My post should have read in our area you can NOT even get an appointment with a Nephrologist with a physician referral regardless if your insurance allowes it.
Does the patient have a Medicare Advantage (HMO, PPO) plan or Original Medicare? Medicare Advantage plans have gatekeepers that want to be the ones to refer patients. Basically, these plans have their network of doctors and they may be slow to refer to specialists or anyone outside their network. Different plans may put up roadblocks to those referrals. People who go out of network pay more to see those doctors.
I’m in Kansas. We don’t have a lot of people here who have Medicare Advantage plans. People here with Original Medicare either get hooked up with a nephrologist in the hospital if they are diagnosed with kidney problems there or they call the nephrologist’s office. Their primary doctor may suggest who to go to, but I’ve had several patients who switched for various reasons. Sometimes patients with commercial insurance had to switch because their insurance changed network providers.
My advice to anyone with a chronic illness is not to choose a Medicare Advantage plan and I’m not the only one who says this. There have been studies that show that chronically ill people in many MA plans are not well served by them. There are some exceptions.
I have medicare and a good insurance. The insurance is my primary. And looking for doctors is not like going to walmart or kmart etc. these doctor form groups that cover some 25 miles in area. plus they tend to know the other doctor outside there area. So the doctors in my area know the doctors who cover the the next 25 mile area and so and so. plus they meet and talk on monthly or some time frame or read in the trade mags. we on dialysis don’t have a free press. Thank goodness for this page. Ihope that it keeps going, this has been only place I can really talk about these things where people read and offer their story.
My father is not in any type of HMO with his Medicare. I purposely chose to keep them free to select Dr.s of their choice. It just so happens in our area it doesn’t matter what insurance you have it is referral only.
When I needed to start dialysis I checked with the list of doctors in network with my ins. co. and started calling doctors offices, multidoctor practices. Each time I was told “we are no longer accepting pts. from that insurance block” until I got to the last name on the list, and that was how I "picked " my neph… There were no nephs. within miles of my home and in the county where I live. The doctor who regularly visits the unit I went to was one who wouldn’t take on any more pts… from my private insurance. I guess with so many on Medicare primary it’s easy to overlook the fact that many of us are on private ins. primary the first years of dialysis, and even after that time if one still has private ins. secondary they also have to abide by their rules because they pay part of the bill not paid by Medicare. I’m now on Medicare primary but still need referrals ect… and need to stay in network with my private insurance. Oh boy, do I have paperwork! When I signed up for Medicare I was told that I must be on original Medicare because I’m under age 65. Lin.
You poor buggers! It all sounds so unneccessarily complicated. You really need to have your wits about you and that is something that takes a bit of a holiday when you start dialysis. :shock:
It is dismally complicated and frustrating here. You think you can have the Dr. of your choice because you didn’t enroll in a HMO and pay more for insurance but then something else stops you. Your told home hemo is an option to dialysis but then there are no programs available. You are told about care plans and the ESRD regulations but enforcement is limited. If I got service in a hospital or Dr. office as fast as I get the bill; I’d be one happy camper. In the U.S. it seems the differences have more to do with where you live, is it the same in Australia and Canada?
In Canada, as everywhere else, access to all these things is often better in the cities than it is out in the country. In my province, we don’t have private or public companies running dialysis centres. They are hospital run, and hospitals are public institutions. So the dialysis centres operate under the hospital’s standards. I’ve never had any complaints, personally. It all seems very well run to me. In my city, we do have one “non-profit” dialysis centre which is run by Fresenius rather than the hospital. It’s left over from a mid-1990’s experiment that didn’t go anywhere. But it’s pretty much the same only smaller than the hospital ones (like 12 stations instead of 30), and it’s in a strip mall instead of on a hospital campus.
Since we have universal medicare, private insurance doesn’t enter into the picture. When it’s time to get on dialysis, your pre-dialysis neph tells you where and when, and you just show up. It’s all part of a university teaching hospital environment where I live, and so once on dialysis, nephs rotate and you don’t see the same one all the time. But there’s no shopping around for a nephrologist. They all work as part of the same team. Home hemo patients do get one constant nephrologist though, and a primary care nurse to talk to when needed (the nurse also follows up on bloodwork, etc.).
The only negative about the whole thing is that there’s a waiting list for home hemo. They can only intake so many patients per year.
I beleive our system in Oz is fairly similar to Canada. So things are relatively patient friendly and equitable. Obviously, because Australia has such vast distances between major centres people often have to do a lot of travelling, but we expect that. Nephrologists are fairly light on the ground in the country and although you could choose which one you wanted within reason, once you go to the training hospital, often a days drive away for some, you can still be with your favourite Neph but the Unit Neph oversees your treatment. This is how it happens in country areas. Bear and amba are city based so they might see things differently. I think the bigger the unit the more bells and whistles you might get (I know amba mentioned they have nightime incentre dialysis) and I also know some Sydney based hospitals offer patients some extra payments for travel. My country hospital is always scraping for money, but I couldn’t fault the service and care I received in a small Unit.
What I think you guys in the US do well at is providing a support team to patients. I was offered an appointment with a Social Worker and a dietician, but I figured i probably would know as much if not more than a couple of fresh young things. The dietician had no experience of Nocturnal and seeing as i have been a school teacher for 30 years I probably had what the social worker was going to say worked out. (Sorry Beth/Dori)!
Typical Aussie attitude “SHE’LL BE RIGHT MATE”! get on with it and get out of here!
The day my Neph decided I was to start dialysis was the day I was also able to start home training.I had a choice of machine (Gambro or a Freni) and whether I wanted to dialyse overnight or short daily. For all that I am VERY grateful. 8)
Whenever I think things are bad in the U.S. so far as choice, I think about the calls and emails I get from family members of patients who live in third world countries where treatment is limited, much less choice of treatment, and you pay out-of-pocket so only the wealthy get treatment. Those are the really sad situations.