A dialysis pioneer whom you might not know about

[noahvale]

^^

[MooseMom]

I very much like Dr. Bower's assertion that if you can drive a car, you can run a dialysis machine. 

It's a real shame that nephrologists don't tell patients more about home hemo.  Mine didn't mention it to me...I mentioned it to HIM!

[Rerun]

We had a person just leave in center for home hemo but she skipped all the time at the clinic.  I hope she does her treatments at home.

[RightSide]

I very much like Dr. Bower's assertion that if you can drive a car, you can run a dialysis machine. 

It's not a good analogy.

Where I live, they allow me to drive a car by myself--but not to do home hemo by myself.

I am told I need a partner to do home hemo.  That's not true for automobile driving.

On the other hand, I can be arrested for Driving Under the Influence (DUI)--but not for Dialysis Under the Influence.   

[MooseMom]

Well, the analogy wasn't "if they let you drive a car, they'll let you run a dialysis machine."

People don't drive a car by themselves anymore, anyway.  Everyone seems to have some sort of backup mechanism they can use if they get into trouble.  Cell phones, Onstar, GPS, all sorts of emergency services.  If you're dialyzing at home, your partner is just there for emergency backup...s/he is your dialysis OnStar service.

If you're blind, they won't let you drive, and they won't let you do home hemo alone, either.

"Home Hemo Alone"...there's a title for a new movie!

[PatDowns]

For Dr. Bower and his team it is a good analogy.  He is saying that if someone is capable of learning how to drive a car, then he has the ability to also learn independent home hemodialysis.   You do not "need" a partner for home hemo.  That is just the bias of your nephrologist and clinic.   A "helper" is there only as a back-up.  His point is a patient should be responsible for his own treatment at home.  Read the attached articles by Dr. Bower.  You will understand the difference in his attitude towards what one is capable of doing and that of your clinic.

I very much like Dr. Bower's assertion that if you can drive a car, you can run a dialysis machine. 

It's not a good analogy.

Where I live, they allow me to drive a car by myself--but not to do home hemo by myself.

I am told I need a partner to do home hemo.  That's not true for automobile driving.

On the other hand, I can be arrested for Driving Under the Influence (DUI)--but not for Dialysis Under the Influence.   

[greg10]

I am not sure I like this Dr. Bower or how his company RCG did business.  The following was a lawsuit that was joined by the US DOJ in 2007.  I haven't bothered to look up the result of this lawsuit.

August 30, 2007

WASHINGTON—The U.S. Justice Department has joined a civil suit against Renal Care Group Inc. and Renal Care Group Supply Company for allegedly submitting fraudulent billing to Medicare over home dialysis supplies and equipment.

Fresenius Medical Care AG subsidiary Fresenius Medical Care Holding Inc. was also named in the suit. FMC acquired Renal Care Group and RCGSC in a $3.5- billion merger in March 2006 under which Fresenius assumed all liability for the companies.

The action was filed in the U.S. District Court in St Louis, Mo., as a qui tam lawsuit, by two former RCG employees: Julie Williams, who was an RCG regional administrator, and Dr. John Martinez, who was a medical director for RCG clinics in east Texas. Under the qui tam provisions of the False Claims Act, a private party—usually as a whistleblower—can file a lawsuit on the behalf of the United States.

The government has alleged that RCGSC submitted false Medicare claims for home dialysis supplies provided to end-stage renal disease patients for the reimbursement of supplies and equipment between January 1999 and December 2005. The United States said all of the claims are alleged to be false because RCG and RCGSC were not qualified to bill for these home dialysis patients.

Under federal law, Medicare will pay companies that provide dialysis supplies to ESRD patients only if the companies that provide the supplies are truly independent from dialysis facilities and the ESRD patients choose to receive supplies from the independent supply company.

According to the federal complaint, the company set up a “sham” company in the form of RCGSC, which was allegedly not independent from RCG and “did little more than submit bills to Medicare.”

In addition, the government alleged that RCG interfered with patients’ choice of supply options by “requiring” patients to move to RCGSC. “Even after RCG employees raised concerns and industry competitors closed their supply companies, RCG kept RCGSC open because of the illicit revenue it created,” the government said in a news release.

[noahvale]

^^

[Bill Peckham]

I am not sure I like this Dr. Bower or how his company RCG did business.  The following was a lawsuit that was joined by the US DOJ in 2007.  I haven't bothered to look up the result of this lawsuit.

August 30, 2007

WASHINGTON—The U.S. Justice Department has joined a civil suit against Renal Care Group Inc. and Renal Care Group Supply Company for allegedly submitting fraudulent billing to Medicare over home dialysis supplies and equipment.

Fresenius Medical Care AG subsidiary Fresenius Medical Care Holding Inc. was also named in the suit. FMC acquired Renal Care Group and RCGSC in a $3.5- billion merger in March 2006 under which Fresenius assumed all liability for the companies.

The action was filed in the U.S. District Court in St Louis, Mo., as a qui tam lawsuit, by two former RCG employees: Julie Williams, who was an RCG regional administrator, and Dr. John Martinez, who was a medical director for RCG clinics in east Texas. Under the qui tam provisions of the False Claims Act, a private party—usually as a whistleblower—can file a lawsuit on the behalf of the United States.

The government has alleged that RCGSC submitted false Medicare claims for home dialysis supplies provided to end-stage renal disease patients for the reimbursement of supplies and equipment between January 1999 and December 2005. The United States said all of the claims are alleged to be false because RCG and RCGSC were not qualified to bill for these home dialysis patients.

Under federal law, Medicare will pay companies that provide dialysis supplies to ESRD patients only if the companies that provide the supplies are truly independent from dialysis facilities and the ESRD patients choose to receive supplies from the independent supply company.

According to the federal complaint, the company set up a “sham” company in the form of RCGSC, which was allegedly not independent from RCG and “did little more than submit bills to Medicare.”

In addition, the government alleged that RCG interfered with patients’ choice of supply options by “requiring” patients to move to RCGSC. “Even after RCG employees raised concerns and industry competitors closed their supply companies, RCG kept RCGSC open because of the illicit revenue it created,” the government said in a news release.

http://www.bowerfoundation.org/htdocs/case_studies/enhancing/kidney_care.html


I think you're selling Bower short Greg, check out the link to the Foundation that he established when his entity was folded into something which eventually was RCG (which I think was based out of Nashville) and then, years after Bower was out (as I read it) RCG went afoul of CMS policy by gaming the old Method II payment option.

[Lillupie]

I very much like Dr. Bower's assertion that if you can drive a car, you can run a dialysis machine. 

It's not a good analogy.

Where I live, they allow me to drive a car by myself--but not to do home hemo by myself.

I am told I need a partner to do home hemo.  That's not true for automobile driving.

On the other hand, I can be arrested for Driving Under the Influence (DUI)--but not for Dialysis Under the Influence.   

So funny and so true. lol

[Bill Peckham]

I very much like Dr. Bower's assertion that if you can drive a car, you can run a dialysis machine. 

It's not a good analogy.

Where I live, they allow me to drive a car by myself--but not to do home hemo by myself.

I am told I need a partner to do home hemo.  That's not true for automobile driving.

On the other hand, I can be arrested for Driving Under the Influence (DUI)--but not for Dialysis Under the Influence.   

 


I've used this analogy, but then I've also dialyzed alone for nine years. I think it's an apt analogy especially if you think about what it would mean to get behind the wheel of a car if you had not only never driven before but if you had not ever even given a moment's thought to the concept of transportation. That's how most people come to dialysis, they have never given their kidneys a moment's thought until they are diagnosed with CKD.

Imagine trying to explain to a completely new driver, new to the idea of driving, how it is you drive to the store. Think of the millions of variable combinations - from all the rules of the road, to the actual hand eye coordination required to drive - oh and by the way you simply press pedals with your feet to control the speed. And don't forget to keep track of your fluids! - gas, oil, radiator. And make sure the air pressure in your tires is correct - but tires are different so you'll have to know the right pressure for your particular tires.

If you can safely navigate a car to the store, you can learn to safely navigate a dialysis treatment. And yes even whilst you dialyze. It is far safer to dialyze alone more frequently than it is to dialyze three times a week for a couple hours even if that conventional dialysis is in a hospital under a doctor and nurses' constant supervision.

[noahvale]

**

[Bill Peckham]

It is far safer to dialyze alone more frequently than it is to dialyze three times a week for a couple hours even if that conventional dialysis is in a hospital under a doctor and nurses' constant supervision.

That's a crappy and libelous statement, Bill.  First of all, the vast majority of in center patients dialyze an average of 3 1/2 hours, so your 2 hour comment is bull s**t.  The days of "high flux/short time" dialysis is over.  Show me otherwise. 

Secondly, in center selfcare patients have just as much control over their treatment as  home patients with the exception of scheduling constraints.  Plus, I'm sure there is a percentage of non-compliant home patients out there who are harming themselves.

I have no problem with you and Hemodoc promoting home hemo - even extended hours home hemo.  However, I have a huge problem with you doing so at the expense of in center.  I've been on incenter for 19 years running between 3 1/2-4 hours and will put my health up against anyone on home hemo who has been on for the same length of time.

It's math.

[noahvale]

^^

[PatDowns]

Thanks, Noah.  I am getting tired of reading how only holier than thou home hemo is the answer to all our woes.  I've been in center for over 18 years (I now run 4 hours per) and consider myself in good health as well.  Also, thanks for the history lessons.  You've posted some interesting articles.

It is far safer to dialyze alone more frequently than it is to dialyze three times a week for a couple hours even if that conventional dialysis is in a hospital under a doctor and nurses' constant supervision.

That's a crappy and libelous statement, Bill.  First of all, the vast majority of in center patients dialyze an average of 3 1/2 hours, so your 2 hour comment is bull s**t.  The days of "high flux/short time" dialysis is over.  Show me otherwise. 

Secondly, in center selfcare patients have just as much control over their treatment as  home patients with the exception of scheduling constraints.  Plus, I'm sure there is a percentage of non-compliant home patients out there who are harming themselves.

I have no problem with you and Hemodoc promoting home hemo - even extended hours home hemo.  However, I have a huge problem with you doing so at the expense of in center.  I've been on incenter for 19 years running between 3 1/2-4 hours and will put my health up against anyone on home hemo who has been on for the same length of time.

[Bill Peckham]

Holier than thou? What are you talking about??


Look at the numbers. For someone in my demographic the mortality rate for someone using incenter, conventional dialysis is about 10%. That's largely from cardiovascular effects of ESRD. I'm not making this up - I spent two days locked in a meeting room in Baltimore going over the data. I can tell you that the recommendation of the TEP based on the data would be that no one dialyzes less than four hours.

But back to my statement. That 10% yearly mortality drops when one uses more frequent dialysis. Does it it drop to 5% or 2%? I can't say but either way that is a significant drop. I am safer dialyzing more frequently. It's safer because I am less likely to die. But dialyzing incenter is much safer than not dialyzing at all.



EDITED TO ADD: It has very little to do with being a "good patient" or controlling your treatment. The problem is with three times a week four hour treatments - the cardiovascular impact of that schedule.

[noahvale]

^^

[MooseMom]

Oh wow!  Now I understand the antipathy shown by PatDowns!  Gosh, do you really think that those who promote home hemo are "holier than thou"?  Anyone who is doing standard inclinic hemo and is in good health like you are, well, that's fantastic, and I really do mean that!  If you were lucky enough to have been thoroughly educated on all modalities and chose the standard one for yourself, and it has helped you thrive, then I'm very glad for you.  But to state that any one of us thinks home hemo is the "answer to all our woes" goes against the spirit of this place, IHD, which is to support each member in whatever treatment choice they have made for themselves.  We talk about what we think works for us, but we know that that same thing might not work best for someone else for a myriad of reasons, but there's no real reason to revert to attack mode.

And noahvale, NO ONE IS LEAVING BEHIND INCLINIC PATIENTS...THEY ARE THE ONES WHO OFTEN ARE IN NEED OF THE MOST SUPPORT AND BETTER DIALYSIS.  If you, too, are thriving after 19 years in clinic and are getting optimal dialysis, that's a success story that I would LOVE to see repeated over and over and over again.  But do you not have the slightest suspicion that you are more the expection than the rule?  How can we all help the rest of inclinic patients be as healthy as you and PatDowns are?

edited to add...@ noahvale
However, I have a huge problem with you doing so at the expense of in center.

To suggest that anyone would desire to promote one modality at the expense of incenter patients is vastly unfair and actually quite appalling.  What's the point of advocating for better health for only the 8% who do dialysis at home?  You have a lot of experience in the advocacy field...do you really think that any one here wants to fob off 92% of the dialysis population in a bid to get better treatment for only a few?  It's the "at the expense of incenter patients" notion that I flatly reject.  That's a terrible thing to say.

[Bill Peckham]

Is your demographic (I'm assuming you are including co-morbidities) the largest or even the average for esrd patients?

Cardiovascular impact depends on numerous factors, with fluid gain and pre-existing problems being at the top of the list. 

As I said, I'll put my health up against anyone in my "demo group" who has been on home hemo for the same period of time.

Holier than thou? What are you talking about??


Look at the numbers. For someone in my demographic the mortality rate for someone using incenter, conventional dialysis is about 10%. That's largely from cardiovascular effects of ESRD. I'm not making this up - I spent two days locked in a meeting room in Baltimore going over the data. I can tell you that the recommendation of the TEP based on the data would be that no one dialyzes less than four hours.

But back to my statement. That 10% yearly mortality drops when one uses more frequent dialysis. Does it it drop to 5% or 2%? I can't say but either way that is a significant drop. I am safer dialyzing more frequently. It's safer because I am less likely to die. But dialyzing incenter is much safer than not dialyzing at all.



EDITED TO ADD: It has very little to do with being a "good patient" or controlling your treatment. The problem is with three times a week four hour treatments - the cardiovascular impact of that schedule.

Noah your n of 1 isn't relevant. DOPPS data is relevant. USRDS data is relevant. The health advantage of more frequent dialysis is seen across ages and comorbidities; it is seen among those older than average and among those with significant comorbidities, which I have few. Anecdotally more frequent dialysis can have its greatest impact on people with the a high mortality risk due to age or diabetes milieu. The overall mortality rate among people using dialysis in US is a dismal 20+% on average people would gain more benefit than I, but I know my numbers so those are the ones I use.

The main driver of cardio problems is genetics, and then phosphorus. How's your arterial calcification? When was the last time you had a MRI of your torso? Calcium deposits in the vascular system is where long term dialysis rears its ugly head, that is what is dangerous.

Whether something is safer doesn't always show up in individual outcomes. I could successfully ride a motorcycle to work for a week without a helmet, without incidence, but given that outcome it would still be true to say that I would have been safer had worn a helmet.

[MooseMom]

I'd like to just make one thing clear.  There are many of us who are proponents of MORE dialysis...more FREQUENT dialysis.  Whether or not it is at home is largely irrelevant.  If you can get the benefits from having MORE FREQUENT dialysis inclinic, then that would be ideal for many, many people.  But right now, the only place you can get MORE FREQUENT dialysis is at home.  Just as "home dialysis" shouldn't be solely synonymous with better dialysis, "incenter" shouldn't have to be synonymous with merely "adequate" dialysis.

[Bill Peckham]

I'd like to just make one thing clear.  There are many of us who are proponents of MORE dialysis...more FREQUENT dialysis.  Whether or not it is at home is largely irrelevant.  If you can get the benefits from having MORE FREQUENT dialysis inclinic, then that would be ideal for many, many people.  But right now, the only place you can get MORE FREQUENT dialysis is at home.  Just as "home dialysis" shouldn't be solely synonymous with better dialysis, "incenter" shouldn't have to be synonymous with merely "adequate" dialysis.

Well said MM. The situation could improve under the bundle - I have an editorial coming in the April issue of AJKD explaining why.

[Trikkechickk]

As to going to Home Hemo;  My final decision was made when a nurse had a bad respiratory flu (1) wore no mask, and I felt like crap for the next 3 weeks!

[greg10]

http://ihatedialysis.com/forum/index.php?topic=23151.0

Fresenius Ordered to Pay $82.6 Million in Overbilling Case

Thursday, May 26, 2011

May 26 (Bloomberg) -- Fresenius Medical Care AG, the world's biggest provider of kidney dialysis, was ordered by a judge to pay $82.6 million to resolve a lawsuit by the U.S. government and whistleblowers that it overbilled Medicare.

Fresenius must pay trebled damages of $38.9 million under the False Claims Act and statutory penalties of $43.7 million, U.S. District Judge William J. Haynes ruled yesterday in Nashville, Tennessee. The decision was made public today.

The lawsuit claimed that two companies now owned by Fresenius, Renal Care Group and Renal Care Group Supply Co., overbilled Medicare between 1999 and 2005 for home support dialysis supplies. RCG, a dialysis facility, violated Medicare statutes by billing for home dialysis supplies when it should have billed at the lower rate for clinics, the U.S. claimed.

[noahvale]

^^