meeting with someone important this week

[kidney_beanz]

Sorry okarol!  I just posted my introduction.  Should've paid more attention to the rules   

Glitter, I live in Brevard.  Sorry to hear about your husband's ongoing problems.  I would be upset too if I were him.  You are right, they should have resolved his issue the first time. 

[dialysisbiller]

well, the meeting was mostly corporate stuff but i was able to talk with him on a more private level before heading back to my cubie... good news is he had asked me to email him and discuss some ideas. Sometimes all you need is a foot in the door.

Being at the corporate level, I don't get to see what is really going on, I  know from a neighbor the center closest to me is wonderful and the staff is so caring... but coming here and reading the horror stories... makes me wonder who's being held accountable for it in the end.

I have always heard about satisfaction surveys done at the center level and never really thought much about that until reading some of the posts on here about conditions and treatment from staff and the inconsideration that goes on there. I don't know what I can do from my position but I'm willing to bring it to the attention of some people who might actually look into it.

I listen to Registration Reps who call insurance companies daily to get 'authorizations' for dialysis treatments and sometimes get asked 'is this a medical necessity?' to which they reply.... 'what do you think? no dialysis, death or dialysis, life?' It's amazing to think that some insurance would turn down dialysis treatment but it has happened. (I have checked my insurance plan to make sure it's covered since I started here)

I might not be able to do something directly to help, but maybe get some wheels in motion.... who knows

[Zach]

... I listen to Registration Reps who call insurance companies daily to get 'authorizations' for dialysis treatments and sometimes get asked 'is this a medical necessity?'...

When the dialysis center is trying to get $2,000 per treatment, no wonder the insurance companies balk.

[dialysisbiller]

... I listen to Registration Reps who call insurance companies daily to get 'authorizations' for dialysis treatments and sometimes get asked 'is this a medical necessity?'...

When the dialysis center is trying to get $2,000 per treatment, no wonder the insurance companies balk.

How much do you think it should be? (and it's under 2K, without meds) but the charged amount doesn't reflect the actual amount even when it's private insurance. It depends on your insurance company and if they have contracted with your center, etc etc.... out of the 385 patients that I have, about 90% are either Medicare or Medicaid. That leaves about 10% with commercial primary coverage. If you look at your EOB (explanation of benefits) that comes from your insurance, look at the 'charged/billed' amount, then look at the 'approved' amount and/or 'paid'.... it's standard with ALL medical billing. I know, it's a terrible thing the medical and insurance industry.... insurance companies are telling medical providers what to do, or we won't pay.

[Zach]

If you look at your EOB (explanation of benefits) that comes from your insurance, look at the 'charged/billed' amount, then look at the 'approved' amount and/or 'paid'.... it's standard with ALL medical billing.

That was already understood.

[Bajanne]

Dialysisbiller, please answer a question that I have been asking for nearly 4 years, and have never got an answer.
Why is it that we buy our equipment, medication, supplies from the US, yet dialysis is much cheaper in the Caribbean - $500 per session here, $300 per session in Barbados, $320 in St.Lucia?
Here we have no reuse, get sureseals, heparin, Epogen, etc., etc.
Why does it have to cost so much in your country???

Isn't it that someone is really profitting from this?

[nursewratchet]

How about another layer of compliance for patients?  I'm speaking of being forced to be tied down in a chair next to patients who fail to shower.  Or wear their shoes.  Or scream into their cell phones about their anal warts.  Or throw their feces all over the bathroom walls.

You get the idea.

There should be certain requirements that speak to common sense and courtesy.

Try putting up with weekly treatments at my clinic with the animalistic antics I'm forced to deal with and you'll demand these type of rules.

  The patients must sign a patient responsibilty form upon admission.  IT is supposed to take care of those kinds of problems.  The only issue is, if it gets enforced by either the Medical Director, the FA, or the company backing you up.  We do a letter of contract with some patients, and if it is violated repeatedly, we discharge the patient.  If several pts. complain about another  pt. and they won't change their behavior, some patients need to go somewhere else.  The company should back that up. 

[twirl]

throw their poo poo     

that would curb my desire for a snack

[dialysisbiller]

Dialysisbiller, please answer a question that I have been asking for nearly 4 years, and have never got an answer.
Why is it that we buy our equipment, medication, supplies from the US, yet dialysis is much cheaper in the Caribbean - $500 per session here, $300 per session in Barbados, $320 in St.Lucia?
Here we have no reuse, get sureseals, heparin, Epogen, etc., etc.
Why does it have to cost so much in your country???

Isn't it that someone is really profitting from this?

as with most medications in the US, the pharmaceutical companies are to blame, the services for dialysis being cheaper in other countries such as in the Caribbean, I have no idea why it would be cheaper other than the government runs it and it is not private like the US medical industry.... i have family in both Canada and US and are just freaked out at the way our health system is here, my family went almost 3 years without health coverage.... in Canada, that's unheard of, i got lotsa questions 'why didn't your government pay for your health care when you couldn't afford it?'.... well, apparently unemployment is making TOO much to qualify for Medicaid.... but if i was an illegal alien, i could easily qualify and get top care... go figure... trust me, I have issues with how the medical industry operates in this country... i have illegals at my centers that get their treatments pd 100% by state medicaid programs or hospital charities... or sometimes, not and who's left footing that bill when they run off after a center has taken them in and given dialysis treatments to help them?.... oh yea, it's not always a profit at some centers in some locations

[Bill Peckham]

Dialysisbiller, please answer a question that I have been asking for nearly 4 years, and have never got an answer.
Why is it that we buy our equipment, medication, supplies from the US, yet dialysis is much cheaper in the Caribbean - $500 per session here, $300 per session in Barbados, $320 in St.Lucia?
Here we have no reuse, get sureseals, heparin, Epogen, etc., etc.
Why does it have to cost so much in your country???

Isn't it that someone is really profitting from this?

as with most medications in the US, the pharmaceutical companies are to blame, the services for dialysis being cheaper in other countries such as in the Caribbean, I have no idea why it would be cheaper other than the government runs it and it is not private like the US medical industry.... i have family in both Canada and US and are just freaked out at the way our health system is here, my family went almost 3 years without health coverage.... in Canada, that's unheard of, i got lotsa questions 'why didn't your government pay for your health care when you couldn't afford it?'.... well, apparently unemployment is making TOO much to qualify for Medicaid.... but if i was an illegal alien, i could easily qualify and get top care... go figure... trust me, I have issues with how the medical industry operates in this country... i have illegals at my centers that get their treatments pd 100% by state medicaid programs or hospital charities... or sometimes, not and who's left footing that bill when they run off after a center has taken them in and given dialysis treatments to help them?.... oh yea, it's not always a profit at some centers in some locations

um 'k. I'd say it is clearly the large dialysis organizations (LDOs) charge thousands of dollars a treatment because people pay them thousands of dollars a treatment. I spoke at a convention of Self Insurance administrators last Thursday and what they see is the LDOs (well one in particular) simply divide the medical max by the thirty months the dialyzor is going to be private primary and there is your rate.

And one thing maybe dialysisbiller could speak to is that there is no rate that DaVita charges - it all depends on insurance limits and what they think they can get. The goal is to leave nothing on the table. One cost containment company told the story of guy who was withdrawing from dialysis because he was going to burn through his family's coverage limits. Luckly the guy's HR Department looked into alternatives and found the cost containment company. The guy was able to train on NxStage in another town and break DaVita's monopoly.

These outrageous rates do not come without a price.

As far as it being the fault of the drug companies that is nonsense. DaVita and FMC get EPO for less than Medicare pays - they make a lot of money on EPO.

[Bill Peckham]

Here's dialysis cost data collected for the National Renal Administrators Association by Avalera Health. Avalera's report comprises the last four pages of this PDF

[dialysisbiller]

well, sure, when you buy something in bulk, you'll get it cheaper, everyone knows that, ie: cosco, sam's club or bj's wholesale clubs.... but I have several patient's who I work through the flow sheets and the notes say 'brought own epo' hence, we do not bill for their epo because they got it at the drug store or other source, it is becoming more and more common for the centers I do billing for, but why is it that you can purchase drugs from Canada online at a cheaper rate than in the US?

EPO has declined since CMS has implimented the reduction rule for it's use, which has lead other insurance companies to review their claims if they exceed certain levels then we have to provide the back up doctor orders etc etc.... so dialysis companies are not making as much as they had back in '05 and '06, a dramatic decline to be frank about it. I know, I see the bills going out and the amounts on claims... Medicare will not pay for more than 400K units in a month, it was 500K back in '06, they call it 'medically unbelievable'...

oh, and as far as charges are concerned, it's a flat fee across the board, no matter what the insurance, medicare, medicaid, medicare hmo, cigna, aetna, great west, unicare, all blues, uhc, indian health and the list goes on and on, the charged amount for each dialysis treatment is the same. i don't know who your source is and i can only speak for my experience on what is on the claim as it goes out the door, same charge, now, when you talk reimbursement rates, that's another ball game altogether. Medicaid programs pay a flat rate for treatments, period. Now, there may be an insurance we are contracted with that the reimbursement rate is a percentage of the charged rate, but again, the same charge of approx $1,500 per hemo treatment, PD treatments are less about $800.

[Bill Peckham]

If all the LDOs charged was $800 per treatment then there wouldn't be a need for Dialysis Cost Containment Companies yet there is an entire industry. There are numbers in the public record via the NRA v. BCBS of GA law suit. $2,900 per treatment/ up to $9,000 when separately billibles are included

[Zach]

One cost containment company told the story of guy who was withdrawing from dialysis because he was going to burn through his family's coverage limits.

The Medicare Secondary Payer (MSP) period is currently 30 months.

But there was a big push few years ago to extend it to 42 months.  We can partially thank those "Caring Kidney" folks.  The above example is one very good reason why the proposed 42 month Medicare Secondary Payer (MSP) period was an awful idea.

One of the main arguments advanced by members of the group was:  "Even if patients want to remain in their private health insurance plan, they are required after 30 months of coverage to go onto Medicare."

I never read anything from any of the members of the "Caring Kidney" folks about the possibility of people on dialysis reaching their lifetime limits as a result of the extended private insurance provision.

One group that did speak out against the proposed extension was American Association of Kidney Patients (AAKP). Good for them!
http://www.aakp.org/press/press-releases/2007/Defeat-MSP-Extension-for-ESRD/

 

[Bill Peckham]

One cost containment company told the story of guy who was withdrawing from dialysis because he was going to burn through his family's coverage limits.

Another reason why the 30 (or was it 36?) month Medicare Secondary Payer (MSP) period was an awful idea.
We can partially thank those "Caring Kidney" folks.

One of the main arguments advanced by members of the group was 'people shouldn't be forced to drop their private insurance (in 24 months) for Medicare.'

I never read anything from any of the members of the "Caring Kidney" folks about the possibility of people on dialysis reaching their lifetime limits as a result of the extended private insurance provision.

This is a terrible shame ... for all of us.

 

You can't pin this one on them Zach http://www.billpeckham.com/from_the_sharp_end_of_the/2008/01/post.html

KCP was constituted in 2003 or 2004. I don't know who was for what in 1981 but it wasn't me, I'm guessing National Medical the FMC forbearers.

[Bill Peckham]

I think what you're remembering is KCP's ill conceived idea to extend it to 42 months or the President's 2006 budget proposal that extended it out to 60 months. They ran up against Detroit so that's never going to be back on the table.

[Zach]

Sorry Bill, I was referring to the 2007 push for the 42 month extension.
I have now edited my original post to reflect the point I was trying to make.

[dialysisbiller]

If all the LDOs charged was $800 per treatment then there wouldn't be a need for Dialysis Cost Containment Companies yet there is an entire industry. There are numbers in the public record via the NRA v. BCBS of GA law suit. $2,900 per treatment/ up to $9,000 when separately billibles are included

do you know who's charging over $2K per treatment(NO drugs included) not where i'm at, as i said a flat charge across the board just over $1,500.... when you include meds, sure that amount sores pretty fast, but when you're talking high dollars like that it's the meds that inflate the claims to the higher dollar.

Cost containment would be having insurance companies use contracts for dialysis patients.  ie: BCBS plan gets charged $1,500 plus all meds, there's a contract that calls for 'all inclusive' rate of reimbursement of $500..... IF the patient rec'd high doses of EPO or other meds, no big deal, the contract is 'all inclusive' and no matter what meds they get, once flat reimbursement rate. that's cost containment. No contract, yes, that price for the treatment and drugs in a single day could definitely shoot up to $9K

[dialysisbiller]

Sorry Bill, I was referring to the 2007 push for the 42 month extension.
I have now edited my original post to reflect the point I was trying to make.

That is insane to push it to 42 months.... i heard it was going to pass but that was a while back and haven't heard anything new since, course my time isn't mainly on Medicare claims these days.

the thing is, if 30 months pushes people's insurances to use up $600K of let's say their $1 mil life time max, i spose their thought is why not push it to 42 months then gobble up the entire $1 mil? it's just insane to push it to 42 mos

any updates on if that is still on the table?(busy working or i'd check it out cos now i'm curious)

[Bill Peckham]

If all the LDOs charged was $800 per treatment then there wouldn't be a need for Dialysis Cost Containment Companies yet there is an entire industry. There are numbers in the public record via the NRA v. BCBS of GA law suit. $2,900 per treatment/ up to $9,000 when separately billibles are included

do you know who's charging over $2K per treatment(NO drugs included) not where i'm at, as i said a flat charge across the board just over $1,500.... when you include meds, sure that amount sores pretty fast, but when you're talking high dollars like that it's the meds that inflate the claims to the higher dollar.

Cost containment would be having insurance companies use contracts for dialysis patients.  ie: BCBS plan gets charged $1,500 plus all meds, there's a contract that calls for 'all inclusive' rate of reimbursement of $500..... IF the patient rec'd high doses of EPO or other meds, no big deal, the contract is 'all inclusive' and no matter what meds they get, once flat reimbursement rate. that's cost containment. No contract, yes, that price for the treatment and drugs in a single day could definitely shoot up to $9K

There are numbers in the public record via the NRA v. BCBS of GA law suit. $2,900 per treatment/ up to $9,000 when separately billibles are included. It was disclosed by NRA in the suit here is the PDF of the suit http://www.nashvillepost.com/documents/NP_pdfs--legal/NRA_BlueCross_Complaint.pdf

The administrators at the self insurance conference named names and the name that came up most often for extremely high charges - 100k/month - which lacking any leverage the self insurers have to pay, was DaVita. DaVita's high charges are widely known and commented on in their industry.

[Zach]

The administrators at the self insurance conference named names and the name that came up most often for extremely high charges - 100k/month - which lacking any leverage the self insurers have to pay, was DaVita. DaVita's high charges are widely known and commented on in their industry.

And here's another DaVita unit which is suing to receive outrageously high charges:

http://www.tribune-democrat.com/local/local_story_110231019.html
Company sues local hospital, insurance plan

By BERNIE HORNICK
The Tribune-Democrat
April 20, 2009 11:08 pm

— A Richland Township dialysis company says the Conemaugh Health System and its health-insurance plan owes it almost $950,000, and is suing to recoup the loss.

Physicians Dialysis Acquisitions Inc. said its subsidiary – DaVita PDI-Johnstown on Budfield Street – has not been paid the full benefits due through two of its patients, “D.D.’’ and “G.T.’’

The hospital’s Health and Welfare Benefit Plan “has engaged in a practice of providing inadequate benefits for out-of-network services,” according to the lawsuit. The strategy aimed “to increase the costs to its members of going out-of-network,’’ the suit said, so members didn’t use those out-of-network providers.

The suit was filed in U.S. District Court in Johnstown.

Conemaugh spokeswoman Fran Bodnar said the health system does not comment on pending litigation.

PDA said it is due payments for D.D. for treatment received from October 2007 until December.

The company said it billed $581,000 for caring for D.D. It believes the health insurance should pay $521,000 of that but Conemaugh paid only $38,000.

So, PDA believes it is owed $483,000 in this instance.

Similarly, PDA said it is owed $464,000 for taking care of G.T.

Physicians Dialysis is asking in its suit to have the bills paid, with interest, as well as attorney fees.

[dialysisbiller]

interesting...... the problem is not knowing what the contracted rate for in and/or out of network benefits should have been.. without those key pieces of information, tough to say anything

you really have to look at the big picture when it comes to this

do you want a goverment run dialysis center? or would you prefer to have options? centers with wireless access and cable with comfortable chairs? or standard chairs and nothing to do during your treatment other than listening to the machines run? 

since the insurance industry is not run by the government as a 'whole'.... these are the things that happens.... HIPPERs bring in the much needed xtra money to centers so they can improve the center's quality.... the problem with a company that gets bigger, it's harder to monitor each individual center and you have ones that don't give the quality of care that it should be providing for patients.

I have a center that I manage with just about 200 patients, it's in a city and about 90% are on medicare or medicaid (including medicare HMO and medicaid HMO plans) the reimbursement for those are crap in comparison to someone who has a commercial primary plan (HIPPER)..... without that 10%, the center is not going to be able to afford to keep fully staffed..... the EPO reimbursement guidelines have pretty much halted the over dispensing of it now..... not only does a center have to pay the staff employed at the unit but costs of billing, you have 3 types of collectors, me, a patient rep that handles everything BUT patient pays  and non contracted insurance plans... from your side, I definitely can see why you feel the way you do but from my side, the health industry with the commercial plans is a necessary evil due to government insurances not paying enough.


i don't want to see the 42 month extension but medicare is having funds sucked dry, they want the insurance companies to fork out more to help, this means more money out of patients' pockets too, that is why I think the extension is crap.

i think you have such a dislike for DaVita that they will never do anything that you like. i get that. i started with them when the gambro aquisition happened, first thing i thought 'bigger isn't always better'......i can only do 'my' part to make it better.

[nursewratchet]

My DaVita clinic NEVER billed out that much for a HIPPER patient.  Lots of Hippers at my unit, but never anything like that.  Sorry I've been gone for so long.  Sometimes life SUCKS!!!! It's all good now... 

[Chris]

Hi nursewratchet