Joe, has the center you are connected with started a home hemo program yet?
Hehehe, Joe didn’t post that…Heather did…she copy/pasted…
Eventhough I agree with most of Dialysis Joe’s points, there is one thing that is like a two-edged sword. The way it has be explained to me by our family member on dialysis, tx for ESRD is such that just one more thing can put one over the edge. What seems like just a little needle stick, can certainly be that one little thing. I can see how most in-center patients, especially, protest that extra stick, since it is unnerving to be uncomfortably stuck right while they are on the machine, when they are cold, when they are asleep, when some nurses have poor skill at delivering the stick, when they are afraid of needles, when it amounts to 3 extra sticks a week, 12 extra sticks a month. It is pretty overwhelming to be tied to a machine to preserve one’s life and to know that a lot more sticks are comming when it could be painlessly put throuth the IV. No one wants to be a human pin cushion. Some patients can handle pain, or even mild discomfort, better then others. So, I do understand how patients look at it. I’ve seen the nurses go right down the line sticking each patient. It kind of reminds me of a vet innoculating cattle and I can understand the patients exasperation with it. Maybe if pain/irritation was fully minimized and it was done at the patients timing it would make a difference, but it is hard to beat painless IV administration.
In my old dialysis clinic almost all of the patients got EPO injections subQ after dialysis after they weighed, when they walked by the nurses’ station on the way out of the treatment area. An RN always gave them the shot. In the “old days” the medicine had a preservative that stung from what patients said. But they were willing to put up with the pain because it kept their hemoglobin/hematocrit more stable. You guys would know better than I do, but I’ve been told that the medication being injected is less painful now.
Quote:
Originally Posted by Heather1
From: Dialysis Joe (Original Message) Sent: 10/27/2006 9:59 PM
Editorial on The Administration of Epoetin Alpha By Joe Atkins, RN, MBA, CNN, CHT
It’s unfortunate that, presently, most dialysis providers have chosen to administer this expensive drug, intravenously, which is the least effective and most costly way to administer the drug.
[QUOTE=Dori Schatell;11005]I can’t imagine why this is surprising, when 92% of US patients are on in-center hemo, which is the least effective and most costly way to dialyze…
From what I’ve heard, IV administration of EPO is just easier in the center setting than subQ, especially when so many patients are resistant to the idea of one more needle. Yes, it’s a small needle, but if you don’t like needles, it’s still one more when you already have an IV line in and it’s someone else’s money you’d be saving at the cost of an extra stick to yourself.[/QUOTE]
We’ve discussed this before, but I find it so unbelievable that 92% of patients are in-center if it is the leaste effective and most costly way to dialyze. From time to time I need to be reminded why CMS has it set up this way? And could you clarify your second comment…not sure what you meant.
[QUOTE=Unregistered;11020]Quote:
We’ve discussed this before, but I find it so unbelievable that 92% of patients are in-center if it is the leaste effective and most costly way to dialyze. From time to time I need to be reminded why CMS has it set up this way? And could you clarify your second comment…not sure what you meant.[/QUOTE]
I don’t know that it’s exactly that CMS has “set it up” to have 92% of patients in-center–that percentage has been climbing each year, and has a lot to do with centers being built, having vacant chairs/time slots they want to fill, and it being easier to slot a patient into a chair than to fully educate him or her and make other options available.
CMS was supposed to create incentives to ensure that more people choose home options, and that has not happened other than that Medicare reimbursement for a home treatment is the same as for an in-center one. Unfortunately, though, home training rates are drastically insufficient ($20/DAY?!!) and the break-even point for home hemo may be 1-2 years out. That’s a long time for centers to have to wait to make money when they can do it from day one in-center.
As far as my second comment (re: extra needle sticks for EPO), I just meant that it’s a tough sell to get dialyzors to “take one for the team” if you will, and get an extra needle stick for subQ EPO rather than have it IV so “the government” or “the taxpayers” can save money.
I think there need to be more research and trials done on SubQ vs IV EPO.
I know I read an article which said the SubQ method only required less EPO for about 3 months. Then there was no difference between IV or SubQ
Hi Folks
On Bill’s point if I understand it the less kilos that come off and the more time spend just cleaning blood help to avoid epo and iron shots?
And dialysis joe is right in that dialysis must rethink , outside the box. But the big problem is too much $$$$ is at stake. Dialysis is no different than other area of life, if $ is in the mix those that have the big $$ to spend on getting laws or bills or anything will win in most cases.
bobeleanor
[QUOTE=Dori Schatell;11021]I don’t know that it’s exactly that CMS has “set it up” to have 92% of patients in-center–that percentage has been climbing each year, and has a lot to do with centers being built, having vacant chairs/time slots they want to fill, and it being easier to slot a patient into a chair than to fully educate him or her and make other options available.
CMS was supposed to create incentives to ensure that more people choose home options, and that has not happened other than that Medicare reimbursement for a home treatment is the same as for an in-center one. Unfortunately, though, home training rates are drastically insufficient ($20/DAY?!!) and the break-even point for home hemo may be 1-2 years out. That’s a long time for centers to have to wait to make money when they can do it from day one in-center.
As far as my second comment (re: extra needle sticks for EPO), I just meant that it’s a tough sell to get dialyzors to “take one for the team” if you will, and get an extra needle stick for subQ EPO rather than have it IV so “the government” or “the taxpayers” can save money.[/QUOTE]
This has always been confusing to me and I’d like to get it straight. Anyone feel free to educate me. CMS makes the rules…but then CMS does not pay enough to back up it’s own rules?? Which is ist?- Are the problems, wrong priorities etc. in the ESRD system due to CMS or the dialysis industry? And everytime a unit trains a patient for home hemo, doesn’t that free up a chair so they can profit more?..so even if there are training costs that must be recouped they won’t lose $$ if they fill the chair, and they usually do right away.
And re patients taking extra sticks, are you saying it is justified for them to reject extra sticks or do you feel they should take them to save the $$?
[QUOTE=bobeleanor;11027]Hi Folks
And dialysis joe is right in that dialysis must rethink , outside the box. But the big problem is too much $$$$ is at stake. Dialysis is no different than other area of life, if $ is in the mix those that have the big $$ to spend on getting laws or bills or anything will win in most cases.
bobeleanor[/QUOTE]
Hi bobeleanor,
Are you speaking of corruption? If so, do you think it’s possible to fight corruption? You asked in another thread if others are pro-active in making a change in the system. We’re aware of a number of patients and professionals who have been/ currently are pro-active, but have never known a national united effort that has succeeded in holding the system accountable. Have heard of a few united state efforts that have effected laws or who advocate for patients’ rights. There is currently an effort in CO. Don’t know the whole story off hand, but think they tried to pass tech certifcation legislation, but got defeated the first time around. Do you have any ideas for how concerned patients and professionals can get united? All your points re what units should be doing if they want higher reimbursements were exactly right- question is, how to achieve it…
[QUOTE=Heather1;11032]This has always been confusing to me and I’d like to get it straight. Anyone feel free to educate me. CMS makes the rules…but then CMS does not pay enough to back up it’s own rules?? Which is ist?- Are the problems, wrong priorities etc. in the ESRD system due to CMS or the dialysis industry? And everytime a unit trains a patient for home hemo, doesn’t that free up a chair so they can profit more?..so even if there are training costs that must be recouped they won’t lose $$ if they fill the chair, and they usually do right away.
And re patients taking extra sticks, are you saying it is justified for them to reject extra sticks or do you feel they should take them to save the $$?[/QUOTE]
Yes, CMS makes the rules, and No, CMS doesn’t pay enough to back them up. I’d say you have that exactly right. I think the priority issues in the renal community are complex and multifaceted, but in the end, like everything else, dialysis follows the money. As far as recouping money because someone else fills the chair, you have to keep in mind that while there are plenty of new patients every year nationally, that doesn’t necessarily mean that they’re in your center. So, if you lose a patient who has a good employer group health policy to home dialysis, it might take you several “regular” patients to make that up–and you may not have enough chairs or enough patients to recoup your loss.
As far as the extra stick, personally I wouldn’t want it. And I’m not aware of any law that would compel people to get a drug subQ vs. IV to save the government money. If it works better for you and keeps your energy levels more constant, then there’s a benefit to you that might be worth the “cost” of the extra stick. Otherwise, it’s a tough sell.
[QUOTE=Dori Schatell;11037]Yes, CMS makes the rules, and No, CMS doesn’t pay enough to back them up. I’d say you have that exactly right. I think the priority issues in the renal community are complex and multifaceted, but in the end, like everything else, dialysis follows the money. As far as recouping money because someone else fills the chair, you have to keep in mind that while there are plenty of new patients every year nationally, that doesn’t necessarily mean that they’re in your center. So, if you lose a patient who has a good employer group health policy to home dialysis, it might take you several “regular” patients to make that up–and you may not have enough chairs or enough patients to recoup your loss.
[/QUOTE]
Can you be more specific on what you mean? I am not at all a $$$ person. I can save it and spend it wisely, but am not as good at making it lol. Nevertheless, I must be doing something right as I have no debts and have everything I need. I’ve read the discussions and understand how things can get pretty confusing as to who is doing what. But I would like it if someone could give me their take on what this is all about- does anyone really understand it? Is it a hopeless cause to do anything about the situation or are there pro-active measures that can be taken? Anyone?
What if the patient who goes into the home program is the one with the high paying insurance?
[QUOTE=Unregistered;11038] I’ve read the discussions and understand how things can get pretty confusing as to who is doing what. But I would like it if someone could give me their take on what this is all about- does anyone really understand it? Is it a hopeless cause to do anything about the situation or are there pro-active measures that can be taken? Anyone?
What if the patient who goes into the home program is the one with the high paying insurance?[/QUOTE]
Sorry, but I’m not sure I understand what you’re asking. A good place to start to get a handle on how the system of dialysis care works is our article on that topic. You can read it at: http://www.homedialysis.org/v1/rotating/0305topicofthemonth.shtml.
Sorry if I wasn’t clear enough, Dori.This board promotes home txs, yet as we just discussed, 92% of patients are in-center although CMS is supposed to support home programs. I asked why this is the case and you said the issues are complex, and like with everything, dialysis follows the $$$. Well I am asking what does that mean, exactly? What is the block if CMS says it promotes home hemo, but then does not pay enough for it?
[QUOTE=Heather1;11033]Hi bobeleanor,
Are you speaking of corruption? If so, do you think it’s possible to fight corruption? You asked in another thread if others are pro-active in making a change in the system. We’re aware of a number of patients and professionals who have been/ currently are pro-active, but have never known a national united effort that has succeeded in holding the system accountable. Have heard of a few united state efforts that have effected laws or who advocate for patients’ rights. There is currently an effort in CO. Don’t know the whole story off hand, but think they tried to pass tech certifcation legislation, but got defeated the first time around. Do you have any ideas for how concerned patients and professionals can get united? All your points re what units should be doing if they want higher reimbursements were exactly right- question is, how to achieve it…[/QUOTE]
Heather 1
Washington DC is what it is. It all about give and take and time and who the upper hand . AS for dialysis I will wait for Bill to start a new thread on how the system should be payed for. I do not have much trust in large advocate groups that have HQ in washington DC. ( what have they done for me lately) And No I do not know the # of people who are active in real work for dialysis consumers. That why I started the other thread. To see if we can find out how many people both on dialysis or caretakers or dialysis workers who are speaking up. The people I met in center for the most part are happy. But if you look at the age AVG. 68, my guess. They really don’t want to have work so hard doing home dialysis. I can’t blame them and don’t blame them. If home dialysis is going to work it is up to the younger consumers of dialysis.
bobeleanor
Heather, I wrote an article on this for the now-defunct iKidney.com. I’m going to repost it here.
Reviving Home Dialysis Therapies: The Medical Education Institute’s Approach
By Dori Schatell, MS
We’ve all seen the dismal figures for dialysis patient survival—23% annual mortality(1), a figure reduced by less than 2% over the past decade despite several years’ implementation of the (K/DOQI) Clinical Practice Guidelines. Yet, some of the first patients who started dialysis in the US in the early 1960s—selected by the “Life-and-Death Committees” when dialysis was too scarce and costly to provide to all—are still alive today.
There is no ceiling on dialysis patient survival.
Longer or more frequent dialysis appears to hold the promise of reducing mortality.(2,3) We can surely do better for our patients, and one way may be by encouraging more use of home dialysis therapies.
More than a decade of Medical Education Institute research conducted under the Life Options program† has led in a single direction: toward the importance to survival of active, comprehensive self-management of kidney disease by knowledgeable patients guided by consultation with their healthcare teams. Think about it: even in-center hemodialysis (HD)—the most medically supervised treatment we have to offer—only places patients under the direct care of clinic staff for 14 hours or so a week—just 8% of their total time. The rest of the time patients are on their own, self-managing for better or worse—often, for worse. “Compliance” with diet, fluid, medications, and treatment alone is never enough to ensure good outcomes. Rather, patient self-management encompasses:
• Following the treatment plan;
• Monitoring safety (to prevent mistakes); and
• Recognizing and reporting symptoms before they become life-threatening.
Home dialysis ensures that patients receive detailed training in at least the first two elements, and, in some cases, all three.
Despite our best efforts, Life Options has not had much impact on dialysis patient employment. Once patients give up their jobs and go on disability—typically prior to renal replacement therapy—it is very challenging to help them regain a productive lifestyle. Non-physiologic dialysis (2-4 hours, 3 times per week) given on an often-incompatible schedule interferes with the workday and leaves patients with a burden of symptoms and unpredictable hospitalizations that makes a “normal” work life the exception rather than the rule. Yet, patients, clinics, and payers all benefit if patients retain their jobs and employer group health plans.
For all of these reasons, we at the non-profit Medical Education Institute (MEI) feel it is imperative to raise awareness and use of home therapies, both peritoneal dialysis (PD) and home HD (HHD). Following is a summary of what we’ve done so far to address each of several barriers we’ve identified to the use of home dialysis.
Barrier 1: Lack of Patient Awareness of Home Dialysis and Where to Find It
In 2002, the most recent year for dialysis data, more than 92% of incident patients began treatment with in-center HD.(1) How many of these patients even knew there were home alternatives? A survey on knowledge of dialysis options was completed by 1,265 randomly-selected new in-center HD patients and 1,114 PD patients who began treatment in 1996. At that time, only 24.6% of in-center HD patients said home HD had been described for them, and just 25.3% had been told about PD.(4)
Patients can’t choose a treatment they have never heard of. Therefore, informing patients about all five home dialysis options—continuous ambulatory PD, continuous cycling PD, conventional HHD, daily HHD, and nocturnal HHD—and where to find them is one of the primary goals of the Medical Education Institute’s Home Dialysis Central website (http://www.homedialysis.org).
Launched in July, 2004, with sponsorship from across the renal community*, Home Dialysis Central includes a “Find a Center” database that lists every clinic in the US that currently offers and trains patients for home dialysis (http://www.homedialysis.org/v1/centers/search.php). Choose a state, city, and modality to find local clinic options. Or check the modality box only on the search page to see how many clinics across the nation offer each type of treatment. Clinics can verify their listings and submit corrections or updates using an on-line form.
We’ve also developed coverage maps to show the location of home modalities (http://www.homedialysis.org/v1/types/maps.shtml). The maps show a 120-mile radius around each site to represent a 2-hour drive—because home dialysis clinics don’t have to be around the corner: they can be as far away as patients are willing to drive once a month for a clinic visit, after training is done. The maps also reveal gaps where certain home treatments are not available, making it easier for clinics to build the business case for a new home program location.
Barrier 2: Systematic Underestimation of What Patients Can Do
To send patients home for dialysis, we need to believe they are capable of completing training and successfully learning how to inventory and order supplies, set up and clean up equipment, conduct and monitor their treatments, report data, and respond appropriately in emergencies. If dialysis technicians can learn how to do these tasks, why not patients—who may be motivated by the potential to improve their own health and quality of life?
Many members of the renal community believe that dialysis patients have very little schooling and are thus not capable of home dialysis. However, as of 1995, the National Center for Education Statistics reported that 32 states had laws requiring school attendance through age 16, nine states and Washington, D.C. required attendance through age 17, and nine states required attendance through age 18.(5) Thus, the “average” education level of U.S. dialysis patients is likely quite a bit higher than many might expect. Results of a national, random Medical Education Institute Life Options study of dialysis patient use of the Internet will shed further light on patients’ education level, and we will share these results with the community in the next few months. (NOTE: This paper has since been published: the average educational level of US in-center patients who read English is 12th grade).
On Home Dialysis Central, we’ve included stories of real patients and family members who are making home dialysis work (http://www.homedialysis.org/v1/profiles/), so patients and professionals can see what truly is possible for patients and how motivated they are to succeed with home therapies and obtain a better quality of life.
Barrier 3: Lack of Awarenesss of the Link Between Home Therapies and Patient Job Retention
Fifty percent of new ESRD patients are of working age(1). Yet, in a Medical Education Institute analysis(6), 37% of working-age patients were employed 6 months before dialysis or transplant, but only 23% were still working by the time they began treatment. Keeping a job provides patients with a sense of identity, income, and—for 72% of full-time employees—an employer group health plan (EGHP). For clinics, patients with EGHPs bring in revenue beyond that of Medicare—an estimated $36,660 per patient per year—often the difference between profit and loss. And for the US government, keeping patients working means it doesn’t pay disability or forego federal income taxes, and Medicare is secondary rather than primary for the first 30 months, an additional savings. The MEI estimates the costs to the government of the 95,402 (in 2002) disabled working-age patients with a diagnosis of “genitourinary disorder” (a larger category than ESRD alone) at more than $1.67 billion/year, without the cost of dialysis itself.
Clinics do not need to compete in a zero-sum game for the small numbers of patients who remain employed and insured once they start dialysis. Rather, we can go upstream into Stage 3-4 chronic kidney disease, and intervene to maintain patients’ jobs, instead of losing tens of thousands of employed, working-age patients to disability. How? Anemia treatment may be one key: patients in a small, qualitative study reported giving up their jobs due to fatigue that was likely caused by anemia.(7) And some estimates suggest that only 23% of CKD patients receive EPO treatment for anemia.(8)
Another key appears to be home dialysis. Not surprisingly, our analysis of USRDS data on working-age ESRD patients from 1995 to 2001 revealed that patients who had a pre-emptive transplant or chose PD were significantly more likely to be working at treatment initiation—and to have an EGHP.(6) National data on employment by modality are not reported after treatment initiation, but it is common sense that transplant and PD patients are more likely to work if they feel better and have more control over their schedules.
Nephrologists have a profound impact on the expectations of patients with chronic kidney disease (CKD). These patients don’t yet know if they can maintain their lifestyles: there is an opportunity to encourage a positive view of the chance for a full life despite kidney failure—a life that includes paid employment for working-age patients. Disability invariably pays much less than employment. The MEI urges nephrologists to consider the employment status of their working-age patients and suggest home therapies as a means of continuing a job, health insurance benefits, and the identity and self-esteem that employment offers.
Barrier 4: Not Enough Clinics Offer Home Dialysis
In the Home Dialysis Central database on March 8, 2005, there were:
• 1,512 clinics offering PD
• 316 clinics offering conventional HHD
• 81 clinics offering NHHD
• 44 clinics offering daily HHD
([b]NOTE: Today, there were:
• 1,606 clinics offering PD
• 373 clinics offering conventional HHD
• 131 clinics offering NHHD
• 143 clinics offering DHHD)[/b]
With a total of 4,478 US Medicare-certified dialysis clinics, this means 34% have PD, 7% have conventional HHD, 2% have NHHD, and 1% have daily HHD. (NOTE: Today, these figures are: 35.8% PD, 8.3% conventional HHD, 2.9% NHHD, and 3.2% DHHD) For patients to have real choices, more programs—large, viable programs—are needed to fill in the gaps between geographic regions that currently have no home treatments, particularly for HD.
The MEI is planning a new section of Home Dialysis Central this year on “How to Start a Home Program.” We’ll gather information on how to become certified to offer home dialysis, where to find existing policy and procedures manuals for various types of home therapy, Medicare reimbursement content, and expert consultation to help clinics that are contemplating a new home program get to the next step. (NOTE: http://www.homedialysis.org/v1/start-a-program/).
Barrier 5: Insufficient Reimbursement for More Frequent Hemodialysis
Industry estimates hold that each Medicare-only patient on in-center HD costs clinics $5-$10 per treatment. Yet the 2002 composite rate for dialysis, $130 (of which Medicare paid $103.50), was worth only $34 in constant dollars.(10) Given the nursing shortage—and an inability to raise pay scales to attract nurses—and the anticipated doubling of the ESRD patient population by 2010, dialysis clinics are already stretched to their financial limits, and most cannot make an unreimbursed investment in more frequent hemodialysis treatments, despite reported improvement in outcomes.
The increased cost of more frequent HD may be offset by reduced hospitalization, but the Congressional Budget Office will not credit a Medicare Part A savings (hospitalization) against a Medicare Part B cost (dialysis). A possible solution: consider moving dialysis from Medicare Part B to Part A, placing costs and savings on the same side of the equation (a long-term strategy, to be sure).
In the interim, the MEI is using its Home Dialysis Central website to help support efforts to collect data to prove the clinical and economic value of longer and/or more frequent HD. The website links to the North American Quotidian database to help the effort of Robert Lindsay, MD, in Toronto, Ontario, Canada, to compare daily and nocturnal HD patients with conventional HD patients matched from the USRDS. We will also offer our assistance to the National Institutes of Health’s study center sites to support recruitment for the prospective modality comparison study.
Home Dialysis Central also includes a Legislative Action Center, powered by CapWiz. In this section of the site, visitors can send e-mails to legislators in support of particular bills, write to local media by inputting a zip code, learn about their elected officials, and check on issues and legislation. This center allows us to notify interested supporters of home dialysis to key bills and votes through an e-mail alert system.
We are now requesting sponsors for the Kidney Care Quality and Improvement Act of 2005, which would fund an Institutes of Medicine study to assess and address barriers to home dialysis (http://capwiz.com/meiresearch/mail/oneclick_compose/?alertid=7262756), and we’ll also be tracking the 2005 version of the Daily Home Hemodialysis bill when it is reintroduced. (NOTE: http://capwiz.com/meiresearch/issues/alert/?alertid=8771121&type=CO) To be notified of the progress of this and other bills, sign up for our monthly e-newsletter (it’s free): http://capwiz.com/meiresearch/mlm/signup/.
Additional Barriers
Clearly no website can address all barriers to home therapies. A notable one we have not yet tackled is nephrologist fellow teaching: many nephrologists are simply not exposed to home therapies during their training and don’t feel comfortable prescribing and monitoring these treatments or trusting patients to adhere to the therapies.
We encourage nephrologists who believe in the value of home modalities to share their knowledge by training fellows whenever possible.
Predialysis patient education has been shown to improve the chances that patients will select a home therapy.(11) Paying for this education and making it universally available would go a long way toward ensuring that patients know about and have the option to choose these modalities.
Meanwhile, the MEI’s on-line (and downloadable) Kidney School (http://www.kidneyschool.org), developed under the Life Options program, is the only national, free, Stage 3-5 CKD patient self-management education tool available 24 hours a day.
Fear of self-cannulation is another key barrier that needs to be addressed by the renal community. Having a consistent cannulator may improve the longevity of any access, and since the patient is always present for the dialysis treatment, he or she is the likely candidate. Yet needle phobia is present in an estimated 10% of the general population, and they don’t have to cope with two 14 or 15 gauge needles several times a week.
Low-cost, over-the-counter, topical anesthetics (4% lidocaine; e.g., Topicaine, Less-n-Pain, or ELA-max) can ease needle pain and help patients get past their fear. Use of the buttonhole technique also promises less pain and easier sticks, once buttonholes are created and blunt needles are used. This information is included on Home Dialysis Central at http://www.homedialysis.org/v1/types/buttonhole.shtml, courtesy of Medisystems.
Outreach and Sponsorship
The MEI is promoting Home Dialysis Central through monthly ads in Nephrology News & Issues (via an in-kind sponsorship), Google search terms, free full-color postcards, monthly e-mails, a proactive link-seeking policy, prepared newsletter blurbs for large dialysis organizations and the ESRD Networks, presentations at national and regional meetings, the MEI exhibit booth, and articles like this one.
Sponsorship supports our efforts to advocate and assemble a unified voice on behalf of all home therapies. Clinics interested in reaching our more than 20,000 monthly visitors (NOTE: Now more than 50,000 monthly visitors) may want to consider a tax-deductible Sponsored Center Listing, which creates a full page in our database with a 300-word description, photo, hours of operation, numbers of patients on each modality, and more. New corporate sponsors are always welcome.
Read more about what benefits corporate sponsors get for different sponsorship levels under “Support Our Efforts:” (http://www.homedialysis.org/v1/support/). With your help, we can extend our reach while raising awareness of home dialysis products and services: a win-win for patients, sponsors, and the renal community.
† The Life Options Rehabilitation Program is administered by the Medical Education Institute and supported by an unrestricted educational grant from Amgen Inc.
*Home Dialysis Central sponsors for 2004-2005 include: Founder level - Nephrology News & Issues; Partner level - Fresenius Medical Care, Gambro; Friend level - Aksys, B. Braun, Baxter, DaVita, Dialysis Clinic, Inc., the Forum of ESRD Networks, Missouri Kidney Program, Northwest Kidney Centers, NxStage, Renal Care Group, Renal Solutions, and WellBound.
(NOTE: Home Dialysis Central sponsors for 2006-2007 include: Champion level - AAKP, DaVita at Home, Nephrology News & Issues, Partner level - Fresenius Medical Care, Northwest Kidney Centers, NxStage Medical, Supporter level - DCI, ESRD Network 8, ESRD Network 13, ESRD Network 16, Missouri Kidney Program, Renal Advantage, Inc., Renal Solutions, and WellBound.)
References
- USRDS Annual Data Report, 2004.
- Charra, B, Chazot, C, Jean, G, Hurot, J-M, Vanel, T, Terrat, J-C, and VoVan, C. Long 3 x 8 hr dialysis: a three-decade summary. Journal of Nephrology 2003;16(Suppl 7):S64-S69.
- Kjellstrand, C, Ting, G, Traeger, J, Sibai-Galland, R, Blagg, CR, and Young, B. Survival in 221 patients treated by short daily hemodialysis for 315 patient years. Hemodialysis International 2005;9(1):80. (Annual Dialysis Conference abstract, Tampa, FL).
- USRDS 1997 Annual Data Report, USRDS Dialysis Morbidity and Mortality (Wave 2), p. 53.
- National Center for Education Statistics: http://nces.ed.gov/programs/digest/d95/dtab148.asp
- Witten, B, Schatell, D, and Becker, BN. Relationship of ESRD Working-age Patient Employment to Treatment Modality. Journal of the American Society of Nephrology, Volume 15, September 2004 (Program and Abstracts issue).
- Schatell, D, Ellstrom-Calder, A, Stec Alt, P, and Garland, JS. Survey of CKD patients reveals significant gaps in knowledge about kidney disease. Part 1. Nephrology News
- Obrador GT, Pereira BJ. Anemia of chronic kidney disease: an under-recognized and under-treated problem. Nephrol, Dial, Transplant 2003;17 Suppl 11:44-6.
- McLaughlin, K, Manns, B, Mortis, G, and Taub, K. Why patients with ESRD do not select self-care dialysis as a treatment option. American Journal of Kidney Diseases 2003;41(2):380-385
- Lockridge, RS, Jr. The direction of end-stage renal disease reimbursement in the United States. Seminars in Dialysis 2004;17(2):125-130.
- Schreiber, M, Ilamathi, E, Wolfson, M, Fender, D, Mueller, S, and Baudoin, M. Preliminary findings from the National Pre-ESRD Education Initiative. Nephrology News & Issues 2000;14(12):44-46.
Thank you for sharing this article, Dori. I skimmed it, but intened to re-read it and comment when I have more time. Something I have wondered, does anyone know how many dept’s and how many public servants comprise the ESRD portion of CMS? Are the head individuals appointed? Who apoints them? What are the qualifications for their positions? How does CMS and the dialysis industry interact to negotiate the regulations for care/ modalities for care? Whose job is it to enforce the regulations?
There are probably around 100 people in the Central Office of CMS working on ESRD-related projects in Baltimore. They work in these departments and subsection under them:
– Center for Beneficiary Choices
– Office of Research, Development & Information
– Office of the Actuary
– Center for Medicare Management
– Office of Information Services
– Center for Medicaid and State Operations
– Office of Financial Management
– Office of Clinical Standards and Quality
In addiion, there are a few people in certain regional offices that work regional offices.
There are also people working in the 18 CMS-contracted ESRD Networks.
These people help to administer a complex program that cares for nearly 500,000 dialysis and transplant patients in 4700 dialysis facilities and 230 transplant facilities (2004 data).
Heads of federal agencies are appointed by the president. They, in turn, appoint others in high level management. Others are not appointment, but are hired based on their education and qualifications. Some of the people working in CMS have worked with dialysis and/or transplant patients.
Thank you, Beth. This is interesting. So, there are approximately 100 people who administrate the ESRD program out of Baltimore. How many more would you say are employed by the networks? Do you know what the various depts. handle including those in the regional offices? Can you give a breakdown of what those at the networks do?
Interesting to see that there are approximately 4700 U.S dialysis facilities and 230 transplant facilities.
Do you know what percentage of those employed by CMS-ESRD have dialysis-related medical qualifications?
And the questions that were on the tail end of my previous post:
How does CMS and the dialysis industry interact to negotiate the regulations for care/ modalities for care? Whose job is it to enforce the regulations?