who to escalate issues to???

[Gryphon]

I'm a nxstage user and have been for the last year. My center is giving me grief cause I refuse to have to talk to them several times a week just to check in. I think that may be a great idea for someone who is just starting out and still learning it all from scratch but after a year this is ridiculous.

I used to email my run sheets to them once a month, now they keep calling and wanting them once a week, that's fine but I get several calls each week to remind me or from a different person requesting them.

I have basically told them to get off my back and stop harassing me about every little thing... now they have decided that they will no longer support me doing home hemo and  will no longer ship me supplies and that I will have to come and get treatment in center... that's not gonna happen as I am more then 200 miles away from the nearest center.

I tried explaining to them that they do not run my life and some of the things they ask me are just plain none of their business, they get paid by medicare to supply me with services that I need to stay alive and that should be the end of it.   

There is no other company that provides dialysis in this state so now I am left with having to move to another state just to stay alive.

I would like to know if anyone has any suggestions on who I can escalate this issue to...  Since medicare pays the bills should I call them? is there a federal or state agency that I can contact?

[stringbandbeth]

If you are Medicare primary then the center has to have your flo sheets every day. It's a medicare rule...if there are multiple months with missing flo sheets they will not pay for treatment anymore. Not sure why you would have to check in multiple times a week unless they think you are skipping treatments instead of just neglecting to fax the sheets.

[amanda100wilson]

I give my unit treatments records once a month.  They wanted me to provide a fax machine which we refused to do because of cost, nor will I scan them every day as my husband works from home and I cannot access it.  The bit about Medicare needing the flowsheets every day is a load of bull fed to you by your dialysis unit.  My unit was audited recently and it was my records that they chose to audit and there was no issue  raised about them not having the most recent treatment records.

There is no reason for you to have to phone in several times a week unless as strinbandbeth says, they suspect you are missing treatments (this would be evidenced by lower URR/Kt/ results).  This is intrusive and unnecessary.  I suggest that you discuss this with your nephrologist and get him involved.   If this is not possible, then you are going to need to arrange a meeting with your nurse and also the Unit Manager, preferably together, to discuss their decision. 

[chiawana]

Yeah, this all sounds hinky to me. We just started home hemo and my husband has Medicare, and there was no demand to get our flow sheets in every day. I work about 3 blocks from the center, so I can drop them by once a week or so, and also pick up whatever supplies we need. Our HHD nurse is the only person at the center who has worked with us, so we really don't have anything to do with anyone else there. She said she'll be coming to our house about once a month, and I think he needs to be seen for a check-up about once a month. Other than that, we are on our own unless we have problems. Our nurse is available 24/7. If in some drastic circumstance we can't get hold of her, then I suppose we would call the center.

[stringbandbeth]

Our Davita unit also supplied us with a fax machine at no cost

[amanda100wilson]

In reality it is Medicare who pay for the fax machine.  I think that what happens is that the unit buys them and then gets reimbursed.  Even though this is the case they don't want to she'll out the money regardless.

[SugarBear]

I have been in two different centers doing NxStage and both were very different in the way they did things.  One center insisted I email my flow sheet every day, while the other ask that it be email in at the end of the month.  The daily flow sheet center was a Davita and the monthly was a non-profit.  The differences come from in-center regulations, from what I hear, most davita centers require daily flow sheet turn ins.

So I would start with scheduling a meeting with both the home hemo nurse and the facility administrator as it was suggest before.  This will probably not help you, but when you contact your local ESRD network they will suggest a meeting and you can say I already did that.  The network has a relationship with your center and will work with them to find a resolution for your concerns. 

If the network can not find a resolution, then they may refer the matter to your state department of health if it is a matter the state can resolve.  I have a feeling they will not be able to help you as this involves your centers rules and regulations which you sign up for before you start training.

[amanda100wilson]

Well if patients get a fax machine when they are with Davita, I can understand why they would expect to get treatment sheets on a daily basis.

[M3Riddler]

I'm a nxstage user and have been for the last year. My center is giving me grief cause I refuse to have to talk to them several times a week just to check in. I think that may be a great idea for someone who is just starting out and still learning it all from scratch but after a year this is ridiculous.

I used to email my run sheets to them once a month, now they keep calling and wanting them once a week, that's fine but I get several calls each week to remind me or from a different person requesting them.

I have basically told them to get off my back and stop harassing me about every little thing... now they have decided that they will no longer support me doing home hemo and  will no longer ship me supplies and that I will have to come and get treatment in center... that's not gonna happen as I am more then 200 miles away from the nearest center.

I tried explaining to them that they do not run my life and some of the things they ask me are just plain none of their business, they get paid by medicare to supply me with services that I need to stay alive and that should be the end of it.   

There is no other company that provides dialysis in this state so now I am left with having to move to another state just to stay alive.

I would like to know if anyone has any suggestions on who I can escalate this issue to...  Since medicare pays the bills should I call them? is there a federal or state agency that I can contact?

I'm sure there is more to the story than just flow sheets and phone calls... Yes, Medicare helps pay for treatments, but they also require you to turn in your flow sheets daily for billing purposes.  Most centers handle this well and you can turn them in by fax, weekly, or at your monthly clinic visit.  Also, if you dialyze on the same schedule, the same days per week, you may ask if you can just notify them when your day off is, or if you ever miss a treatment.  They cannot bill medicare without the sheets and if they dont have the sheets, they dont get paid and it may lead to you losing being able to dialyze at home.
If the 2 reasons you mentioned are the only reasons, I believe it could be worked out instead of fighting with the center.