At this point there are a limited number of dialysis clinics that train patients to do home hemodialysis and even fewer offer daily or nocturnal home hemodialysis. Some people have suggested that regional training programs might make home hemodialysis available for more patients. What are barriers to more clinics becoming a regional home hemodialysis training programs?
Im thinking about starting a home dialysis business. Im a dialysis RN in the Detroit area. I was thinking I could travel with a dailysis machine to do in home dialysis . What would be the reinbursement for each treatment? How could i get started
Has your clinic considered offering staff-assisted home dialysis? Some dialysis clinics do, but most do not. Most of the staff-assisted home dialysis that is available seems to be done through supply companies (durable medical equipment companies). Some companies are Medicare participating providers and others are not. Some accept only commercial insurance. I suspect the Medicare providers bill under Method II which reimburses more than what Medicare pays clinics get hemodialysis in-center or at home. You can read about Method I and Method II in the Medicare FAQs on this website.
When a nurse or technician helps the patient do home hemodiaysis, generally the patient has the machine in his/her home rather than the nurse taking the machine from person to person. The nurse or technician goes to the home to do dialysis…sometimes set up and tear down if the patient is too debilitated. I’ve known clinics that have billed Medicare or commercial insurance for the hemodialysis treatments and a few patients who paid a nurse or technician on an hourly or per treatment basis for being his/her partner for home hemo.
There could be a market for paid home dialysis partners especially for single people who want to keep their jobs and need someone to help them do dialysis at times that fit with their jobs. There is even a Social Security work incentive (impairment related work expenses) that could allow Social Security to deduct the cost of an home dialysis partner from countable work earnings if someone on disability goes back to work.
Beth W. writes:
When a nurse or technician helps the patient do home hemodiaysis, generally the patient has the machine in his/her home rather than the nurse taking the machine from person to person. The nurse or technician goes to the home to do dialysis…sometimes set up and tear down if the patient is too debilitated. I’ve known clinics that have billed Medicare…
I heard that NW Kidney Center pays a stipend of $40 per tx for a helper for 3x week home hemo, but do not know how they afford same. Also, have heard of other units that provide helpers. Do you know where the units are located and how they are able to bill Medicare?
Medicare doesn’t currently pay for aides to help patients do home dialysis. Some insurances may pay while others do not. It would be important to ask the patient’s insurance carrier if it has coverage for home nursing. This might pay for a home dialysis helper if a clinic requires that a patient have someone with them during home hemo treatments (most do).
Northwest Kidney Centers is a nonprofit dialysis organization with a foundation that helps pay for care that is not covered by insurance. You’re right…NKC pays $40 a treatment for helpers for people using the B Braun machine. NKC doesn’t pay for helpers when a patient uses the Aksys machine. NKC bills and has collected for home dialysis helpers from some insurance companies. However, even when insurance doesn’t pay, NKC still pays for helpers when needed because their board and staff are such strong home hemodialysis advocates.
Some clinics and durable medical equipment companies offer “staff assisted home dialysis.” From what I gather, most of the patients they care for are very debilitated. I suspect most get paid through commercial insurance since Medicare won’t pay for helpers. It would be interesting to know how many other clinics pay for helpers when patients need help and have no family or friends to serve as a helper.
In case anyone reads this thread. As of January 1, 2011, there is no longer the option for Method II reimbursement from Medicare. Medicare only reimburses dialysis facilities for home dialysis equipment, supplies, and support from the home training nurse, dietitian, and social worker as well as certain labs and ESRD-related drugs under the ESRD prospective payment system (PPS).
The barriers might be machines, complications involved
I’d really like to learn more about the barriers you specified. It’s possible that these are not real barriers, but there is a lack of information that prevents people from offering/doing home dialysis.
Professionals may be reluctant to promote home dialysis and patients may be nervous about doing home dialysis because of the possibility of complications. However, complications can happen in-center as well and staff in-center may have 4 or more patients to provide care to whereas at home there is 1 care partner to 1 patient and both get similar training to what a technician has. If home training is done well by an experienced home training nurse, a home trained patient and/or his/her care partner should know how to handle most complications. Also, dialysis clinics are supposed to provide 24/7 support to home patients, which includes someone who can answer questions about complications if the patient/care partner doesn’t know what to do or has forgotten.
Can you be more specific about machines being a barrier? CAPD doesn’t use a machine. When a machine is used for home HD or PD, that equipment is provided by the dialysis clinic and billed to Medicare and/or other insurance. Home training nurses teach patients how to use the type of machine that they will be using at home, including how to handle alarms and malfunctions and patients can call the machine manufacturer for technical assistance.