Treatment every other day

[NickL]

I have a question for the members of this forum about the quantity of dialysis we receive that is accosted by medicare - which is three times a week. How many of you would like to be dialyzed every other day. I realize this means alternating days every other week, but before you question the logistics of this - think of the benefits to your existence. Anyway I would just like to get a feel of how many of you would be interested in such an idea. Please note that there is no solution to this right now - but I feel that nothing is ever written in stone.




EDITED: Thread MOVED to proper section - Epoman, Admin/Owner.

[Epoman]

I have a question for the members of this forum about the quantity of dialysis we receive that is accosted by medicare - which is three times a week. How many of you would like to be dialyzed every other day. I realize this means alternating days every other week, but before you question the logistics of this - think of the benefits to your existence. Anyway I would just like to get a feel of how many of you would be interested in such an idea. Please note that there is no solution to this right now - but I feel that nothing is ever written in stone.

  I can do dialysis daily, which is better than every other day. I do home-hemo 5 or 6 times a week. Check out http://www.ilovenxstage.com to read my story with NxStage. I guess I don't understand your question or you are not up to date with current home-hemo options.

Oh and this is the "Introduce Yourself" section which is only for introductions, please create all future threads in the correct section. For example this thread should have gone in the "General Discussion" section.

- Epoman

[NickL]

My question  was for those who do not, or can not do dialysis at home. I probably could -but don't because I don't want to bring it home to my family. However there are others - the old , the foreigners who don't speak English well, or those who are just plain afraid. The government limits us to three tx's a week due to I'm guessing budget reasons within the medicare system. I always felt this was a 3 step up and 1 step back situation which is what hurts us in the long run.

[Epoman]

My question  was for those who do not, or can not do dialysis at home. I probably could -but don't because I don't want to bring it home to my family. However there are others - the old , the foreigners who don't speak English well, or those who are just plain afraid. The government limits us to three tx's a week due to I'm guessing budget reasons within the medicare system. I always felt this was a 3 step up and 1 step back situation which is what hurts us in the long run.

Ah ok now I understand better, I was just worried that you didn't know about home-hemo options, I too did not want to bring it home to my family but man I got to tell you it was the best thing I ever did. 

[Rerun]

I would dialyze every other day if I could.  That weekend really messes me up on my fluid intake.  But, Medicare can only do so much.  Tax Payers can only do so much.  The quality of dialysis could go up if so many people weren't on it.  Oh, the good 'ol days!   

[BigSky]

The government will actually pay for more than 3 days a week.  However what they pay for each additional treatment in that week drops quite a bit with each one over 3.

[NickL]

every other day tx would amount to 14 tx in 4 weeks as opposed to 12. It should not be a burden to the taxpayers - only a different allocation of the monies that the government already takes out of our pockets. All it requires really is a loud enough voice . For instance, if people normally dialyzed their pets, don't you think there would an entire group of hollywood stars screaming that it is inhuman to only give them their life saving treatments 3 rimes a week!!! What about Sunday - do our bodies take a day off from producing waste, collecting fluid? As i said before we are the unwanted stepchild of that rockstar - transplant. We need to start unifying and shouting about what we need to the right people and not just among ourselves.

[Zach]

That weekend can be a killer!

In-center dialysis every other day sounds like an idea whose time has come.         

[angieskidney]

I just figured it was the way it was because other people have to dialyze too and there are only so many open slots. I mean .. you got for example...

George on at 7am on Monday Wed Friday

Pete on at noon on Monday wed Friday

Paula on at 4pm Monday wed Friday

Sam on at 7am Tues Thurs Sat

Trish on at noon Tues Thurs Sat

Cameron on at 4pm Tuesday Thus Sat

.. well you get the picture right? Now that is just one chair. Times that by how ever many chairs are in each unit...  Kinda hard to do inclinic hemo every other day unless everyone started going on rotating days and included Sundays .... If we did that I would never remember what days I was supposed to go in at .. 

[Rerun]

It would be nice to have Sundays open to those who wanted an extra day.  Maybe just one shift.  But, it's not fiesable financially.  It just costs too much to keep us alive at 3 days a week. 

I like the idea of a home dialysis patient hooking up with another dialysis patient and using the same machine.  The home patient would get paid from Medicare like the clinic would.

[Zach]

It would be nice to have Sundays open to those who wanted an extra day.  Maybe just one shift.  But, it's not fiesable financially.  It just costs too much to keep us alive at 3 days a week. 

Visits to the E.R. resulting from those weekends in between treatments would be reduced, and perhaps more than off-set the extra 2 or 3 treatments a month. I think it might be budget neutral ... or perhaps even a small reduction in overall expenditures.

[Zach]

I am bringing this up as a new topic only because I asked a question which was  - how many of us would like to get dialyzed every other day as opposed to three times a week. I explained that this would amount to 2 extra tx within a 4 week period. I asked not to think about the logistics of the scheduling. From the responses I received it seems that all responses said they would like to get dialyzed every other day - but there was concern about the scheduling of such an endeveour and to my surprise concern about whether the government could pay for this.

My answer to these concerns are that any graduate with a business management degree or any one who has run his/her own business could create a scheduling of this in a matter of hours. As far as the number of seats available - well that doesn't change only the number of treatments for each patient - which in turn would create more jobs. Also people would probably need less time on the machine in the long run which would mean less stress in the unit. Then looking again at the long run (because we are all here for the long run) there would be less long term dialysis health problems which happen to be much more expensive to the government then 2 extra txs a month.

Whether the government can afford to pay for this is like asking what is the price of your life. I did not want to bring politics into this equation -  just a sense of what is best for us - the dialysis patients, which I thought was the purpose of this site. The three times a week tx was hard fought for by dialysis patients many years ago, and it was meant to keep people alive until they received a transplant. That was back when the "list" was a 1-2 year wait. Now, depending where you live, it can be up to a ten year wait. I believe it's time to update the thinking here - it's time to question the reasoning behind dialysis. Every other day tx brings what is known as a steady state to the body. That steady state means less variation in your clinical numbers - your blood values, which in turn means less toxin build up, less calcium/phosphorous build up, less fluid ,potassium.sodium and every other thing that hurts us buildup - which in turn means a better quality of life for us  - the dialysis patient ...

Let's continue this conversation.
 

[Zach]

Doesn't anyone have an opinion on this topic??

[Bill Peckham]

I think there is good chance it would be budget neutral. It would amount to 26.5 additional treatments a year, which at a $120 per treatment the expense for Medicare would be about $3,300. I think on average people on dialysis have 11 visits to the hospital and spend 21 days a year inpatient. Eliminating a single hospital visit could pay for the program without even calculating the benefit of improved health. Currently Medicare will reimburse a forth treatment at their standard rate, there is no drop in reimbursement, if it medically justified. The Medicare financial intermediaries decide if Medicare will support the forth treatment - FIs decisions vary by location. But even if Medicare would support it there are logistical issues.

Right now with most everyone following a three day/week schedule it is easier to staff the unit and keep operating at a high capacity. It would take a new mind set to offer schedules in addition to a three/week standard. I for one think units should be open 7 days a week. People should be offered the option of dialyzing every other day - in Angie's example all six of the people using a station would need to be on the every other day schedule. In addition I would like this same unit to offer four day a week schedules so that instead of having back to back days off you'd have back to back dialysis days a M-W-F-S schedule or a T-T-S-S schedule.

There is a question about how many people could or would want to have an enhanced schedule but I think additional runs provide a lot of dialysis bang for the buck time . 16% more time spent dialyzing (going from 3/week to 3.5/week) would give you 33% more dialysis. 33% more time spent on the machine (going from 3 to 4 days/week) would give you 70% more dialysis. This based on the Hemodialysis Product which I have found to be a broadly accurate way of comparing schedule choices (when keeping the machine particulars the same and just changing the time and/or frequency).

The three day a week schedule is not justifiable on clinical grounds. Different people need different amounts of dialysis and studies show the deadliest day for a dialyzor is the day after two days off. It would be harder to operate a clinic seven days a week but it would allow healthier schedules.

[BigSky]

I have thought that it would be a much better idea to do 4 days a week.

Maybe we should just add an extra day to each week of  the calender and that will be the calender renal patients go by.   


However the way most talk on this board and how most act in my unit I have a hard time believing that most would want to sit for another day.

Most look at me like I am crazy when it took me months to get more time added to my run.

[stauffenberg]

You always have to think of these issues in cost/benefit terms.  If you have to spend too large a percentage of your life just keeping yourself alive and healthy, you may have to ask yourself what you are keeping yourself alive and healthy for? -- so you can do more dialysis?!  You have to find some psychologically and socially optimal balance between the disruption of your life by the treatments and the improvment of your life by the treatments.

Doing dialysis every other day might generate problems with patients losing track of their dialysis schedule, and it would create scheduling difficulties to combine a large number of patients doing dialysis every other day in the same center with those following the traditional treatment regimen.

It would be better if society adopted, just for the sake of dialysis patients, the old calendar the Ancient Romans followed, which divided the year into weeks lasting 10 days each, with the surplus days taken up by various special holidays.

[Black]

I think this does need to be discussed and should be implemented for the patients who want it.  The solution to many of the problems noted in making this change would be solved by putting every patient possible on home dialysis.  I read somewhere that every patient on the NxStage is saving Medicare about $25,000 a year.  Even if they're off by half, and only saving $12,500 per year, can you imagine what the total would be if the majority of dialysis patients were on home dialysis and the incenter patients were only those who could not do home dialysis?!?

[kidney4traci]

I feel better doing dialysis at home 5 x/week vs the three times in clinic.  I never feel like it is running my life.  Well, except training because it was longer hours etc.  But now I feel better and by doing it at home I not only control the time which I couldn't before but I can multitask if I want and not be bothered.  I find the two hours enjoyable as I can read, watch TV or visit with my kids - or nap and not be bothered.  I can't do anything else since I can't move out of my seat.  So I make the most out of it and since I am feeling better too, it is better than being sick or worse dead! I do dialysis to live life.