Believe it or not, after reviewing the math, Staff Assisted Home Dialysis(6x week) is cheaper than In-Center Dialysis(3x week). In fact, the beginning savings for the government and taxpayer would be in the neighborhood of $10,000.00 per year. However, this figure does not include other savings such as the elimination of drugs or Hospital costs. The average Nocturnal client is in the hospital only 1-2 days per year against the average In-Client hospital stay of 17 days per year. (UCLA)
The time has come for each and everyone of you to tell your family, parents, friends, and neighbors, and any taxpayer that you come in contact with, to show them how they can truly help you and themselves as taxpayers. I have told as many of these people as possible, as well as the taxpayers. It is time that this taxpayer and dialysis consumer rip-off and cruelty to stop.
It makes sense to me that home dialysis should cost far less than in-center. However, on the chart on the home page of this website, that compares the different types of dialysis, it says a ‘drawback’ to home daily and home nocturnal dialysis is that they cost the centers more. http://www.homedialysis.org/learn/types/ This must be an error but I have also heard and read this before. Can someone explain this?
Too bad the primary focus and reason to push home dialysis isn’t on the well being and health benefits to human beings. That should be reason enough.
[QUOTE=Wendy Ramsay;20541]It makes sense to me that home dialysis should cost far less than in-center. However, on the chart on the home page of this website, that compares the different types of dialysis, it says a ‘drawback’ to home daily and home nocturnal dialysis is that they cost the centers more. http://www.homedialysis.org/learn/types/ This must be an error but I have also heard and read this before. Can someone explain this?
Too bad the primary focus and reason to push home dialysis isn’t on the well being and health benefits to human beings. That should be reason enough.[/QUOTE]
Any stats that I have seen from people who work in the Staff Assisted Home Dialysis field have shown that this form of dialysis is cheaper or at worst, the same level of cost for more dialysis.
Perhaps Dori, Beth, or whomever presented the chart on the home page titled, “Modality comparison: minuses” could explain the entries that are checked under the columns for Daily HHD Nocturnal HHD in the row at the bottom named “Clinics lose money on it”. Those are the only two modalities listed where centers ‘lose money’.
This has always confused me.
Hi Wendy, we put this chart together. The numbers basically come down to the # of treatments per week. Medicare (and therefore many health plans) only pay for 3 treatments per week. Offering treatments 5-6 days a week costs more, even if they are done at home, due to machine rental and supplies (PACs or bags of dialysate, dialyzer cartridges…).
I’d like to see the data that staff-assisted costs less than standard in-center.
I treat 6+ nights/week. My insurance has paid incenter rates for every one of my unassisted home treatments. Soon, unfortunately, I will be forced to go on Medicare like all dialysis patients after the coordination period. My time is up in July. I certainly hope my center will continue to get paid for all my home treatments. Why does Medicare only pay for 3 treatments??
Medicare pays for 3 treatments because of a historical accident. In the 1960s in Seattle, where dialysis first started in the US, the treatment was experimental. Insurance would not pay for it, but a few Government pilot sites were set up to study it. Researchers were not sure how much dialysis was needed–but there were not enough machines and dialyzers for everyone who had kidney failure to be treated. So, they had “Life and Death Committees” of clergy and public volunteers who would read the medical charts of people who needed treatment and decide who would get it–or not. I know several people who lived through this process!
Meanwhile, researchers tried 1 day of dialysis a week, and people died. 2 days, and they died. 3 days (but remember, these were 8-12 hour long treatments back then) and they lived. So, when Congress was persuaded in 1972 to pay for dialysis, the 3x/week schedule was written into the law. But there turned out to be MANY more people who needed treatment than Congress had been told–so many that there was pressure to make the treatments shorter to fit more people in. Medicare said 3 treatments–[i]but they never said how long they had to be[i]. In the 1980s, high flux dialyzers came out, and they were sold on the basis that “you can do a 4-hour treatment in 2 hours.” This seemed like a win-win: folks could go home sooner and dialysis clinics could get more people in the chair and be paid for more treatments. The mortality rate went up until treatments slowly started to get longer again–but they’re still far shorter here than in Europe or Japan, and the survival rates there are far better than ours.
Does that help?
Yes, Dori, thank you. Now I remember. How tragic. There is so much information about dialysis that, to date, I have only focused on the parts that directly affect me at any given time as I, joyfully, pick up and start living the other parts of my life. I hate to admit it, but following the life-consuming research and fight I had against cancer from 2005 - 2008, I have been unable to hone in on many of the aspects of the world of dialysis. I think I have been recouping all this time since. It’s evident that I need to take more time to dig in to this world of dialysis as my life has taken on a more predictable pace. Thank you to everyone who has so unselfishly continued to educate everyone over and over again and for all the great efforts that are being done to create much needed change for dialysis.
Believe it or not, after reviewing the math, Staff Assisted Home Dialysis(6x week) is cheaper than In-Center Dialysis(3x week).
Can you provide a reference? I’d be very interested in reading the article to find out if the data include inpatient as well as outpatient charges for both 3x/week and 6x/week with and without a paid helper, whether the data is based on charges billed to commercial payers and Medicare or payments made.
Commercial payers and Medicare have approved amounts, but Medicare’s is likely to be less than the commercial payers (which also vary as to how much they pay). Medicare reimbursement policy does not allow payment for a helper and recently stopped paying Method II providers directly and they now have to bill clinics and clinics must bill Medicare and/or other insurance. I’ve heard that some commercial insurances and long-term care policies apparently do pay for helpers for those who use paid helpers. I have known of some clinics that provide staff-assisted home dialysis (they’re in the Home Dialysis Central’s Find a clinic near you database), but they’re few and far between. Time will tell whether bundling will encourage more or fewer clinics to offer home HD. Many people believe it will stimulate growth in PD more than home HD.
The cost of providing Nocturnal treatments 6x per week, per month is $9,600.00 with a Registered Nurse. The cost for In-Center dialysis 3 times per week with an ambulance is $10,560.00 per month. In my In-Center experience, most of the individuals on dialysis need someone to drive them to the treatments, many do use an ambulance in my experience. These costs savings do not include the reduction or in the vast majority of cases the elimination of medications in the life of the dialysis consumer. In fact, nocturnal dialysis is comparable to a kidney transplant. Moreover, this does not include a great cost savings to Medicare Part B due to a major reduction in the number of hospital visits and admissions by 15 days per year, per patient. The beginning cost savings per dialysis consumer with staff assisted home dialysis is $11,520.00 per year, per patient.
Table 2. Weekly Costs of IHHD, ICHD and SAHD
Cost of bed : 585 × 7 = $4095
Dialysis cost (246+127) : 373 × 3 = $1129
Total cost per week : $5224
In-Center Hemodialysis with ambulance transportation
Ambulance cost : ∼375 one way
Weekly ambulance cost : 375 × 6 = $2250
Weekly dialysis cost : 130 × 3 = $ 390
Total costs per week : $2640
Staff Assisted Home Hemodialysis
∼ $400 per treatment × 3/Week : $1200
Most people do NOT get to standard in-center HD via ambulance–only a tiny minority does. This was a very small study–just 28 people who were terminally ill or very debilitated. It’s nice to see that the staff-assisted costs were not that high, but unfortunately this doesn’t prove anything.
Years ago–in the '70s or early '80s (Beth would remember), Medicare used to pay for a home partner for dialysis. But–as with MOST of Medicare, there was some fraud found. Medicare threw the baby out with the bathwater and hasn’t paid for a home helper since. It would take more than one small study of costs to get them to reverse this, especially since Medicare fraud overall is estimated at $6 BILLION a year… This could be a worthy goal for advocacy, though.
My experience was different than yours, I saw many use the ambulance. I am happy to hear that many do not.