When the Dialysis Industry Screams About Reimbursements

Discussions for Patients, Family, and Friends HD For Patients
1

Have three family members that are in Nursing.

I work for Fresenius Medical, and I believe they do provide some sort of compensation for the certification, but I’m not eligible to sit for it yet… two of the nurses I work with have the certification.

Pay depends largely on where you live and your specific job responsibilities. I was out of nursing for a couple of years before I found this company last year, so I don’t know how they compare to other positions in nursing – but I have nothing to complain about. Fresenius offers an AMAZING benefits package, and many of the perks my coworkers were not aware of until I did the research and pointed it out to them. There is a Flexible Benefits program, choice of two major carriers for health insurance, with three levels of coverage on each (also dental and vision), discount programs with automobile makers (I was able to buy two new Ford vehicles last November at less than dealer cost), they match up to 3% of your pay when you contribute to their 403b retirement plan (after the first year), and tons of other discounts with health clubs, LASIK surgery, and on and on. My unit utilizes a 7-on, 7-off schedule, which I LOVE: Our weeks run from Thursday to Wednesday, so we work Thurs/Fri/Sat, have Sunday off (except for the one nurse taking call, which means once every 2-3 months), then Mon/Tues/Wed. Then we have 7 straight days off, which is great because you can plan so many things (like dr visits or vacations) that you would otherwise have to take vacation time for. Then twice a year you can sell back your vacation time for cash.

My unit is inside a major hospital, and our benefits are WAY better than those of the staff that actually works for the hospital. That’s how we get many of our nurses – they jump ship from the hospital to join us!

One thing about Dialysis – you either love it or hate it. There’s a good six-month learning curve before you really start to gain confidence and it is extremely technical. You are taught everything you need to know, and the training period (with classes) is 1-2 months long. I have found it to be much more satisfying than previous positions I had in OR or ICU. Acute (inpatient) is quite different than outpatient.

Hope this helps.

2

I’ve got alot to say on the subject, but before I jump the gun I’d like to know what your post has to do with “When the Dialysis Industry Screams About Reimbursements”. I read the threads on the link you posted and it seemed there was almost unanimous agreement that the LDO’s didn’t provide “patient first” service, nor did they treat their employees that well either.

3

My point is that if the reimbursements were as bad as dialysis industry claims, they would not be able to provide that level of compensation for their employees. I provided the link so you would be able to read the link for yourself.

Mark

4

Mark,

The LDO’s are making quite a bit of money, much more than the SDO’s whose cost structure is about 8% more because they can’t buy supplies in the same volume. And I certainly don;t want to see the SDO’s go out of business or get bought by the LDO’s. Right now the LDO’s account for about 70% of the in-center dialyzors in the country. And we can probably debate all night wheter they provide better service than the Small independents, but not tonight.

What we home dialyzors need to be concerned about isn’t the over all profitability of dialysis prociders, but how Medicare reimbursement affect us. Currently most MACs are pauing for all home treatments if the neph gets the paperwork done to shoe a medical necessity for more treatments. That’s usually using a reason of fluid overload or congestinve heart failure. With CMS about to define the new bundling package, it hasn;t been decided whether they will continue with per treatment reimbursements, or weekly or monthly reimbursements. If they decide on monthly, then they will give a reimbursement for 13 treatments per dialyzor. That could cause a real problem for us. We need to act very quickly to put as much pressure on CMS as possible to maintain the current reimbursement method.

BTW, while a dialyzor is in the Co-ordination of Benefits period, they make tremendous amount of money from private insurance companies, often charging around $1500 per treatment, just one of the reasons why they were in favor of extending the COB from 33 to 60 months when Bush tried to change it.

5

[QUOTE=Rich Berkowitz;17756]Mark,

The LDO’s are making quite a bit of money, much more than the SDO’s whose cost structure is about 8% more because they can’t buy supplies in the same volume. And I certainly don;t want to see the SDO’s go out of business or get bought by the LDO’s. Right now the LDO’s account for about 70% of the in-center dialyzors in the country. And we can probably debate all night wheter they provide better service than the Small independents, but not tonight.

What we home dialyzors need to be concerned about isn’t the over all profitability of dialysis prociders, but how Medicare reimbursement affect us. Currently most MACs are pauing for all home treatments if the neph gets the paperwork done to shoe a medical necessity for more treatments. That’s usually using a reason of fluid overload or congestinve heart failure. With CMS about to define the new bundling package, it hasn;t been decided whether they will continue with per treatment reimbursements, or weekly or monthly reimbursements. If they decide on monthly, then they will give a reimbursement for 13 treatments per dialyzor. That could cause a real problem for us. We need to act very quickly to put as much pressure on CMS as possible to maintain the current reimbursement method.

BTW, while a dialyzor is in the Co-ordination of Benefits period, they make tremendous amount of money from private insurance companies, often charging around $1500 per treatment, just one of the reasons why they were in favor of extending the COB from 33 to 60 months when Bush tried to change it.[/QUOTE]

I would agree, I really like the non-profit companies. I think the LDO’s are lousy. The Boston Renal Conference is very telling, directors would not have treatments in their own centers, how telling. We do need to keep the heat on CMS, could not agree more with your post. The dialysis industry badly needs competition. I am really thinking about switching to a non-profit group. However, I do not want to lose my nephrologist. The nephrologist is great, very even keeled and reasonable. I talked to high ranking aide for my state rep for about 30 minutes, really hammered home the benefits of nightly nocturnal dialysis, and how they could save thousands of dollars, per patient, per year.

In my mind, the compassionate approach to dialysis is nightly nocturnal or daily dialysis. The cost savings per patient are incredible and the patient is much happier, a win-win situation. It really blows my mind that it has taken this long for a change of approach and thinking. Sometimes, when I talk to these people in the dialysis industry, I want to bang my head against the wall. Quite honestly, I have thought that professional people are control freaks, until I have met certain individuals in the dialysis industry. What part of “NO” do they not understand? I have never met such a group of people with such group think in my life, do anything of these people think for themselves?

Mark

6

Hi Mark,
I’m confused about whether you work for a dialysis company, are a dialysis consumer, or both.

There have been a number of studies comparing dialysis care between for profit and non-profit companies, and there is NO difference between them. If anything, the larger companies may have more resources to devote to quality improvement and patient education efforts.

As far as the docs at the Boston conference not wanting to dialyze in their facilities, I think they probably meant they were not willing to dialyze in-center (with standard treatments) at any facility, because the ones who are “in the know” are aware that more dialysis is better for day-to-day health and long-term survival.

7

I am a dialysis consumer. I meant in terms of how the dialysis consumer is treated, not level of care. I would agree on an economics scale that larger companies have more resources to devote to quality improvement and patient education. Yes, I would agree, I am sure the directors would realize that standard in-center dialysis would not be an optimal level for long-term survival on dialysis. For long term survival, I believe that nocturnal dialysis is the best modality.

Mark

8

You’re on dialysis and you for FMC?

9

What I failed to mention before when stating that the total costs to SDO’s is about 8% higher than LDO’s is that the cost of meds for LDO’s is about 2% higher. If there seems to be a disconnect with that data there is. It seems that the LDO’s are overdosing on Epo and thus making a huge profit.

10

What do you mean overdosing on EPO- I thought the profit incentive had been removed? BTW, does anyone know how clinics formerly overdosed on EPO and were allowed to get away with it? My neph and nurse were jesting one day about how they previously made profits off of EPO, but can’t do it anymore. What is this about?

11

No, I went to the In-center clinic for FMC, was not impressed.

Mark