This is disturbing

[MooseMom]

There's a new nephrology blog out in cyberspace:

www.thekidneydoctor.org

The blogger is one of the nephs who worked on the discovery of suPAR in fsgs.  Anyway, I saw this particular entry that made me want to 

http://www.thekidneydoctor.org/2011/09/cherry-picking-in-esrd-patients-should.html?showComment=1316033552406#c243590825283721635

If you look at the comments, you can see that I can't keep my mouth shut.  Even though this is supposed to be a blog for nephs, in my world, any medical blog is ultimately for patients, so I made sure to have my say, and I'd encourage you all to do the same, especially if you feel that you have been a victim of cherry-picking.

[Willis]

Here's what I posted on that article...

Is it cherry picking when a PD patient under the Medicare bundle is held to an HGB level between 10-12...even if a higher level seems warranted based on a patient's physical conditioning and activity? What if that patient is an athlete with no history or signs of cardiovascular disease? Oh, I get it, those EPO injections are expensive!

 

[jbeany]

 "...there remains a possibility that some providers might figure out ways to stint on services in order to maximize profits."

Oh, come on.  The for-profit centers hardly needed an excuse to start scrimping on costs to make a bigger profit.  It was already SOP.
 
Allergic to the cheapest gauze tape on the market?  Tough, buy your own.
 
Tend to have break-out bleeds an hour after you leave the center?  You can buy sure-seal bandages online. 

Want a blanket warmer so all the patients don't have to shiver through 4 hours of treatment?  Start selling raffle tickets for the local organization nice enough to donate one. 

Need information on diet, treatment options, or coping skills?  Best get yourself a smart phone, because the dietitian, doc and social worker are going to do a 2-minute drive-by appointment while you are hooked to the machine, bill your insurance for a full consultation, and then tell you to go look up what you need on the internet anyhow.

[CebuShan]

All I can say is:   
I will have to post a comment later. Right now I am so angry, I can't think straight!

[tyefly]

Thx  MM    another great find......   We need all the voices we can to try to change these ideas....  its hard when profit is involved....   I will have a say too..... Going to forward this to Hemodoc..... I bet he will have a say too....and lets not forget Bill........

[MooseMom]

Sometimes I really do suspect that doctors lose sight of what should be the real goal, and that is to relieve suffering.  I know that doctors cannot cure everyone of everything all the time, but at least "do no harm".  At least TRY to give your best efforts.

I do want to point out, though, that the blogger Drs. Singh and Parker do seem to be on the side of the patient in that they are concerned about this "cherry-picking", so if you leave a comment, do try to be respectful if possible.   It's great that they would call out their fellow nephs who might engage in this behaviour, but it would be great if they could come up with some ideas to stop it altogether.  I don't know if that is possible, though, when the health care system in this country is so profit driven.  Profit in and of itself is fine, but like any system, it is open to abuse by people who are inherently greedy and uncaring.  I guess we cannot expect doctors to be morally and ethically superior to the rest of us.

[MooseMom]

Hey, I've just looked, and Dr. Parker posted a reply that is actually a comforting read.

[CebuShan]

That is a good reply. I think I'll run a copy off and ask my neph what he thinks about this. (no, I don't think he indulges in this kind of practice.)

[Hemodoc]

Cherry picking in dialysis units is an practice unfortunately that will likely get worse, not better under the bundle. The entire policy of how easy it is for a dialysis unit to get rid of so called problem patients is a problem in itself. Simply speaking and demanding access to optimal renal care is enough in some units to get a letter of dismissal.

So, in my mind, it is not only the issue of cherry picking, but that combined with the ease of dismissal that places dialysis units in a continued quest to optimize their bottom line. Some of these issues were addressed in the CMS bundle comment period, but it remains a large problem.

[MooseMom]

The entire policy of how easy it is for a dialysis unit to get rid of so called problem patients is a problem in itself. Simply speaking and demanding access to optimal renal care is enough in some units to get a letter of dismissal.

I'm sure that's true, but that's no excuse for letting ourselves be neglected.  We can let fear keep us from getting optimal renal care.  I've read posts from IHD members who have worked closely with their clinics to get the care they wanted, and they've been successful.  I choose to believe that most clinics want the best for their patients, but I know that there are units who see their patients as less than human.  If you are dismissed simply because you expect the best care, then you know it's time to change clinics.  We can't just sit back and whine.