NxStage Costs the Center only $1,500 per month???

[Black]

Note the underlined paragraph near the bottom.  Anyone know if this is accurate?

Busy lives demand at-home dialysis
Market grows for smaller, more portable machines that allow some kidney patients to be more active
By Christopher Rowland, Globe Staff  |  December 12, 2005

Being confined to a dialysis clinic three times a week for up to four hours each session didn't make sense to 29-year-old kidney patient Ryan Stanger.

The full-time Tufts University School of Dental Medicine student and father of two young children couldn't fit 12 hours in a dialysis clinic into his schedule -- at least not without making major career or family sacrifices.

So after his kidneys failed, Stanger this year became one of a tiny fraction of dialysis patients who treat themselves at home.

Among the advantages: Instead of long sessions three times a week, he undergoes shorter dialysis treatments daily, which have been shown to be better for patient health. His portable machine doesn't take up much space in the office of his Watertown home, and it only weighs about 70 pounds so he can lug it along on trips.

Best of all, instead of sitting with 20 other kidney patients in a medical facility full of bright lights and machinery, he gets to read bedtime stories to his children while his leased dialysis unit, manufactured by NxStage Medical Inc., of Lawrence, purges toxins from his blood.

''I can be with my family rather than go to a dialysis clinic every other night," he said. ''I can do it whenever I want."

More than 300,000 Americans undergo hemodialysis treatments to compensate for their loss of kidney function, with the majority covered by the government's Medicare program.

Home dialysis has been available for years, but its use has yet to become widespread. Most of the machines available until recently have been similar to in-clinic equipment, which requires electrical wiring and plumbing modifications to supply purified water.

As a result, about 99 percent of patients travel to specialized dialysis clinics three times a week. They sit in big vinyl recliners and doze, read, or watch television while their blood is cycled through thin plastic tubes.

That may not be the best form of care for many kidney patients. About one-third of them are under 50, and many attempt to lead active lifestyles. Increasingly, patients are demanding more flexible care, fueling a nascent market in smaller, more convenient dialysis machines like the NxStage unit in Stanger's home, which uses preshipped bags of purified water.

NxStage believes there are at least 45,000 US kidney patients who could benefit from the flexibility of home dialysis and who also have the skills required to operate the equipment. The company won Food and Drug Administration approval for its system in June and launched an initial stock offering Oct. 27 at $10 a share. NxStage stock closed Friday at $12.10 on the Nasdaq exchange, down 3.89 percent. It reached its highest point in November at $14.80.

Economics and ingrained physician attitudes have prevented faster adoption of in-home dialysis, said Dori Schatell, executive director of the Medical Education Institute Inc., a Madison, Wis., nonprofit foundation that receives funding from companies in the dialysis industry, including NxStage, a competitor called Aksys Ltd., and DaVita at Home, a division of the large DaVita Inc., the country's largest for-profit chain of dialysis clinics.

Having patients centrally located in a clinic is more convenient for doctors, so they have little incentive to encourage home treatment, said Schatell. ''The doctors make the rounds in the dialysis clinic and they can see 20 patients at a time, and they can bill for all of them," she said.

Physicians also underestimate the ability of patients to handle the technical aspects of dialysis on their own, said Schatell. As a result, she said, surveys have shown that few kidney patients are aware that home dialysis is available.

''If 75 percent have never heard of these treatments, they are not asking their doctors for them," she said. ''But any of that in-home technology will deliver a good treatment and give patients a better life."

Dr. Lynda Szczech, chairwoman of the dialysis advisory group of the American Society of Nephrology and a professor at the Duke University School of Medicine, said Schatell's criticisms were ''not entirely off-base." She agreed that many physicians worry that their patients cannot handle home dialysis.

''You wouldn't want to risk the patient's safety for a clinical improvement that they may not be able to achieve," Szczech said. Because of the logistics, training, and complex billing procedures required, traditional dialysis clinics are in the best position to support patients who want to do dialysis at home, Szczech said, but they have been slow to support in-home dialysis.

''Is it because the center doesn't have the resources for it? Or because the center has looked at it and decided that the amount of people who would be eligible for this kind of home-program doesn't justify the investment? It could be both," she said.

NxStage says it has developed an economic model that will work. The company charges $1,500 a month for the rental of equipment and supplies, which NxStage chief executive Jeffrey H. Burbank said is enough to provide a dialysis clinic supervising an in-home program the same profit that a clinic-based patient would generate.

The company also is lobbying Medicare to boost reimbursements specifically for in-home dialysis. Currently, Medicare does not have a separate reimbursement system for in-home dialysis. ''Improved reimbursement would drive adoption as well," Burbank said.

Christopher Rowland can be reached at crowland@globe.com. 


© Copyright 2005 The New York Times Company
 
 

[Zach]

I believe there are two Medicare payment methods for home dialysis:

Method I pays the dialysis clinic for treatment,

Method II pays a vendor for all home supplies.

I'm not sure if it still exists.     

[Black]

I believe there are two Medicare payment methods for home dialysis:

Method I pays the dialysis clinic for treatment,

Method II pays a vendor for all home supplies.

I'm not sure if it still exists.     

I don't think that is a totally accurate description of the two methods, but both methods do still exist.  I also think patients can still periodically switch from one method to the other.

If the cost to the center for the equipment and supplies for home dialysis on the NxStage is only $1,500, why I am getting crap from the Social Workers about how much more expensive it is for the clinic to provide home dialysis on the NxStage than it is to provide in center dialysis?

[Zach]

Sorry if I misstated the two payment methods. 

More expensive may mean less profit.     

[Black]

Sorry if I misstated the two payment methods. 

More expensive may mean less profit.     

No problem, Zack.  I went to the Medicare site and refreshed my memory on the two methods as I had forgotten the details.  I'll get to that in a sec.

My point was that apparently the cost to the clinic is the same for NxStage patients as it is for incenter patients.  Yet, I have had TWO Social Workers tell me that  there is no way my husband can get a NxStage because he does not have insurance to cover the additional costs.
 
Under Method 1 the patient gets supplies and equipment from the dialysis center

Under Method 2 the patient gets the supplies and equipment directly from the supplier

Under BOTH plans the patient gets support directly from the center and Medicare pays them directly for those services.

[Panda_9]

If its only $1500 a month then that doesnt explain why we dont have nxstage here!

[Hawkeye]

If you dialyze at a Fresenius clinic you will never be given the option of NxStage.  In fact even mentioning NxStage is a big no no.  Fresenius has it's own Home Dialysis machine the 2008K at home, so that is the only home hemo option provided.  At least that its how it works with our home program.  The really bad thing is that the NxStage seems like such a better system.  Not only that, but it is portable.  The 2008K at home is maybe 5 inches shorter than a standard 2008K, and you have to have this huge bulky R.O. and carbon tank setup to go along with it.  The whole setup has a footprint about the size of a large office desk.

[Zach]

Under Method 1 the patient gets supplies and equipment from the dialysis center

Under Method 2 the patient gets the supplies and equipment directly from the supplier

Under BOTH plans the patient gets support directly from the center and Medicare pays them directly for those services.

Can a dialysis center refuse your wish to follow Method 2?

[Panda_9]

I think considering we are in a drought at the moment, the government need to move their big greedy arses and look at getting NxStage over here. I know it may not be as simple as that, but theres not even a thought about getting it here. Think of all the water it would save. Its how they did it in the old days, so why cant we do it again.

[Black]

Under Method 1 the patient gets supplies and equipment from the dialysis center

Under Method 2 the patient gets the supplies and equipment directly from the supplier

Under BOTH plans the patient gets support directly from the center and Medicare pays them directly for those services.

Can a dialysis center refuse your wish to follow Method 2?

I have no idea.  There is a Federal Law which requires that every dialysis clinic inform every patient of ALL of their options - there are 6 or 7 kinds of dialysis and at least 5 of them can be done at home.  When the patient chooses then the clinic is required by that same law to either provide that kind of dialysis to the patient, or find the patient a clinic which does.  As most here know, despite the law, that doesn't happen.  So my guess would be that if they don't want to do Method 2, they won't.

[billable]

I think the medicare reimbursement method is up to the clinic, not the patient.  It isn't really an issue for the patient since you will be billed the same either way.

The reason that the clinic is reluctant to offer you the Nxstage is money.  You are right about the $1500 per month cost to the clinic, but you have to look at medicare reimbursement rates.  If medicare allows, let's say 145 per treatment up to a maximum of 3 treatments per week (reimbursement varies by patient and by location), that is payment of 145 X 13 treatments per month = 1885 per month.  But medicare only pays 80 %.  You are responsible for the other 20 %.  So, medicare pays $1508.  In order for the clinic to have any money at all, they have to collect that other 20%.  Without other insurance, you will owe a little over $300 per month on the dialysis alone.  Then there are copays on labs, epogen, other injectables, etc.  It adds up to about $500 to $600 per month for some people.

It is a sad fact that most people can't afford to pay that when they are well.  Much less when they are not feeling up to working at their fullest potential.

[billable]

BTW, I think that Nxstage chose $1500 per month because of the medicare reimbursement rate, not based on their costs.  The more units they get out, the cheaper it is for them per unit.  That means that I expect them to be able to lower their fees at some point to get a better market base.  If it isn't available to you now, there is still hope for the future.

[Gram2Twinz]

I requested an itemized bill from our Davita Center so we could try to track our cost when we began Home Hemo Training with NxStage.
Our training began on 10/23/07, these are just an example of the costs billed to our insurance-
Home Hemo Training                    Quantity 1 each      $ 1578.00  at center (by RN)
 (Grand total= 24 sessions x $1578.00= OMG!

On our own at Home:
Home Hemo                                                            $ 1389.00  at home   (self)
Heparin    1000 UT                        Quantity  6                 48.90 at home    (self)
Epogen> 10,000      100 UT SQ2    Quantity 100          $1265.00  at home    (self) Geez- one little shot, sub Q each week- yikes!

I don't think this includes the supplies that are used with each treatment. I'm sure that will be an interesting read! I know we have great insurance, I know because we still pay our own premiums (until medicare kicks in)- but I choose to make an attempt to understand the costs, the invoicing and try to keep everyone "honest". Hey, I've got more time than money! It may turn into a full time job just trying to track the monthly expenses. I find the cost of that little Epo injection unbelieveable. We used to have Aranesp sub Q at home that our rx service covered with only a co pay of $15.00 per month. Imagine our surprise when reading our invoice for Epo in early Nov. for a prescribed 19,000 units for a mere $2403.00!

I guess the lesson we learned is that you should know your insurance benefits, talk to your center's insurance specialist or "social worker" and keep them honest!

[Roadrunner]

Our Medicare was also billed $1578 for each day of training and for each day the nurse came to our home to watch that we could do it OK.  What really surprised me was the $10,120 each month for Epoetin alfa, 100 units.  What is 100 units?  He uses 2 bottles, (20000 each) per week

[cherpep]

I'd love to know how much cheaper it is now, with the influx of the PureFlo.