Has anyone ever changed centers to change modality?

[cattlekid]

So yesterday I had my 90-day care plan review with the dietitian and social worker.  They sprung it on me so I wasn't prepared.  I told them that next time (if there is a next time, because I'm having donors worked up for transplant), I would like to have the care plan discussion outside of dialysis.  They mentioned my work schedule and I told them that I can take as much time as I need to come in and have a proper discussion of my care plan, not while I'm hooked up. 

I felt that having the care plan discussion while in the middle of treatment does not put the patient in a position of power as it should be.  Also, I'll be asking them for a copy of the care plan prior to the meeting so that I can review it and make sure that I have all my questions ready.  Also, I just realized that they did not give me a copy of the  current care plan for my records, which I'll be asking for on Thursday. 

All of this is really just prelude to my question.  The SW stated that my long term goal is transplant, which is correct.  Then I sprung it on them that if my current group of living donors don't pan out, I'll be transferring to another clinic (DaVita instead of FMC) so that I can start NXStage.  Well, that freaked them out.  They started blubbering about how they have an NXStage clinic, but I told them that the DaVita NXStage clinic is closer to my home than the FMC. 

I get the distinct feeling that if the time comes that I am planning on changing clinics, I'm going to get a bunch of static from my current clinic.  Has anyone ever changed clinics?  If so, what hoops did you have to jump through and what issues occurred?  I just want to make sure I know what I'm getting into when the time comes.

[okarol]

If you have private insurance and Medicare, your clinic is going to really work to keep you there, as it's more money for them.

[cattlekid]

Oh I figured just as much.  I don't want to be a special snowflake, but unless they are going to open a fourth shift for me (preferably 7-11 PM) or start an NXStage program at my local clinic, I'm bolting. 

Hopefully, it will all be unnecessary as I started talks with University of Wisconsin today about their transplant program (thanks LarryG!)  They have a much shorter wait time and also can work up live donors faster than Northwestern - I'm getting in touch with all my live donors today - if they don't have good information from NW, I'm going to have everyone switch to UW instead.

If you have private insurance and Medicare, your clinic is going to really work to keep you there, as it's more money for them.

[Rerun]

Sometimes your Nephrologist only visits certain clinics, so you may have to switch Nephrologists.  Go to the new clinic and talk to that social worker and she will get the ball rolling.

Also remind the currant idiots that having a health care meeting while you are hooked up where neighboring patients can here is a HIPPA Violation.

[noahvale]

^^

[cattlekid]

Thanks noah!  I have a few comments:

1.  My initial neph that referred me to dialysis does not round at the clinic that I am currently at - one of his office partners does.  So I'm used to choosing a new neph, no big deal. 

2.  Good to know.  Believe me, I've learned a lot in these last four months. The biggest thing I've learned is that clinics assume that patients are morons who have no need to have information regarding their care.  If I have the need to walk into a new clinic, I'm going in with my eyes fully opened this time.

3.  About the care plan - you would think that after all the years of getting written performance reviews at work, I'd know better than to sign something I hadn't really read.  I'll know better the next time.

4.  Another good to know - I really despise how I only get to see my dietitian/social worker while at treatment.  They say it's because they don't want to impact my work schedule - well, I set them straight this time.  My work schedule is none of their business.

5.  Oh believe me, I can make a stink when I have to.  I'm about to make one with Northwestern because I just found out that it's been over a month since my mother has heard anything about her status as a living donor.  This is unacceptable, when I can drive a couple hours north and get immediate service. I'm sure they won't be happy, but I'm not going to sit in the dialysis chair any longer than I have to when I have multiple living donors just waiting to be tested.

I appreciate your comments about switching to NXStage right away.  However, I feel that if Northwestern could get off their behinds and get my donors tested, there would be no reason to waste the time and resources to go through NXStage training.

Before switching clinics, please check on the following:

1) Will your current nephrologist have privileges at the new center?  If so, will he or his nurse practitioner/physician's assistant be willing to round there once a month?  From my understanding, this is now required by CMS.  However, if your nephrologist is friends with the medical director, a courtesy arrangement could be made where the medical director will do the monthly follow-up.  Otherwise, you will have to find a new nephrologist associated with the new clinic.

2) Know what you want out of the NxStage Program and get IN WRITING from the facility that they will provide those services.  I'm not on NxStage, so have no idea what the ins and outs are. However, there are people on here who do.  Tap them for that info.  I'm thinking like prescription needs, supplies, back-up, follow-up, training, etc.  I realize some of this is provided directly by NxStage, but your clinic gives the prescription.  It's not uncommon for dialysis centers to "offer the moon," but when push comes to shove, they bug out.  GET IT  WRITING ON WHAT THEY WILL PROVIDE otherwise, you could be going from one bad situation to another, or even worse (disclosure: I'm not a big fan of DaVita).

Also, at your current clinic:

1) It is your right to have your care plan filled completely out by treatment team before signing off on it.  You can also write in your own comments if there is something written you do not agree with.

2) You have the right to set up a time to review the care plan at your convenience, and not while on treatment. 

3) If you do decide to leave, give your current clinic at least 4 weeks notice to get your transfer paperwork in order.  Don't know about how FMC works, but DaVita will drag the process out as long as possible.  I know of a couple of patients who had to get the ESRD Network involved because of DaVita's recalcitrance, especially since they were fully insured.

I think its great you have multiple donor prospects lined up.  However, remember, the work up process could take a while.  You might want to go ahead and make the switch to NxStage.  You will get better dialysis at home.

[okarol]

I have yet to see a dialysis clinic or transplant team EVER put exactly what to expect in writing!
Maybe just our bad luck. Anyone else ever get service providers to write out what you're getting?

[Lillupie]

yes I have transfered clinics. And I really, really hate to admit it, but it actually wasnt my choice. To make a long story short, for dialysis there was only 2 doctors. One didnt like how I dealt with lupus over 10 years ago. and the second doctor, him and I just simply didnt get along. I think he was trying to force me on hemo, which i refused and he was one of these that wants to put patients in a category of 'you are not going to last long'. I was given a month to find another place. So God just wanted me some where else
 Anyways, so yeah I did. And it was the best thing for me. I love, love, love my center I have been at now 4 years come December. I would suggest going to the centers that have your modality to make sure they do things the way to your liking. I have realized that every center has their own rules and regulations and does things slightly bit differently then another. So, make sure you are comfortable with where you are going.

Yeah Im sure you are not the only one who has had to do this. Especially if a center only has hemo, and you want to go to PD,
 Which makes me wonder if a center if talks a patient out of going on PD to keep them at their hemo center....

Lisa

[PatDowns]

I have yet to see a dialysis clinic or transplant team EVER put exactly what to expect in writing!
Maybe just our bad luck. Anyone else ever get service providers to write out what you're getting?

I don't think any center would ever guarantee in writing outcomes, but to how it practices medicine, then yes.  Have you ever asked or just assumed?

[Jie]

It seems that a care plan is not a big deal. It is just standard forms that strike to get patients' lab results to be the target ranges. If one lab results are good, the care plan is just the routine paperwork for Medicare.

"If you have private insurance and Medicare, your clinic is going to really work to keep you there, as it's more money for them.":   For the first 30 months, the private insurance does not just pay more money, it may pay 400% or 500% higher. However, for FMC, the clinics do not involve with the billing, so the dietitians and SW may not care about how much money one pays.

[kitkatz]

I changed clinics and got no grief from anyone. Kaiser okayed it while I was sitting in the doctor's office and I was moved tot he new setting for nocturnal within three days.