I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Centers => Topic started by: bluedove57 on March 17, 2007, 06:48:01 PM
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I'm in North Carolina visiting my daughter and am using one of Davita's clinics. It is yukkkk!!! :thumbdown; The chairs are all busted and taped together. The nurses are nice but couldn't care less about the patients. They wanted to give me Epo when my clinic specificly told them I didn't need it. They were told I can ride at 85 with my blood pressure and I fiind out I'm not feeling good because I'm riding at 75. The nurse said he was aware of my pressure but watching it. That could so easily clot my access. I asked for some saline to bring my pressure up so only then they gave me some. A half hour before my treatment was over I told them I had a slight cramp in my back if they could give me 100cc saline but instead they took me off. They didn't want me to have a bad weekend. I have 4 treatments left and get worried they will kill me or just pretend I'm not there. I didn't reach my clearance because they took me off early. I think they wanted to get out of there so the hell with me. I may be a guest visiting but I still have a condition that has to be monitored. :thumbdown; :thumbdown; for Davita. I feel for anyone that has to use Davita as their clinic all the time.
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Epoman would have a field day with this one, lol, What is scary is that you just described the unit that i used to go to when i was on hemo, yes it is Davita too. >:(
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Ask for copies for each of your treatment runs. They even may be computerized, so no funny business, like changing numbers. ;)
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Tomorrow I go back to Davita for another treatment. Makes me a little nervous being I just had a weekend. I have to watch everything they do. Am I the only one that seems to think they are a weird bunch of techs and nurses? Are all Davita clinics so careless?
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I dialyize at a Davita clinic in Birmingham, AL and can't complain. Of course, I've only been on hemodialysis for two months now but the staff is friendly and has been extremely accomodating during this time. I have noticed, however, that the clinic is a bit understaffed and therefore I have had to do a good bit of waiting around for a chair...and I guess there tv's could use some work as well.
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I have been going to Davita on Cape Cod Mass for 9 months now and have no problem. The nurses are great and the techs are very good. The unit could use some new chairs and Tv's. I think it depends on which unit you go to.
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It all depends on the unit. My unit in Atlanta looked like a warehouse with chairs in it when I first started going. Since then its had a complete renovation. But I don't go anymore because I am a home patient now.
-Jaybird
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It all depends on the unit. My unit in Atlanta looked like a warehouse with chairs in it when I first started going. Since then its had a complete renovation. But I don't go anymore because I am a home patient now.
-Jaybird
Funny thing. I read that line whore house, not warehouse, and did a double take!
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It all depends on the unit. My unit in Atlanta looked like a warehouse with chairs in it when I first started going. Since then its had a complete renovation. But I don't go anymore because I am a home patient now.
-Jaybird
Funny thing. I read that line whore house, not warehouse, and did a double take!
Yep, Vegas will do that to you girlfriend :P :beer1;
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I hope you made it through your visit OK. I dialize at a Davita clinic in Durham, NC. Mine is very clean with working chairs and TV's. The techs care about you (out of 3 Doctors that take turns, only 1 gives you the impression that he cares) and the Nurses are excellent.
Marv
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Im glad everyone thinks the nurses and staff are good. But I also want to tell you that the companies no matter who they are are not being cheap. The average patient has either medicare or medicaid. The average reimbursement is anywhere from $120-140 per tx from these government agencies. So to start you need a dialyzer which is depending on the contract rate approx. $20. Then the blood tubing approx $10. Then the labor of your nurses, techs, sec., machine maintenance guys, dietitians and SW. anywhere from $60-70 per tx. Then that doesn't include the supply cost of about $15/tx. thats the gauze, bandage, tape, syringes, lidocaine, heparin, Tylenol, b/p meds etc.... Then there is the cost of medical directors, building maintenance, utilities and lease. So if you think about it the gov. doesn't even pay for a treatment the dialysis companies eat the cost. Thats why they hire managers to keep these costs down. It is a very stressful job for a manager. And if they didn't keep the cost down to try and profit a few cents per tx then there wouldn't be companies here to dialyze the pts. they would be forced out of business.
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Im glad everyone thinks the nurses and staff are good. But I also want to tell you that the companies no matter who they are are not being cheap. The average patient has either medicare or medicaid. The average reimbursement is anywhere from $120-140 per tx from these government agencies. So to start you need a dialyzer which is depending on the contract rate approx. $20. Then the blood tubing approx $10. Then the labor of your nurses, techs, sec., machine maintenance guys, dietitians and SW. anywhere from $60-70 per tx. Then that doesn't include the supply cost of about $15/tx. thats the gauze, bandage, tape, syringes, lidocaine, heparin, Tylenol, b/p meds etc.... Then there is the cost of medical directors, building maintenance, utilities and lease. So if you think about it the gov. doesn't even pay for a treatment the dialysis companies eat the cost. Thats why they hire managers to keep these costs down. It is a very stressful job for a manager. And if they didn't keep the cost down to try and profit a few cents per tx then there wouldn't be companies here to dialyze the pts. they would be forced out of business.
WTF?? :banghead; What country are you in?? DaVita or "Total Renal Care" as the statement says charges me $3,000 a time. That includes EPO and Zemplar. Do the math.....$36,000 a month. M O N T H! That is what they charge. My insurance pays $5,000/mo and I don't know what Medicare pays. We are ALL on medicare. If you are a dialysis patient and have been for more than 3 months you ARE on medicare. Don't tell me they are scraping by. AND if I'm the only one paying the bills then why can't I have the SHIFT I want and the CHAIR I want??
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Davita in the business news:
DaVita 1st-qtr profit rises 33 pct
Mon Apr 30, 3:49 AM ET
NEW YORK (Reuters) - DaVita Inc. (NYSE:DVA - news), the biggest provider of dialysis in the United States, said on Monday its first-quarter profit rose 33.2 percent, helped by an increase in the number of treatments at its facilities.
First-quarter profit increased to $76.6 million, or 72 cents per share from $57.5 million, or 55 cents per share, a year earlier.
Wall Street analysts had on average forecast 72 cents per share, according to Reuters Estimates.
Looking ahead, the company said it expects operating income in 2007 to be between $740 million and $780 million, compared with its earlier forecast of $700 million to $760 million.
Net operating revenue increased about 10 percent to $1.28 billion in the first quarter.
Total treatments for the quarter were 3.7 million, compared with 3.5 million in the year-ago quarter. Non-acquired treatment growth in the quarter was 4 percent.
Operating cash flow for the year is expected to be in the range of $460 million to $510 million.
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My Comment: It appears they are profitting more than just a few cents...
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WTF?? :banghead; What country are you in?? DaVita or "Total Renal Care" as the statement says charges me $3,000 a time. That includes EPO and Zemplar. Do the math.....$36,000 a month. M O N T H! That is what they charge. My insurance pays $5,000/mo and I don't know what Medicare pays. We are ALL on medicare. If you are a dialysis patient and have been for more than 3 months you ARE on medicare. Don't tell me they are scraping by. AND if I'm the only one paying the bills then why can't I have the SHIFT I want and the CHAIR I want??
There is a huge difference between what is CHARGED and what DaVita is PAID. It sounds like you are Medicare primary with a supplement or secondary insurance.
The COB (coordination of benefit) period for patients that have commercial insurance is 30 months. During those 30 months, the commercial insurance is primary and the medicare is secondary. Beginning the 31st month, Medicare becomes primary and the commercial insurance secondary.
The truth is, for every MEDICARE PRIMARY patient that DaVita treats, they lose $15-20 per treatment. It is through efficient management and patients with commercial insurance that DaVita remains in the black.
Mongo
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Davita in the business news:
DaVita 1st-qtr profit rises 33 pct
Mon Apr 30, 3:49 AM ET
NEW YORK (Reuters) - DaVita Inc. (NYSE:DVA - news), the biggest provider of dialysis in the United States, said on Monday its first-quarter profit rose 33.2 percent, helped by an increase in the number of treatments at its facilities.
First-quarter profit increased to $76.6 million, or 72 cents per share from $57.5 million, or 55 cents per share, a year earlier.
Wall Street analysts had on average forecast 72 cents per share, according to Reuters Estimates.
Looking ahead, the company said it expects operating income in 2007 to be between $740 million and $780 million, compared with its earlier forecast of $700 million to $760 million.
Net operating revenue increased about 10 percent to $1.28 billion in the first quarter.
Total treatments for the quarter were 3.7 million, compared with 3.5 million in the year-ago quarter. Non-acquired treatment growth in the quarter was 4 percent.
Operating cash flow for the year is expected to be in the range of $460 million to $510 million.
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My Comment: It appears they are profitting more than just a few cents...
The key here is "per share".
DaVita is a for-profit, publicly traded company. There is board of directors that is elected by stockholders and they are responsible for keeping the stockholders happy. For profit healthcare companies have a difficult task...providing excellent care for their patients while keeping their stockholders pleased with their investment.
I have yet to see a company balance clinical outcomes and business better than DaVita.
Mongo
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I agree davita does a good job. I feel sorry for people that are in a bad clinic. That is not Davita. That is a poor manager and a poor ROD that is afraid to improve their clinic because they dont want to go out of their "budget". I feel its better to keep a nice clinic and happy patients I care about my patients and if I didnt I wouldnt be here. I just also know how business is run and thats out of my control... So why dog it. Im thankful for being there for my patients and giving them the quality of life they deserve. I dont care who pays the bill or if they profit. I just care that I can see all my patients everyday and know I do the best I can for them. I take it personally if a patient expires, I mourn for their families and always reflect back if I did everything I could to enhance their lifes. My patients become my family and dont even think about money when it comes to them. All my discussions with dialysis pts has been about life and quality of it. I have never had a pt tell me there were unhappy that Davita is making a profit. Who gives a care... Im just thankful for everyday I can help someone be a more productive human being. Maybe if you were paying out of pocket for your treatments you could feel angry. But since the fed gov. is footing the bill . what is the big deal??? what would happen to you if the gov decided to cut dialysis?? I dont even want to think about that. I know alot of countries that would let people die. If anyone ever knew what it was like to be a pt. in another country believe me you would be very thankful to be an american. Do you ever wonder why we have so many illegals on diaysis? Its because their country dont give a care. They want to live just like we all do. They are not complaining.
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Maybe if you were paying out of pocket for your treatments you could feel angry. But since the fed gov. is footing the bill . what is the big deal??? what would happen to you if the gov decided to cut dialysis?? I don't even want to think about that. I know a lot of countries that would let people die. If anyone ever knew what it was like to be a pt. in another country believe me you would be very thankful to be an American. Do you ever wonder why we have so many illegals on dialysis? Its because their country don't give a care. They want to live just like we all do. They are not complaining.
Until you walk in the footsteps of a patient- you will never really understand their point of view...just because they get better care then a third world country does not make it okay for the crap they do put up with. What about the countries like the UK or Australia or Ireland or Germany where the care is not only as good as a America, but some will say better? The Federal Government does not foot the entire bill either- we still pay for private insurance. and we pay for Medicare. and we pay deductibles. and co-payments. Saying we should be grateful our dialysis patient are treated better here then in Mexico is absurd.
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There is a huge difference between what is CHARGED and what DaVita is PAID. It sounds like you are Medicare primary with a supplement or secondary insurance.
The COB (coordination of benefit) period for patients that have commercial insurance is 30 months. During those 30 months, the commercial insurance is primary and the medicare is secondary. Beginning the 31st month, Medicare becomes primary and the commercial insurance secondary.
The truth is, for every MEDICARE PRIMARY patient that DaVita treats, they lose $15-20 per treatment. It is through efficient management and patients with commercial insurance that DaVita remains in the black.
Mongo
While I have never dealt with Davita I do have my reservations about them, especially since they have been trying to undercut the nursing laws in this state for years.
They lose $15-$20 per treatment? BS!! Far too much companies like this come up with some overinflated price as to what they charge for services and then try to pass this bs over about losing money on treatments.
$76.6 MILLION PROFIT in one quarter. If that pace is kept up, that is over $300 million in PROFITS in one year, not gross income but PURE PROFIT! Losing money my a**
Efficient management? That may be, but no company, and I mean no company is that efficient they can claim they are losing money on their mainstay business while ranking in millions in PROFITS, not sales, but PROFITS! It is IMPOSSIBLE to lose money on patient treatment yet rank in millions of dollars in profits off that same treatment of those same patients.
But by all means, Davita wants to make such claims, open their books. Lets see just what they are paying on an individual basis for all supplies, workers, equipment etc. etc. Then lets see just what they are fudging on and including in that amount, such as overpaid CEO's etc, etc,. We all know its not the people who are actually doing the work that are making the money since Davita is famous for pushing to have nursing laws changed so that lower paid techs can do the job.
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Maybe if you were paying out of pocket for your treatments you could feel angry. But since the fed gov. is footing the bill . what is the big deal??? what would happen to you if the gov decided to cut dialysis?? I don't even want to think about that. I know a lot of countries that would let people die. If anyone ever knew what it was like to be a pt. in another country believe me you would be very thankful to be an American. Do you ever wonder why we have so many illegals on dialysis? Its because their country don't give a care. They want to live just like we all do. They are not complaining.
Until you walk in the footsteps of a patient- you will never really understand their point of view...just because they get better care then a third world country does not make it okay for the crap they do put up with. What about the countries like the UK or Australia or Ireland or Germany where the care is not only as good as a America, but some will say better? The Federal Government does not foot the entire bill either- we still pay for private insurance. and we pay for Medicare. and we pay deductibles. and co-payments. Saying we should be grateful our dialysis patient are treated better here then in Mexico is absurd.
I'll say better. Apples to apples the US mortality rate is 20% higher than it would be if it met European standards of care.
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Davita in the business news:
DaVita 1st-qtr profit rises 33 pct
Mon Apr 30, 3:49 AM ET
NEW YORK (Reuters) - DaVita Inc. (NYSE:DVA - news), the biggest provider of dialysis in the United States, said on Monday its first-quarter profit rose 33.2 percent, helped by an increase in the number of treatments at its facilities.
First-quarter profit increased to $76.6 million, or 72 cents per share from $57.5 million, or 55 cents per share, a year earlier.
Wall Street analysts had on average forecast 72 cents per share, according to Reuters Estimates.
Looking ahead, the company said it expects operating income in 2007 to be between $740 million and $780 million, compared with its earlier forecast of $700 million to $760 million.
Net operating revenue increased about 10 percent to $1.28 billion in the first quarter.
Total treatments for the quarter were 3.7 million, compared with 3.5 million in the year-ago quarter. Non-acquired treatment growth in the quarter was 4 percent.
Operating cash flow for the year is expected to be in the range of $460 million to $510 million.
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My Comment: It appears they are profitting more than just a few cents...
The key here is "per share".
DaVita is a for-profit, publicly traded company. There is board of directors that is elected by stockholders and they are responsible for keeping the stockholders happy. For profit healthcare companies have a difficult task...providing excellent care for their patients while keeping their stockholders pleased with their investment.
I have yet to see a company balance clinical outcomes and business better than DaVita.
Mongo
How many companies have you looked at?
If you just believe Davita's own PR you might think so but their PR is wrong, some would say an outright lie. http://biz.yahoo.com/prnews/070514/sfm026.html is a recent example.
They're touting their internal 2006 data as compared with CMS publicaly available 2004 data. If you look at just the publicaly available 2004 data from CMS/USRDS you see Davita is trailing the industry - 38% to 40%.
By the way - the Northwest Kidney Centers? 68% fistula rate.
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Ok here is how I see it. The for profit companies like DaVita and Fresenius are reporting losses, but the losses only exist in what they think they should be making per treatment. I know that for example Fresenius has a $20.10 budget for each treatment for dialysis supplies. This is gauze, tape, bandaids....everything except medications with the exception of Heparin and Sterile Water. I don't know of any clinic that achieves this target unless they are A. Getting suplies from an outside vendor and not putting it on there reports, B. Have a very small patient population where it is easy to control supplies and their use. On average most clinics lose around $1.00 per treatment. Then there is understaffing, so instead of paying regular time to several staffers they are paying overtime to a few staffers. So there is indeed a loss seen on the clinical level. Where they make up the lost profits is in the medications. Epogen is a great example of this. Each vial of Epogen is required to hold X amount of fluid. To insure that the vial contains at least that much through out the packaging process the vials always have overfill or extra Epogen in them. You don't pay for that overfill only the labeled amount. You just combine up that overfill and save tons of money. I'm sure it was most likely Okarol who posted an article that explains this and gives the exact dollar amount of profit from this practice. It also shows the loss that would occur if there was no overfill. The bottom line is yes the companies do have loss, but they make it up other ways to gain a profit.
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I'll say better. Apples to apples the US mortality rate is 20% higher than it would be if it met European standards of care.
What are the European standards for deciding who gets dialysis and who doesn't?
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I'll say better. Apples to apples the US mortality rate is 20% higher than it would be if it met European standards of care.
What are the European standards for deciding who gets dialysis and who doesn't?
They're about the same. Remember for the purpose of mortality comparisons the US does not include those who pass in the first three months so if you're thinking of palitive dialysis care then it is not a factor.
What you would look at is the The Dialysis Outcomes and Practice Patterns Study (DOPPS). Here is a starting point http://www.nature.com/ki/journal/v57/n74s/full/4491626a.html
"First, although the overall mortality rate is exceedingly high among dialysis patients, outcomes vary substantially across facilities and countries 1,2,3,4. For example, a fivefold variation in crude mortality was reported across facilities in the United States and adjusted mortality indicators show comparable variability 1,2. Also, the reported 5-year mortality rates for end-stage renal disease (ESRD) patients in Europe and Japan are 20–35% lower than those reported for patients in the United States, even with adjustment for age, sex, and diabetic status 3. The observed variation in mortality across centers and countries raises the strong possibility that differing treatment practices may contribute to the variation in outcomes. Second, dialysis outcomes can be modified by changes in dialysis practice. For example, several studies have shown that improved patient survival is associated with higher dialysis doses and use of different types of dialysis membranes 4,5,6. Finally, observational studies have proven to be an efficient means for discovering associations between treatment patterns and outcomes 4,5,7,8,9. Findings from large, well-designed, nationally representative observational studies have prompted changes in the national practice of dialysis and provided the impetus for important clinical trials 10,11."
References
1. McClellan, WM, Flanders, WD, Gutman, RA: Variable mortality rates among dialysis treatment centers. Ann Intern Med 1992 117:332–336,
2. Hulbert-Shearon, TE, Loos, E, Ashby, VB, Port, FK, Wolfe, RA: USRDS 1999 Unit-Specific Reports for Dialysis Patients: A Summary. 1999 University of Michigan, Ann Arbor,
3. Held, PJ, Brunner, F, Odaka, M, Garcia, JR, Port, FK, Gaylin, DS: Five-year survival for end-stage renal disease patients in the United States, Europe, and Japan, 1982–87. Am J Kidney Dis 1990 15:451–457,
4. Owen, WF, Lew, NL, Liu, Y, Lowrie, EG, Lazarus, JM: The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med 1993 329:1001–1006,
5. Held, PJ, Port, FK, Wolfe, RA, Stannard, DC, Carroll, CE, Daugiridas, JT, Greer, JW, Hakim, RM: The dose of hemodialysis and patient mortality. Kidney Int 1996 50:550–556,
6. Hakim, RM, Held, PJ, Stannard, DC, Wolfe, RA, Port, FK, Daugirdas, JT, Agodoa, L: Effect of the dialysis membrane on mortality of chronic hemodialysis patients. Kidney Int 1996 50:566–570,
7. Churchill, DN, Taylor, DW, Cook, RJ, Laplante, P, Barre, P, Cartier, P, Fay, WP, Goldstein, MB, Jindal, K, Mandin, H, McKenzie, JK, Muirhead, N, Parfrey, PS, Posen, GA, Slaughter, D, Ulan, RA, Werb, R: Canadian hemodialysis morbidity study. Am J Kidney Dis 1992 19:214–234,
8. Greenfield, S, Sullivan, L, Sillman, RA, Dukes, K, Kaplan, SH: Principles and practice of case mix adjustment: applications to end-stage renal disease. Am J Kidney Dis 1994 24:298–307,
9. Held, PJ, Wolfe, RA, Gaylin, DS, Port, FK, Levin, NW, Turenne, MN: Analysis of the association of dialyzer reuse practices and patient outcomes. Am J Kidney Dis 1994 23:692–708,
10. National Kidney Foundation: Dialysis Outcomes Quality Initiative Clinical Practice Guidelines. Am J Kidney Dis 1997 30(Suppl):S1–S240# ,
11. Eknoyan, G, Levey, AS, Beck, GJ, Agadoa, LY, Daugirdas, JT, Kusek, JW, Levin, NW, Schulman, G: The Hemodialysis (HEMO) Study: Rationale for selection of interventions. Semin Dial 1996 9:24–33,
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In Japan CAPD is you only option. If you fail at that then you have to do hemo. And thats only if there is a machine. Same in Europe. Its not like here where every corner is a clinic.Thats why they have less mortality rates. The pts dont have a choice like they do in the USA. NOT ALL pts can do CAPD or home hemo but I bet 50% could but wont. So whats up with that??? Americans dont want responsibility for their own care. If that was the case they would do it. Then they wouldnt have nothing to complain about.... I personally would do CAPD to preserve my residual renal function as long as I could and to have a more normal way of life and to continue to work and be productive. I think the US is lacking in education for our patients. I do a real good job in educating and trying to get people to do self care, but I hear every excuse in the book why they cant. I think the US needs to start everyone out one CAPD unless of course they are elderly and alone, or in a SNF. My CAPD pts are happy, travel, work, and feel normal. Sometimes I think its easier to blame then take responsibility. Cant blame dialysis companies for poor pt outcomes like potassium, albumin, phosporus and KT/V. Those on the pts non compliance with diet and signing off and refusing to get a fistula.
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In Japan CAPD is you only option. If you fail at that then you have to do hemo. And thats only if there is a machine. Same in Europe. Its not like here where every corner is a clinic.Thats why they have less mortality rates. The pts dont have a choice like they do in the USA. NOT ALL pts can do CAPD or home hemo but I bet 50% could but wont. So whats up with that??? Americans dont want responsibility for their own care. If that was the case they would do it. Then they wouldnt have nothing to complain about.... I personally would do CAPD to preserve my residual renal function as long as I could and to have a more normal way of life and to continue to work and be productive. I think the US is lacking in education for our patients. I do a real good job in educating and trying to get people to do self care, but I hear every excuse in the book why they cant. I think the US needs to start everyone out one CAPD unless of course they are elderly and alone, or in a SNF. My CAPD pts are happy, travel, work, and feel normal. Sometimes I think its easier to blame then take responsibility. Cant blame dialysis companies for poor pt outcomes like potassium, albumin, phosporus and KT/V. Those on the pts non compliance with diet and signing off and refusing to get a fistula.
Hmmmm I'd like to argue with you but I think you are right. I don't want to do Home Hemo because I don't want the responsibility and the mess. You have to do your own machine maintenance etc... I would do CAPD but I have too much scar tissue. And I am alone so I go in center and complain at their incompetence. But yeah you nailed it.
:beer1;
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In Japan CAPD is you only option. If you fail at that then you have to do hemo. And thats only if there is a machine. Same in Europe. Its not like here where every corner is a clinic.Thats why they have less mortality rates. The pts dont have a choice like they do in the USA. NOT ALL pts can do CAPD or home hemo but I bet 50% could but wont. So whats up with that??? Americans dont want responsibility for their own care. If that was the case they would do it. Then they wouldnt have nothing to complain about.... I personally would do CAPD to preserve my residual renal function as long as I could and to have a more normal way of life and to continue to work and be productive. I think the US is lacking in education for our patients. I do a real good job in educating and trying to get people to do self care, but I hear every excuse in the book why they cant. I think the US needs to start everyone out one CAPD unless of course they are elderly and alone, or in a SNF. My CAPD pts are happy, travel, work, and feel normal. Sometimes I think its easier to blame then take responsibility. Cant blame dialysis companies for poor pt outcomes like potassium, albumin, phosporus and KT/V. Those on the pts non compliance with diet and signing off and refusing to get a fistula.
I've never dialyzed in Japan but I can tell you that the provision of dialysis in Europe is available as widely as it is here - and unless you have some data I'll go with the DOPPS. The main difference I have observed is more dialysis time per kilogram being delivered in Europe and Singapore.
As far as self care explaining mortality rate differences that is not supported by the data. The DOPPS provides a pretty clear picture, we in the US should be doing better. As John Maynard Keynes said, "When the facts change, I change my mind - what do you do, sir?"
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I personally would do CAPD to preserve my residual renal function as long as I could and to have a more normal way of life and to continue to work and be productive.
You are NOT a dialysis patient are you? There are many members here on Hemo that work are are still productive members of there community. You should not judge someone for not wanting to do home care. It is a personal choice that shouldn't alter their level of treatment. No patient should have to put up with incompetent techs and substandard treatment just because they want to do incenter dialysis. Self care is just not for everyone. It doesn't mean they are non compliant. Non compliance is another issue.
oh... I am a home APD dialysis patient that is very compliant ;)
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I'll say better. Apples to apples the US mortality rate is 20% higher than it would be if it met European standards of care.
What are the European standards for deciding who gets dialysis and who doesn't?
They're about the same. ...
Have a link to that info? TIA
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... I think the US needs to start everyone out one CAPD unless of course they are elderly and alone, or in a SNF. My CAPD patients are happy, travel, work, and feel normal. Sometimes I think its easier to blame than take responsibility. Cant blame dialysis companies for poor patient outcomes like potassium, albumin, phosphorus and KT/V. Those on the patients non compliance with diet and signing off and refusing to get a fistula.
What is "SNF"?
Many patients cannot do any kind of PD due to health issues - abdominal scarring, hernias, large kidneys (PKD), and many diabetics. Most patients who live long enough have to switch to HD. The life expectancy of PD patients is shorter than those on HD. There is not ONE clinic within a 20 mile radius of where we live which offered my husband home hemo. His kidneys are huge and PD was NOT an option for him, but even if it were, he would not have chosen PD.
I most certainly can blame some dialysis centers for poor outcomes like potassium, albumin, phosphorous, and KT/V. All clinics are not as proactive in patient education as you apparently are with your patients. There are patients here who have dietary problems and they have to come here to get answers and help. There are also some here who have signed off early due to neglect or abuse by center staff, and some because they had other commitments, such as a job, because they were started late.
The low percentage of fistulas is most likely NOT the patients fault. Many in the medical community are often not forthcoming with information and support which patients need to make the best choice for their access. Check out the threads and questions here about fistulas. If we had listened to my husband's nephrologist and the first surgeon he saw, he'd most likely have a graft.
If all nephrologists and all center staff were proactive in educating patients, the life span and quality of life for dialysis patients would be better, and this forum would not have been so successful.
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Skilled Nursing Facility what we use to call nursing homes
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I'll say better. Apples to apples the US mortality rate is 20% higher than it would be if it met European standards of care.
What are the European standards for deciding who gets dialysis and who doesn't?
They're about the same. ...
Have a link to that info? TIA
Here is a link to an article by one of the high profile deniers of a high US mortality rate http://www.aakp.org/aakp-library/Comparison-ESRD-Therapy-United-States-Overseas/
This was written in 2000, before the DOPPS results. I doubt he would write this article today, I've not seen criticism of the DOPPS on the basis of selection bias, etc. With the DOPPS data you can look at just one demographic - youngish, non-diabetic males - people who have complete access to care abroad, and in the US, and see the same persistent mortality bias.
We can try to figure out the reasons - I spend a lot of time thinking about it - but the discussion has moved past the access to care question.
Even before DOPPS I knew the access to care issue was a red herring. I've dialyzed in over 20 units throughout Europe, going every year from 1996 to 2005, I've talked to the staff, and to the dialyzors. They're doing a better job over there. Dialysis is in my experience better on average in Europe than the US (I've been to dozens, maybe scores, of US units in 16 years of treatment). I think this is indisputable.
My primary theory about mortality is that they get more dialysis per kilo, something all units, for profit and non-profit units alike could offer but do not. If your unit does not offer the option of 6 hour runs they could be doing more but they don't because of money. Max five hours? I've seen four hour maximums. When those go away then we'll talk about "compliance" or more correctly what providers can do to help dialyzors better accommodate CKD5.
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You know I am glad to see a dialysis patient is up in arms over our care and really working to do something about it. Thanks Bill P.
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Here is a link to an article by one of the high profile deniers of a high US mortality rate http://www.aakp.org/aakp-library/Comparison-ESRD-Therapy-United-States-Overseas/
This was written in 2000, before the DOPPS results. I doubt he would write this article today, I've not seen criticism of the DOPPS on the basis of selection bias, etc. With the DOPPS data you can look at just one demographic - youngish, non-diabetic males - people who have complete access to care abroad, and in the US, and see the same persistent mortality bias.
We can try to figure out the reasons - I spend a lot of time thinking about it - but the discussion has moved past the access to care question.
Even before DOPPS I knew the access to care issue was a red herring. I've dialyzed in over 20 units throughout Europe, going every year from 1996 to 2005, I've talked to the staff, and to the dialyzors. They're doing a better job over there. Dialysis is in my experience better on average in Europe than the US (I've been to dozens, maybe scores, of US units in 16 years of treatment). I think this is indisputable. ...
Thanks so much, Bill. I was under the impression that other countries were turning away medically fragile patients and the elderly who would be put on dialysis in the US, and that accounted for the difference in mortality rates.
... My primary theory about mortality is that they get more dialysis per kilo, something all units, for profit and non-profit units alike could offer but do not. If your unit does not offer the option of 6 hour runs they could be doing more but they don't because of money. Max five hours? I've seen four hour maximums. When those go away then we'll talk about "compliance" or more correctly what providers can do to help dialyzors better accommodate CKD5.
Bravo!
:twocents; Until home dialysis is the norm and in center the exception, the majority of dialyzors will continue to receive inadequate treatment.
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Fixin' To Die Rag Revisited:
" And it's one, two, three, what are we suffering for?"
"That Corporation don't give a damn"
" That Quality O' Care pledge is just a scam"
"we're just doing the best that we can"
" unlike some congressman"
"Whoopie sometime we're all gonna die" :oops;
In A Getto Duh Vita
Goin' to Duh Vita this morning Baby
Don't know if I'll be comming home
Gotta go to Duh Vita Honey
How I wish that it wasn't so.
I think theiy're gonna kill me.
I can barely do my time.
When it comes to being stuck with needles
I could just lose my mind
Please won't you just come with me
Don't let go there alone again
In A Getto Duh Vita Honey
Don't you know i miss you so.
( Pardon me for this )
......bd
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I loved that rhyme time !
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Im all for longer dialysis treatments at lower blood flow rate. I feel its more gentle on the body and of course the patient feels better. No Im not a patient, but Im very proactive for my patients because I could be a patient someday. And I know how I would want to be treated. I remind the staff many times to rememember that we or our families could be here at dialysis and would we want the best. So I expect that every patient be treated like their most loved family member. I dont tolerated incompetentece, sure people make mistakes and must admitt to them. To work in dialysis is a hard job and to meet the standards is also very hard. So the key is education and support. Of course you always get the few patients that no matter what you preach, they just dont listen. And I agree with al of you, no one should have mediocor care. But I can tell you from my own experience with health care, my father died in a hospital,(even though Im a nurse and was very proactive in his care) He got a MRSA infection, and in his advance directives he wanted only CPR no life support. The nurse did not read the chart right and she did have him coded. To me that is gross negligence. So I am all for qailty care. The problem is not the dialysis companies, its the management of your clinics. They ned to hire, train and keep the good ones and let the losers leave. Thats were the care is.
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They need to hire, train and keep the good ones and let the losers leave. Thats were the care is.
They are getting rid of the bad staff and keeping the good staff as best as they can, but with so many bad techs out there the good techs are overworked and burn out. Turnover of staff is one of the biggest problems the clinics face when it comes to quality care of the patients.
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Fixin' To Die Rag Revisited:
" And it's one, two, three, what are we suffering for?"
"That Corporation don't give a damn"
" That Quality O' Care pledge is just a scam"
"we're just doing the best that we can"
" unlike some congressman"
"Whoopie sometime we're all gonna die" :oops;
( Pardon me for this )
A little Country Joe And The Fish parody gotta love it.
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What are the maximum run lengths at your units?
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What are the maximum run lengths at your units?
I don't know about the run times at gr8fulrn's clinic, but the most I have ever seen someone run was 5hrs and that was a temporary thing. Most run an average of 4hrs.
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Huh? What? Longer run times at a lower blood flow rate? I thought higher blood flow rates were more desireable.
In six years of Hemo, with the exception of a few nurses, I havent seen the kind of management or care that you speak
of here in Florida.
I can barely make it through three and a half hours in chair. Five to six hours seems impossible for me.
How can anyone do that?
I agree that a lot of things are contingent on a good manager and regional manager but these seem
to be exceptions to the norm as do you.
....bd
Im all for longer dialysis treatments at lower blood flow rate. I feel its more gentle on the body and of course the patient feels better. No Im not a patient, but Im very proactive for my patients because I could be a patient someday. And I know how I would want to be treated. I remind the staff many times to rememember that we or our families could be here at dialysis and would we want the best. So I expect that every patient be treated like their most loved family member. I dont tolerated incompetentece, sure people make mistakes and must admitt to them. To work in dialysis is a hard job and to meet the standards is also very hard. So the key is education and support. Of course you always get the few patients that no matter what you preach, they just dont listen. And I agree with al of you, no one should have mediocor care. But I can tell you from my own experience with health care, my father died in a hospital,(even though Im a nurse and was very proactive in his care) He got a MRSA infection, and in his advance directives he wanted only CPR no life support. The nurse did not read the chart right and she did have him coded. To me that is gross negligence. So I am all for qailty care. The problem is not the dialysis companies, its the management of your clinics. They ned to hire, train and keep the good ones and let the losers leave. Thats were the care is.
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What are the maximum run lengths at your units?
I don't know about the run times at gr8fulrn's clinic, but the most I have ever seen someone run was 5hrs and that was a temporary thing. Most run an average of 4hrs.
I thought you were at FMC? FMC offers incenter nocturnal at a number of their units. There is one by my Mom's house that I use when I visit her and run incenter.
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I thought you were at FMC? FMC offers incenter nocturnal at a number of their units. There is one by my Mom's house that I use when I visit her and run incenter.
You are correct I do work for Fresenius but none of the centers in my area offer incenter nocturnal dialysis so I have no experience with that.
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What are the maximum run lengths at your units?
I don't know about the run times at gr8fulrn's clinic, but the most I have ever seen someone run was 5hrs and that was a temporary thing. Most run an average of 4hrs.
I am concerned when a sizable dialyzor population has no one running 5 hours (or more. But I use to run only 4.75) or 4 times a week. Some Fiscal Intermediaries are more lenient than others but I think four day a week schedules should be a standard menu item. Does your unit provide four day a week schedules?
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I've never heard of one that offers 4 times a week. What is a "Fiscal Intermediary?"
How do you deal with being in the chair that long?
..............bd
What are the maximum run lengths at your units?
I don't know about the run times at gr8fulrn's clinic, but the most I have ever seen someone run was 5hrs and that was a temporary thing. Most run an average of 4hrs.
I am concerned when a sizable dialyzor population has no one running 5 hours (or more. But I use to run only 4.75) or 4 times a week. Some Fiscal Intermediaries are more lenient than others but I think four day a week schedules should be a standard menu item. Does your unit provide four day a week schedules?
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How do you deal with being in the chair that long?
It's tough, no question about that. A good book or DVD can really help pass the time.
The Renalist 8)
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How do you deal with being in the chair that long?
It's tough, no question about that. A good book or DVD can really help pass the time.
The Renalist 8)
A good dose of Benadryl helped me pass a good couple of hours :P ::)
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Oh Yes Benadryl helps me through the hours in the chair!
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I've never heard of one that offers 4 times a week. What is a "Fiscal Intermediary?"
How do you deal with being in the chair that long?
..............bd
Providers don't really bill Medicare directly, they send their bills to a Medicare Fiscal Intermediary. There are I think 18 FIs, each covers a region of the country.
They make the decision on what is covered, it is the FIs that decide if something is reimbursable by Medicare and those decisions vary from one FI to the next.
For instance, the actual law around how many treatments per week is reimbursable is vague. Some FIs reimburse for a forth treatment under very narrow circumstances, while other FIs will reimburse for every treatment. I believe that units should be open seven days a week and routinely offer forth treatments because it is logistically difficult to accommodate forth treatments with units closed one day a week. If FIs routinely reimbursed for forth treatments I think units would be open seven days a week.
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Does your unit provide four day a week schedules?
No clinics that I am aware of offer a 4 day a week schedule. Your choices are M-W-F or T-Th-S. Depending on your remaining renal function you may only go 2 days a week instead of 3. The only time you may dialyze more than 3 time in one week is if you are going to miss your first treatment the following week, or there is a holiday that the clinic is closed for so they opened on a Sun. instead of that holiday.
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Sure there are all kind of variables that effect dialysis facilities. The State you reside in, the staff, the management ect.
It is my belief that most facilities could be improved upon and regardless of which company runs them, you have the good, the bad and the ugly.
State and Federal legislators must protect and improve medicare and medicaid for Americans on dialysis NOW.
.......bd
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Does anyone here realize that the DaVita clinic in Lufkin Tx. is closed temporarily closed down because of a sudden spike in deaths? I recognized 9 names in the obits just in April and I haven't worked there in almost 2 yrs. Beware of DaVita!!!!
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No need to post this info more than once. Thanks.
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My center is private non-profit and does offer 4 day treatments for those who need it. One guy that I know fairly well does 4.5/hrs. 4 days/week.
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Does your unit provide four day a week schedules?
No clinics that I am aware of offer a 4 day a week schedule. Your choices are M-W-F or T-Th-S. Depending on your remaining renal function you may only go 2 days a week instead of 3. The only time you may dialyze more than 3 time in one week is if you are going to miss your first treatment the following week, or there is a holiday that the clinic is closed for so they opened on a Sun. instead of that holiday.
there is a woman at my clinic who is currently doing 4 days a week, requested by her doctor. the clinic adds her to which ever day/shift they have space open.
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Does your unit provide four day a week schedules?
No clinics that I am aware of offer a 4 day a week schedule. Your choices are M-W-F or T-Th-S. Depending on your remaining renal function you may only go 2 days a week instead of 3. The only time you may dialyze more than 3 time in one week is if you are going to miss your first treatment the following week, or there is a holiday that the clinic is closed for so they opened on a Sun. instead of that holiday.
I must have missed this response back in June but many units offer forth treatments including all Northwest Kidney Centers Units. I hope by the end of the 111th Congress in 2010 Medicare will routinely reimburse for forth treatments and we'll start seeing units open 7 days a week, followed by a decrease in overall mortality.
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This talk of treatment time reminds me of one of my last txs in-centre, there was a problem with the bicarb and my machine was in bypass for a half hour (just circulating blood and removing fluid-no actual dialysis). Several times before when that happened, I had to come off after four hours without reaching my clearance goal. (I had a :rant; or two on here when that happened). This last time though, I successfully persuaded them to let me reach my clearance goal. I think I was the first patient there who fought to stay ON the machine.
Adam
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Are all Davita clinics so careless?
I'm sorry for your horrible experience. People forget that in our line of work, it's not just a job. We care for human beings with feelings. The DaVita clinic that I worked for in Oklahoma City was the best clinic that I ever worked at. We all cared deeply for our patients and they knew it. Unfortunately, it's not like that everywhere. I wish it could be. You can either change clinics or talk with the social worker about the problem. They are usually the nicest people in the clinic. Just remember that you are in control. If you insist that they do something, they must do it. If you want to stay on the machine and also receive 100cc of saline, that is what you should get. Don't let them decide for you. The techs and nurses are following doctors orders and cannot change them. (which is what they did when they took you off early). Sorry I'm going on and on, but I hate to hear of things like this. It shouldn't happen. Ok...I'm done. ;) I hope you have better experiences in the future!
Joanna ;D
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After hearing about all of the awful things with DaVita's hemodialysis, does anyone have experience with the peritoneal dialysis staff of DaVita? Which company do they use to supply with and how accommodating the staff is???
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After hearing about all of the awful things with DaVita's hemodialysis, does anyone have experience with the peritoneal dialysis staff of DaVita? Which company do they use to supply with and how accommodating the staff is???
My PD staff at Davita are the best! They are very supportive, knowledgeable, and just plain nice! They are helpful with just about any problem, and they are more than willing to go the extra mile (one of my nurses even offered to give me a ride home from the centre when my motor scooter wouldn't start). As for the supplies, we get ours from Baxter, but I imagine some probably go through Fresenius. I seriously feel that if all Die-Vita staff were like the ones at my centre (at least the home care staff), the company wouldn't seem quite so >:D
Adam
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Dialysis is Dialysis. The company doesn't really matter. I think each clinic is driven by there manager, either a good one, who cares about patients, and clinical outcomes, or just someone who wants the money, and a bit of power. The attitude of the staff, and the care of the patients all follow the managers attitude and concern. A strong, and concerned manager will stand up for good care, not just keep her mouth shut to whatever.
BTW, patients who are Medicare ONLY, cost money to the clinic. That is why they want the Hippers. FMC, Davita, USRenal, privates. All dialysis companies want the private insurance pateints. Make no mistake, there is alot of money to be made., and they are all making it. Still, good care has to come from the clinic, not specific companies.
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I agree davita does a good job. I feel sorry for people that are in a bad clinic. That is not Davita. That is a poor manager and a poor ROD that is afraid to improve their clinic because they dont want to go out of their "budget". I feel its better to keep a nice clinic and happy patients I care about my patients and if I didnt I wouldnt be here. I just also know how business is run and thats out of my control... So why dog it. Im thankful for being there for my patients and giving them the quality of life they deserve. I dont care who pays the bill or if they profit. I just care that I can see all my patients everyday and know I do the best I can for them. I take it personally if a patient expires, I mourn for their families and always reflect back if I did everything I could to enhance their lifes. My patients become my family and dont even think about money when it comes to them. All my discussions with dialysis pts has been about life and quality of it. I have never had a pt tell me there were unhappy that Davita is making a profit. Who gives a care... Im just thankful for everyday I can help someone be a more productive human being. Maybe if you were paying out of pocket for your treatments you could feel angry. But since the fed gov. is footing the bill . what is the big deal??? what would happen to you if the gov decided to cut dialysis?? I dont even want to think about that. I know alot of countries that would let people die. If anyone ever knew what it was like to be a pt. in another country believe me you would be very thankful to be an american. Do you ever wonder why we have so many illegals on diaysis? Its because their country dont give a care. They want to live just like we all do. They are not complaining.
I think we should step back and reflect a little bit. I spoke to a nurse from South Africa - they would come home daily and cry about the patients they had to turn away because of not meeting qualifying criteria. Some countries have a "cut off" of services - @ age 55. Now - if you look around the clinics - the majority of patients are over 55. How sad is that.
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I'm in North Carolina visiting my daughter and am using one of Davita's clinics. It is yukkkk!!! :thumbdown; The chairs are all busted and taped together. The nurses are nice but couldn't care less about the patients. They wanted to give me Epo when my clinic specificly told them I didn't need it. They were told I can ride at 85 with my blood pressure and I fiind out I'm not feeling good because I'm riding at 75. The nurse said he was aware of my pressure but watching it. That could so easily clot my access. I asked for some saline to bring my pressure up so only then they gave me some. A half hour before my treatment was over I told them I had a slight cramp in my back if they could give me 100cc saline but instead they took me off. They didn't want me to have a bad weekend. I have 4 treatments left and get worried they will kill me or just pretend I'm not there. I didn't reach my clearance because they took me off early. I think they wanted to get out of there so the hell with me. I may be a guest visiting but I still have a condition that has to be monitored. :thumbdown; :thumbdown; for Davita. I feel for anyone that has to use Davita as their clinic all the time.
Bluedove
Can you give me the 'name' and location of your center please? private message if needed. I'll explain later. I cannot get into specific detail, but I really would like to know and it is important. That is horrible for you to experience it.
If possible take pictures too!
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Bluedove got a transplant - hopefully will check back in soon.
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DaVita is in it for the money, plain and simple. True, all companies must make a profit, but a huge profit should not come before a patients heath. Do you know why they tried to give a visiting patient EPO that wasn't prescibed it? Because the more EPO they give, they more they make off of it. It's a little deal they have going with the drug company. I worked for DaVita for 3 yrs and I saw how they work. Yes, they do treat hipper patients differently, eventhough they are not supposed to. They tend to get the chair they want and the time they want for treatments. Maybe not at every clinic, but at most. Half the time the other patients can tell you who the hippers are just from the way they are treated. That is sad. I have been on the inside and I have seen first-hand how they work. They are not in it for the patients, they are in it for the profit. Those who work for them that DO actually care about the patients don't make it there very long, especially if they start pointing out problems and issues that need to be worked on. Those employees either eventually give up on trying to make things better, or get run off when they start stirring up too much dust. You are supposed to just work there with your eyes and mouth shut. You don't see anything, you don't say anything and you are the perfect "teammate".
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I will have Epoman rolling on the floor or getting the big stick out to use on me, but my Davita center beats the pants off of my old Fresenius center. Better staffing, better dialysis, and the staff seems more professional. Maybe because I am sleeping and not up the entire time I am there. Also I am getting great blood work results and I feel better!
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well on the positive side, kitkatz, at least there is one good Davita
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I will have Epoman rolling on the floor or getting the big stick out to use on me, but my Davita center beats the pants off of my old Fresenius center. Better staffing, better dialysis, and the staff seems more professional. Maybe because I am sleeping and not up the entire time I am there. Also I am getting great blood work results and I feel better!
:beer1;