Yes, I watched Shona’s story, if you take any system and put people in it there is going to be human error and mistakes are going to made, so I have a hard time being impressed by the isolated cases.
If you want to talk about people falling through the cracks, how about the 18,000 people a year who are dying a year due to a lack of health insurance? Too bad they all didn’t make videos:
"The final IOM report, “Insuring America’s Health: Principles and Recommendations,” culminated three years of in-depth study about the effect lack of insurance has on individuals, families, communities and the country, Coleman said. Among other findings, the reports noted:
• 18,000 deaths a year can be attributed to a lack of health insurance
• Eighty percent of Americans who are uninsured have jobs or are part of families in which someone works
• Uninsured Americans get about half of the care those with insurance receive, and they forego preventive care, such as blood pressure and cancer screenings, and annual check-ups for their children, as well as routine care of chronic conditions such as diabetes and heart disease" http://www.ur.umich.edu/0304/Jan19_04/00.shtml
Huge risk pools for health insurance seem to work, so why not support the biggest of all - just one pool to spread out that risk? And why not support the most efficient system for administration? Something based on Medicare is looking very fine:
“Private insurers take, on average, 13% of premium dollars for overhead and profit. Overhead/profits are even higher, about 30%, in big managed care plans like U.S. Healthcare. In contrast, overhead consumes less than 2% of funds in the fee-for-service Medicare program, and less than 1% in Canada’s program.” http://www.pnhp.org/facts/why_the_us_needs_a_single_payer_health_system.php
Let’s bring this discussion back to the implications of a health plan (of any sort) on home dialysis specifically. I’ve banned NDXUFAN12 for a week for spamming, and I’d like us to return to our REAL topic.
DaVita’s first quarter of 2009 Earnings Call (from April 28, 2009) transcript is online available from Seeking Alpha. It includes DaVita CEO Kent Thiry’s take on healthcare reform and what a “public plan” would mean for DaVita. At the Kidney Care Partners’ meeting recently in DC I heard that alarmist terms were bandied about when discussing what the impact might be of a public insurance plan (here is a PDF making the case for a robust public plan). Reading through the DaVita call transcript it is clear that Davita’s business model depends on treating people with private insurance and a robust public plan is seen by DaVita as a threat to their business model.
In prepared remarks to start the call Thiry asks and answers a series of questions on the issue health insurance reform: Question number two, what benefit would the dialysis received from any expansion coverage for the uninsured? The answer is simple. It would be a positive if we increase the number of insures with private insurance and neutral if the expansion were entirely Medicare.
His answer isn’t complete because it leaves Medicaid out of the equation. Right now if someone has CKD5 and no insurance they will, in most states, have to spend down to qualify for Medicaid. After 33 months they’ll qualify for Medicare if they have enough quarters of work. Those with Medicare through disability or CKD5 vintage might still need Medicaid to pay the 20% not covered by Medicare - these are the so called dual eligibles: Medicare primary and Medicaid secondary.
In most states Medicaid is an awful payer. On average 10% of DaVita’s patients are Medicaid primary and an additional third likely have Medicaid as their secondary payer to Medicare but at no time during the call is Medicaid mentioned. In some states when Medicaid is secondary to Medicare, Medicaid does not pay the 20% Medicare leaves unpaid. To the degree a public plan would draw in people who are currently covered by Medicaid, dialysis providers (including DaVita) will benefit and it is a significant benefit in states where Medicaid is a bad payer, for instance Florida where DaVita has many units.
Again and again on this call the importance of the private payers are highlighted (note there is an error in the transcript in several places they have “pair” instead of “payer”) and health insurance reform is seen only through the lens of what it would mean to the lucrative business of treating private pay patients. I understand that this is a point of view coming from a for profit dialysis provider with fiduciary responsibilities to stockholders, that’s fine. But I think this is the wrong way for the KCP to position themselves on the issue.
I think a public plan would be very good for the people of working age who require dialysis and I think a public plan would just as likely increase average reimbursement in many states. I think the KCP should support a public insurance option.
DaVita and the rest of the US dialysis providers are not driving the healthcare reform discussion in DC but as matter of principal KCP should support reform that would allow people treating their CKD with dialysis options, options other than Medicaid. A robust public insurance option would allow people with CKD5 options that are now closed, particularly employment and entrepreneurial options. It would improve the lives of those with CKD5 and there is no reason to think it would decimate dialysis provider finances.
ETA: Reading back through this I think you would also have to consider the impact of more widespread CKD care. How many people with no insurance who show up in the ER needing dialysis would have been able to slow their CKD if they had access to basic healthcare? You would also see more people with working fistulas at the start of dialysis.
I have very strong views on this subject, but I think it’s gotten to the point that it’s degrading the entire forum. Quite frankly, I don’d think anybody’s going to change the other person’s views. I think we should get back to the business of home dialysis. I’m refusing to get caught up in these arguments. It’s not going to matter what’s argued on these pages. The die has been cast, and I don’t think either side is going to get what it wants. From my perspective, that’s too bad. Because until this country has a truly Universal Healthcare system, we will continue to see costs go up and healthcare becoming a memory for most. That’s all I’m going to say. I’m not going to back up my words. I just want to get back to where members of this group regain their footing and support each other with their home dialysis,
I apologize if I overindulged one of my passions. I will say if we had a Medicare-for-all program I don’t see it denying payment for home dialysis like I have heard some of the private insurance companies doing.
Anyway, thanks for allowing me a chance to express how I feel about all this.
Bill! Good to hear from another old-timer! (my daughter is the one dealing with kidney disease by the way, has a transplant) I still remember you being the one informing me how reimbursement for dialysis drugs worked - hoped that has changed; I don’t recall seeing much lately.
Still with Northwest Kidney Centers? Dr Belding Scribner, one of the founders or founder of NKF, has always been an inspiration. I recall him being quite concerned about the for-profit motive in medicine: http://www.seattlepi.com/opinion/129982_scribner09.html
I’m sorry I didn’t respond to this statement sooner, but I must have overlooked it.
Bill’s posting in early July said: “His [Kent Thiry’s] answer isn’t complete because it leaves Medicaid out of the equation. Right now if someone has CKD5 and no insurance they will, in most states, have to spend down to qualify for Medicaid. After 33 months they’ll qualify for Medicare if they have enough quarters of work. Those with Medicare through disability or CKD5 vintage might still need Medicaid to pay the 20% not covered by Medicare - these are the so called dual eligibles: Medicare primary and Medicaid secondary.”
Those who have Medicaid and enough work credits to qualify for Medicare qualify for Medicare the month dialysis starts if they start a home training program prior to the 3rd full month. Those who don’t have enough credits to qualify for Medicare, can earn credits after they start dialysis.
If someone with Medicare qualifies for a program called Qualified Medicare Beneficiary, the state Medicaid program must pay the full amount of Part A and Part B deductibles and coinsurance for Medicare covered services. Workers with disabilities can qualify for Medicaid even if they have incomes of 250% of the federal poverty level under the Medicaid Buy-in program in those states that have chosen to offer this under Ticket to Work legislation. http://www.cms.hhs.gov/apps/firststep/content/medicare_dualelig.html
BTW, some patients have individual plans when they start dialysis and some dialysis facilities have billed those plans primary as if they were obligated to pay primary under Medicare secondary payer. Only those with employer group health plans must meet a 30-month Medicare secondary payer period. Individual plans are not liable for primary payment for dialysis if they’re not paid for or sponsored by an employer. They should always be billed secondary to Medicare.
Coverage for patients who get jobs or employer group health plan coverage as a worker or dependent during the Medicare secondary payer (MSP) period will shift to the employer group health plan for the remainder of the MSP.
Finally, if dialysis facilities educated more patients about home HD, offered home HD and evening shifts for patients who don’t have partners for home HD, encouraged social workers to learn about programs that promote work, and gave social workers the time to help patients use the work incentive programs instead of mis-using them as financial coordinators, maybe more patients who have Medicaid only would have better coverage for dialysis and other healthcare needs and providers could be better off financially too. Why they haven’t figured this out is beyond my comprehension.
Finally, if dialysis facilities educated more patients about home HD, offered home HD and evening shifts for patients who don’t have partners for home HD, encouraged social workers to learn about programs that promote work, and gave social workers the time to help patients use the work incentive programs instead of mis-using them as financial coordinators, maybe more patients who have Medicaid only would have better coverage for dialysis and other healthcare needs and providers could be better off financially too. Why they haven’t figured this out is beyond my comprehension.
One of the major reasons why Medicine is so expensive:
Dr. Rezko Will See You Now
July 24, 2009
The President, who suggested Wednesday night that doctors routinely perform unnecessary, dangerous surgery on children for profit, thinks that government bureaucrats are more qualified to prescribe treatment for these children than are physicians. His superior faith in unelected, unqualified bureaucrats over medical professionals should be no surprise. He learned it while serving quietly as an appendage of the Chicago Democrat political establishment and protecting corrupt state entities like the Illinois Health Facilities Planning Board.
I have committed this campaign to sharing with you the true nature of state government systems and unelected entities that are fixed against our interests. The Health Facilities Planning Board, which the Chicago Tribune recently referred to as a “Soviet-style exercise in central planning,” is yet another life-threatening example.
Before your community can build a new hospital, it must go before the politically-appointed Health Fac ilities Planning Board and prove to its members that the new hospital will not compete with any with existing hospitals. You heard right: the state actively restricts the number of healthcare providers in your community.
Do you think a new kidney-transplant facility would be a good thing for Illinois?
Oak Lawn’s Advocate Christ Medical Center is seeking state approval to start Illinois’ first new kidney-transplant program in more than decade. This plan has been approved by the United Network for Organ Sharing, the national transplant accreditation body. But that’s not enough in Illinois.
Advocate must now seek approval from friends of the Governor who sit on the Health Facilities Planning Board. Why must a provider of life-saving services kneel before bureaucrats in order to save lives?
Because building hospitals is big business for the political class. There is money to be made and influence to be sold. You might have first heard about the Health Facilities Planning Board during the Tony Rezko federal corruption trial. A former member of the board, Stuart Levine, was using his influence to get kickbacks on projects the board was reviewing, and splitting those kickbacks with Rezko.
But this is not simply a personnel problem. Corruption in Illinois state government is like water, it finds its own level. The corruption that has plagued the Health Facilities Planning Board flows from the very existence of an unelected body of political appointees with such decision-making power.
The Board itself is the problem.
But instead of abolishing this counter-productive and, frankly, dangerous entity, the state has decided to expand it, from 5 to 9 members. Only under the reign of the Chicago 9 is expanding membership on a corrupt body whose very existence impedes the sensible development of our state’s health infrastructure seen as reform.
If President Obama feels ill, he is welcome to visit Dr. Rezko or Dr. Levine for his diagnosis. But in Illinois, under a Proft Administration, you’ll be able to see a doctor at a hospital in your neighborhood. I will abolish the Health Facilities Planning Board and expand, rather than restrict, medical access in Illinois by freeing hospitals and health care professionals—the people who actually know what they are doing in the health care sector—to make the sensible decisions about the needed developments to our health care infrastructure.
Bringing system change reforms to Springfield may require a collective spine transplant for the General Assembly, but at least such a procedure would not require Health Facilities Planning Board approval in a Proft Administration.
For those in both parties content to tinker on the margins while the quality of health care in Illinois suffers, Dr. Junkyard Dog is ready to see you now
Care is rationed by government mandates that push insurance policy costs beyond the income levels of individuals and families. Why in the world would someone who is twenty-five years of age purchase a health insurance policy that is hundreds and hundreds of dollars per month, for services, he or she is not likely to ever use in this lifetime? Slash taxes and regulations, along with mandates, and then, young and health individuals will be much more likely to purchase health insurance policies.
Since Congress doesn’t want to read the Health Care Bill and Obama, ACORN, Unions, Lawyers, & Special Interest Groups don’t want you to know whats in this monstrosity, I decided to do it myself. I’ve taken all my tweets on the HC bill and put them into one single place for your enjoyment. Additionally here is the link to the full bill – [B]Health Care Bill [COLOR=Black]Checkout Fleckman’s Blog
It is looking more and more like the future of dialysis is bleak. Those who govern us have clearly told us that Medicare is just too expensive and needs to be cut.
This means that dialysis needs to be cut. Maybe not for all people, but for those over 70. Some may see this as a plus, because it will yield more $$ for younger people.
At the same time, i can’t see any percentage for the government to go into frequent home dialysis. I know those that argue that when you add hospitalizations to direct costs of in-center dialysis that you will spend more that HD.
But, if you try and argue that HD is more efficacious and allows people to live longer, you’re just ceding the argument that it is too costly. The total cost of 10 years of HD will cost more that 5 years of in-center dialysis plus whatever hospitalizations you have.
The only way to care for all the dialysis patients is to have a robust economy and an innovative healthcare system whose main goal is to care for their patients.