I am a nephrology consultant at a safety net clinic, Marin Community Clinic, in San Rafael, CA. I am aware of a general push to get patients into the home for ESRD services, to both improve QOL and to address costs for ESRD. I have identified an uninsured CKD-5 patient who should have a hidden PD catheter placed, to initiate home training. He has been evaluated by a PD nurse affiliated with Satellite Healthcare, Greenbrae, and deemed acceptable for home training. A private practice nephrologist will assume his care at the clinic and training can begin…WHEN he has the equipment. If he is not trained, he is at risk to enter ESRD via the ER, ICU, a central venous catheter, emergency hemodialysis, a week in the hospital, at an estimated cost of $250,000. THEN, with a CV catheter in place, having had dialysis, he will be given MediCal, and proceed to have placement of a catheter for PD and embark upon training while getting HD. CRAZY! What are the resources I can use to prevent this farce, and motivate others, like myself, to identify what is best for the patient, and society, and then accomplish society’s end; compassionate, cost effective renal care?
Is the patient undocumented? If so there are some kidney fund options for undocumented that my social worker uses, but I personally have found per my surgeon that the buried caths are 30% less effective when unburied. We don’t bury them, we do an non-esrd consent to teach patient how to manage and care for exit site. We continue to have patient go to nephrology consult, and when it’s time we simply begin training and admit patient to the facility. Personally I have been trying to admit undocumented with single payor agreements with the hospitals as well.
Shoot me a call or text to this number tomorrow 1-888-Kidney-0. Would be interested to hear more.