I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: News Articles => Topic started by: okarol on January 08, 2011, 07:53:34 PM
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New rules may increase patients on home dialysis
By ALICIA CHANG, AP Science Writer
Sat Jan 8, 5:21 pm ET
LOS ANGELES – Rodney Sokoloski used to get up before dawn three times a week and drive two hours from his high desert home to the Los Angeles suburb of Torrance to get hooked up to a dialysis machine.
The blood-cleansing treatment was time-consuming and often left him feeling drained even before his workday began.
Not anymore. After four months of shuttling back-and-forth, the 61-year-old last year switched to doing dialysis at home every night while he sleeps. He starts it after dinner, wheeling the dialysis machine — the size of a carry-on suitcase — into the living room where he can watch TV or chat with his wife.
"It makes you feel like you're in control of your life," said Sokoloski, whose combination of diabetes and high blood pressure led to kidney disease.
Yet only about 8 percent of kidney patients do dialysis at home. Many don't know they can. Others are afraid to try it. And a limited number of places around the country offer training and support for home dialysis.
New Medicare payment rules that just went into effect could change that. The changes give dialysis clinics more motivation to control costs and raise the amount centers get to teach do-it-yourself dialysis.
As for the patients, Dr. Leslie Spry of the National Kidney Foundation says, once they "experience the difference between home and in-center dialysis most will not return to in-center treatment."
There are two types of dialysis that can be done at home. The older and more widely used method — peritoneal dialysis — uses the lining of the abdomen to clean out waste. Patients pour a fluid into a tube in their belly and drain it out several times a day, or a machine handles that while the patient rests — the approach Sokoloski uses.
A second, newer method is home hemodialysis. Blood is drawn through a tube from the arm and pumped through a portable machine where it is cleansed and returned to the body. Patients do this four to seven days a week for about 2 1/2 hours each time.
People who prefer home dialysis say it's more convenient, allowing them to set their own schedules and even travel with their dialysis machine. They also like the idea of cleansing their blood of toxins more often because they feel better and don't need to take as many drugs.
Dialysis clinics used to bill Medicare separately for costly medications such as the anti-anemia drug Epogen and often made a profit on it. Under the new payment system, centers get a flat rate for dialysis treatments, and certain lab tests and drugs including Epogen.
This bundling may spur the industry to take a closer look at home therapy since people who dialyze in their living rooms tend to take fewer drugs than those in centers, cutting costs, according to the kidney foundation and some doctors.
Slightly higher reimbursement to centers to do home training and to health care providers who tell patients about their choices may also help send more patients home, they say.
LeAnne Zumwalt, vice president of DaVita Inc., which runs 1,600 dialysis clinics, said the company already provides home training to patients who meet the criteria. Zumwalt doesn't think the ranks of home dialysis patients will expand significantly unless Medicare reimburses for more treatments, especially for those on home hemodialysis, which requires more supplies and is costlier to support.
Home dialysis isn't for everyone. It can be scary. People who are frail, squeamish about blood or who don't have family support at home are not good candidates.
It requires weeks of intensive training and involves some risk: There's potential for infection and the chance of getting an air bubble into the bloodstream, which could lead to death in rare instances. Patients are trained what to do in such emergencies. Many dialysis centers require that spouses or other family members also get schooled as backups.
Eugene Abbott bypassed in-center dialysis and started home hemodialysis last summer after five weeks of training. It's been a learning curve. Sometimes the machine's alarm goes off and he's had to stay calm and troubleshoot.
"It's mind-boggling. There's a lot of things to learn," said the 58-year-old machinist from Lincoln, Neb.
He now does dialysis at home six days a week for about three hours each session. During college football season, he skips Saturdays so he can go to games.
The outlook is good for the future of home dialysis. Research published last year in the Archives of Internal Medicine found that patients who do it themselves fare as well as those who went to dialysis centers.
"The biggest challenge in this country is that most patients don't know they have the choice to dialyze at home," said Dr. Rajnish Mehrotra of Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center who led the study. "Many people would prefer to dialyze at home, but they're afraid."
Nearly a quarter of Mehrotra's patients now do home dialysis — a number that has grown because nurses explain the home dialysis option on a patient's first visit.
Lois Lucci was among Mehrotra's patients who chose home dialysis in 2008. Lucci does it while she sleeps so her days are free when she's not working part-time as a nurse.
"I can go shopping. I can run errands. I can pretty much do anything except go swimming," said the 53-year-old from Redondo Beach, Calif. She takes the dialysis machine with her twice a year to visit family on the East Coast.
Sokoloski, who works in the high-performance automotive industry, hopes to travel soon. He recently bought a vintage Chevrolet hot rod and plans to take his dialysis machine and supplies with him on the road to car shows around the country this year.
"Some people, when they find out they have kidney failure, just curl up in a ball. That's not me," he said.
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Online:
NIH dialysis info: http://health.nih.gov/topic/KidneyFailureandDialysis
National Kidney Foundation: http://www.kidney.org
Home dialysis training locator: http://www.homedialysis.org/locate/
http://news.yahoo.com/s/ap/20110108/ap_on_he_me/us_med_home_dialysis_4
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Home dialysis is NOT more costly...that's a lie. For one thing, you don't incur the labor costs of the techs/nurses/staff. The issue really isn't where dialysis is done, rather, it's how much you get. It's just easier to get more dialysis at home because you don't have to fit into a clinic's schedule. Patients should be able to get MORE dialysis in their clinics.
If you really want to look at the costs, keep in mind that patients are healthier if they get more dialysis, so money is being saved because you have fewer hospitalizations.
I think home dialysis is going to grow over the next five years as the technology gets better, smaller and more portable.
It is true, though, that home hemo is not for everyone. That's why we have to ensure that everyone gets enough dialysis, not just those who dialyze at home.
Thanks for posting this!
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Home dialysis is NOT more costly...that's a lie.
A lie? Really? This isn't the first time you have used such an absolute without looking at all the facts.
Initially, home dialysis is more expensive than in center. According to the most comprehensive clinical trial comparison analysis to date, "cost savings are only statistically significant if the patient remains on the home modality for at least three years."
http://www.nature.com/ki/journal/v62/n6/full/4493344a.html
The investigators, proponents of home dialysis, also admitted to the shortcomings of the study (including the need for a larger-scale prospective trial with randomization of patients to their form of dialysis and participants did not represent "average" hemodialysis patients) so their conclusions should not be generalized to the broader dialysis population.
I think home dialysis is going to grow over the next five years as the technology gets better, smaller and more portable.
Grow, yes. There will be nephrologists, mainly those unaffiliated with for profit centers, who will take a closer look at outcomes literature and begin to work the modality into their patient populations. At a healthy rate? Not until the for profit providers get on board.
Patients should be able to get MORE dialysis in their clinics.
Not going to happen anytime soon as long as the providers have so much influence over politicians. The NKF and the nephrologists have been bought off by them as well. Here in the States, the vast majority of patients come from lower socio-economic groups and have no clout. Also doesn't help that there is no longer a widely respected national kidney patient advocacy voice.
What's it going to take then? Probably a few high ranking career bureaucrats in CMS and the GAO saying enough already to the providers! Let's start educating them.
In the meantime, how about all of you on this site who have been complaining about facility and nephrologist quality of care issues start initiating grievances with the local ESRD Network. Put it in writing so there is a record. Also, send a copy to your U.S. congressional representative and senators. They need to know the current delivery of care system is broken!
Another idea for those of you who have a bit of discretionary cash - buy a share of stock in DaVita and Fresenius. Then you can have access to communicate directly to shareholders. Let them know what truly is going on in the clinics. Shame them for investing in a company that puts profits over patient needs and quality of care!
Just a newbie lurker's thoughts. - PatDowns
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Just a newbie lurker's thoughts. - PatDowns
Where are you from? and welcome to the forum, PatDowns. It will be nice if you can introduce yourself and post something about your location, gender and background for your first post. Thank you and look forward to your participation.
http://ihatedialysis.com/forum/index.php?board=14.0
The study you are quoting is coming from Canada, it may have nothing to do with the for profit structure of most (70%+) in-center dialysis centers in the US where I believe MM is residing.
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PatDowns, what a lovely and gracious first post. Thank you so much for that.
I'm not touching this one.
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It's very difficult to take this article seriously when it contains such obvious factual errors, e.g.: peritoneal dialysis being older and more widely-used than hemodialysis. It's almost as if the author did no actual research at all.
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It's very difficult to take this article seriously when it contains such obvious factual errors, e.g.: peritoneal dialysis being older and more widely-used than hemodialysis. It's almost as if the author did no actual research at all.
Oh, fer cryin' out loud... the article was about HOME dialysis, wasn't it? Obviously my reading comprehension isn't what it used to be, so I'm just going to shut up now. (Is that applause I hear all around?)
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^^
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Another idea for those of you who have a bit of discretionary cash - buy a share of stock in DaVita and Fresenius. Then you can have access to communicate directly to shareholders. Let them know what truly is going on in the clinics. Shame them for investing in a company that puts profits over patient needs and quality of care!
Good idea. And you might even earn a few dividends while you're at it.
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DaVita and Fresenius have home dialysis business too. For the rate I paid, Fresenius is making a huge profit from me as a home dialysis patient. I believe this profit margin is higher than any in-center patients. I believe the low % of home dialysis patients have much to do with the patients and neph.
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I believe the low % of home dialysis patients have much to do with the patients and neph.
Do you think that nephs don't tell more of their patients about home dialysis?
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The neph does play an important role for patients to choose dialysis methods. Patients here (this board) are very active and can choose their method. However, a lot of patients do not know much and follow what their neph told them.
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The neph does play an important role for patients to choose dialysis methods. Patients here (this board) are very active and can choose their method. However, a lot of patients do not know much and follow what their neph told them.
I know a lot of patients end up on dialysis quickly without having much time to prepare, but even so, do you think that most nephs educate their patients as to the different modalities available?