My transition from Kaiser to FMC here in Idaho has been less than good. They couldn't get my financial affairs correct and the local folks were just sitting on their hands. I called the central verification officer in Arizona for FMC and they ended up putting me with the lead supervisor who stated that they should have been able to EASILY approve me locally. After I made my own verification, about three days later, the center called up and acted like THEY got the approval.
They made me switch over to the PureFlow which in some ways is easier, but the chicken foot leaked and blew my hard drive. They are sending me a new control by tomorrow.
Yesterday, I went to the clinic for my second clinic visit. The doc seemed a bit reserved from our first meeting. After seeing her, they brought in the ENTIRE home dialysis dept all at one time INCLUDING the second nurse even though she was not doing my clinic visit that day. The reason:
12 days earlier during another visit for my initial eval by dietician and social work, the nurse sat down with a graph and said she had "good news." I could reduce my filtration fraction (I have it elevated at 45%) and improve the efficiency of my treatment and use less dialysate. I spent about 10 minutes going over the physiology of solute removal with her hand drawing a graph of that relationship with NxStage and then she was back yesterday like as if I had not already had that conversation.
To state that my second meeting was a confrontation is an understatement. In addition, even before I started at this unit, I asked all I talked to if being on 40 L a treatment was going to be an issue. They all assured me it wasn't. When "they" "approved me" they stated that it was only if I switched to the Pureflow but it was not a problem to keep my 40 L.
To say the least, I have no trust in these folks and I will explore my further options. My old unit here in Spokane is not part of Group Health even though Kaiser was not a problem at all.
Long and short of it is that the for-profit dialysis centers are in general a bunch of creeps that could care less about you or your outcomes. It is all about money period.
If your unit is filthy, you are justified to leave and report them.
I wish you the best dealing with this horrible industry.
Peter one regret I have about the advocacy about the bundle - 2009/10 is that I didn't give any real thought to Method II which went away in the final rule, not so much about keeping Method II as it was but I didn't spend anytime imagining what Method II could be.
My memory is that prior to 2011, Method II was a way to receive Medicare reimbursement as the dialyzor. Sort of being like a general contractor you manage the books and pay your subcontractors - under Method II, for instance, you would contract with FMC to provide backup services, and you would have a contract with a company to provide your supplies, etc. I'm not entirely sure what the problem was that caused Medicare to eliminate the program but I think it came down to middlemen abusing the system, maximising charges in the name of dialyzors who were their own General Contractor in name only, for instance people in nursing homes being signed up for Method II (doing PD) with the nursing home filling the general contractor role. I know George Harper dialyzed under Method II in order to have the latitude he wanted to self dialyze when and where he wanted and I know one other person who did in the '90s but it wasn't at all common.
I think we should imagine a new Method II - an Emancipated Dialyzor model. An Emancipated Dialyzor (ED) would have to show themselves to be committed and knowledgeable about their own care, perhaps a dialyzor would need need to be certified ED qualified by the networks. A fully qualified ED could contract directly with vendors to be supplied, and have backup services, you could have any physician who would take you, no in or out of network issues. Even for those who prefer incenter dialysis being a fully qualified ED might mean you could have responsibility for managing your dry weight, be allowed to have the machine within reach, do your own cannulation, etc.
What do you think? What should be required to be an ED? Peter you'd be a perfect candidate to be an ED, what would work best in your situation - would you want to manage your treatments to the degree that you would contract with NxStage directly? In your case it is Kaiser that would have to see/treat you as an ED - so maybe Medicare rules wouldn't come into play, I'm not sure.
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