Medicare and nocturnal

[AnnieB]

This may be a dumb question, but will Medicare pay for incenter nocturnal dialysis? Or is there a problem because someone wants to go beyond the 3-4 hour 3x week schedule? Also, should I be thinking "extended" when I discuss options with my neph?

Anne

[noahvale]

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[Desert Dancer]

I run for eight hours every other night at home (NHHD). I don't have anything but Medicare.

[Rerun]

I run incenter Nocturnal 3 nights a week for 8 hours and no problems with Midicare. 

[thegrammalady]

yes, medicare as rerun says pays for incenter nocturnal. i was running 7 hours 3 times a week, but am taking the summer "off" to try and regulate my sleep. i run 4 hours from 5:45pm to 9:45 pm. i'll go back to 7 hours at some point. my clinic has had nocturnal for 3 years and there are a total of 7 clinics in the denver metro area that are doing nocturnal.

[AnnieB]

I'm still ploughing through all the info about different treatments, but nocturnal does sound like the way to go if you're not going for a transplant. Reading all the stories about fistulas has me cringing, though. I hate needles.

[M3Riddler]

This may be a dumb question, but will Medicare pay for incenter nocturnal dialysis? Or is there a problem because someone wants to go beyond the 3-4 hour 3x week schedule? Also, should I be thinking "extended" when I discuss options with my neph?

Anne

Anne,

Yes, Medicare will pay for the nocturnal treatments in-center.  Medicare will pay for 3 treatments per week, but your nephrologist can write a letter of justification to have a fourth treatment paid for.  Most nephrologists do not do this unless the patient brings it up.

As for "Extended"  I dont believe there is an accepted definition of it other than it is more than the normal 2.5 - 5 hours they typically start you on with home short daily.   I consider my 6 days per week, 5 hours per treatment to be extended.    Nocturnal is nothing more than dialyzing at nite.     

If you want to add more hours, unless you know your center offers nocturnal, dont mention the word extended or nocturnal. This is a red flag, especially for many who go to DaVita.  As you know, DaVita only offers nocturnal in the unit setting and has very few patients who do home nocturnal.     I would recommend you just tell the neph you want to add some time to your treatment as the more dialysis you get, the better you will feel and wilill produce better results.

I do home extended daily and I am on no bp meds, no binders and have a free diet. Labs are normal.   It should be the patients decision on how much time they would like to dialyze, but as you know, the kidneys work 24/7, so the more time, the better outcome..

///M3Riddler

[Desert Dancer]

As you know, DaVita only offers nocturnal in the unit setting and has very few patients who do home nocturnal.   

Uh, I'm with DaVita here in Arizona doing home nocturnal. Their clinics back home in NJ offer home nocturnal as well. I'm wondering where you got this info?

[M3Riddler]

This may be a dumb question, but will Medicare pay for incenter nocturnal dialysis? Or is there a problem because someone wants to go beyond the 3-4 hour 3x week schedule? Also, should I be thinking "extended" when I discuss options with my neph?

Anne

Anne,

Yes, Medicare will pay for nocturnal.   Medicare will pay for up to 4 treatments per week.  In order for the 4th treatment to be paid for, your nephrologist needs to medically justify the reason which is nothing more than an explanaing of why you need more dialysis. This can be anything from fluid control, potassium control etc... Your  nephrologist should know how to do this...

[M3Riddler]

This may be a dumb question, but will Medicare pay for incenter nocturnal dialysis? Or is there a problem because someone wants to go beyond the 3-4 hour 3x week schedule? Also, should I be thinking "extended" when I discuss options with my neph?

Anne

Yes, Medicare will pay for nocturnal in center or home hemo nocturnal.   They will also pay for a 4th treatment if the doctor writes a medical justification which should not be an issue.
Extended is nothing more than running a little longer than short daily... It has no exact limit as per time.  I do extended 6 days per week.      If you know your nephrologist will not write for nocturnal, just tell him/her you wish to extend your treatments or add more time...  It costs nothing more to do a 5 or 8 hour treatment than it does a 2 or 3 hour treatment other than if you need a heparin pump.  That is the only additional cost and Medicare will pay for it.   Regardless of the time on dialysis, the center is getting paid the same amount with the Medicare Bundle etc... If anything, it will save them money long term.

///M3Riddler

[AnnieB]

There is a center not far from me which does nocturnal. At this point, it really would not be an option for me to do this at home (though that could possibly change in the future if my living situation changed). I think my neph would be open to 4 sessions a week; I've already asked him about that.
First things first, though. I have to check into getting an access placed, as well as getting on the list. I am really hoping my kidneys can hold up at least long enough for Medicare to kick in by next summer, since I don't have insurance.

 

Anne

[M3Riddler]

As you know, DaVita only offers nocturnal in the unit setting and has very few patients who do home nocturnal.   

Uh, I'm with DaVita here in Arizona doing home nocturnal. Their clinics back home in NJ offer home nocturnal as well. I'm wondering where you got this info?

Desert Dancer.. I stand corrected... DaVita does not offer NxStage Nocturnal unless the nephrologist writes for an off script label and not many nephs that work with DaVita are willing to do this. But DaVita does offer nocturnal with the larger in center machines...   They are waiting for the FDA indication and are very strict unless a nephrologist will step in. There are a limited number with nxstage that do nocturnal, but they do not offer nxstage with the in center nocturnal.

[rocker]

As you know, DaVita only offers nocturnal in the unit setting and has very few patients who do home nocturnal.   

Uh, I'm with DaVita here in Arizona doing home nocturnal. Their clinics back home in NJ offer home nocturnal as well. I'm wondering where you got this info?

I have been told in no uncertain terms that DaVita corporate policy is "no extended, no nocturnal".  I was told that 171 cartridges are not allowed by DaVita for medicine administration and not obtainable, regardless of prescription.  Much less a syringe pump.

If one were cynical, one might suggest it's because the 171s cost more.

 - rocker

Desert Dancer.. I stand corrected... DaVita does not offer NxStage Nocturnal unless the nephrologist writes for an off script label and not many nephs that work with DaVita are willing to do this. But DaVita does offer nocturnal with the larger in center machines...   They are waiting for the FDA indication and are very strict unless a nephrologist will step in. There are a limited number with nxstage that do nocturnal, but they do not offer nxstage with the in center nocturnal.

[thegrammalady]

inhome nocturnal and incenter nocturnal are two different animals using different types of machines. i'm not aware of any centers using nxstage machines. but then i don't know everything.

[lmunchkin]

I do NxStage on hubby.  I don't believe they would ever know if I were doing an "Extended" on him.  There are several ways that this can be done without the approval of Neph or clinic.  Let me tell how I would do it:  I would put a 3 day batch in PFlow cabinet, currently he is prescribed 20L, I would extended that to 30L or possibly 40L, dialysis him an extra 2-3 hrs. If using 30 then do it 2 nites in a row.  If 40 then do him all nite, 1 day off, then make another batch and so on.
Though I have not done this, but it seems like it would work.  You might ask your neph to prescribe more dialysate amt. but I still believe it can be done (at home) without anyone's approval.

If I did not work fulltime, I would do this in a heart beat! Hey, its his body, and no body should dictate how he does things.  You would think they would want you to dialysis more, but I quess the drug companys don't want that.  No money in it for them!

If you ever do get to do hemo at home, Anngie, you will dictate your health & how you feel. It will be in your control, dear, where it should be!!

Good luck & God Bless,
lmunchkin

P.S.  I don't have problems with my Neph on this.  She is all for optimal dialysis. That is why she loves helping Home hemo patients, because "they get it". She certainly is not going to deny something that will help, that's for sure!

[rocker]

I do NxStage on hubby.  I don't believe they would ever know if I were doing an "Extended" on him.  There are several ways that this can be done without the approval of Neph or clinic.  Let me tell how I would do it:  I would put a 3 day batch in PFlow cabinet, currently he is prescribed 20L, I would extended that to 30L or possibly 40L, dialysis him an extra 2-3 hrs. If using 30 then do it 2 nites in a row.  If 40 then do him all nite, 1 day off, then make another batch and so on.
Though I have not done this, but it seems like it would work.  You might ask your neph to prescribe more dialysate amt. but I still believe it can be done (at home) without anyone's approval.

You're missing something here, lmunchkin, and that is heparin administration.  For proper heparin administration (continuous), one would need a 171 cartridge (with medicine port) and a syringe pump for delivery. 

Now, if one were not to have that setup supported by one's corporate dialysis provider, due to cost or whatever reason, I have heard that there are other ways to administer the heparin without the port on the 171.  It's not continuous like it should be, but I'm told it can work.

[lmunchkin]

Rocker, I thought about that too.  I would just set my alarm to administer at times throughout his treatment.  Eliminates the need for a pump.  But like I said, I would do this if I did not work.  The problem would be having enough dialysate to last the long period of time.  Monitoring his BP would be a problem especially if I was sleeping.  It can drop on a dime.  But I believe the extended hours can be done with some tweaking.  I could be wrong though!

God Bless,
lmunchkin

[AnnieB]

I am in the process of moving after all, so I'm considering doing PD rather than in-center hemo. I will need to talk to my neph after I get moved completely into my new place. I don't remember that he ever mentioned PD as an option, just hemo - though the reason for that is unclear to me, unless he just prefers hemo. However, I really hate needles, and like the flexibility of PD as opposed to in center dialysis. I realize that no treatment is without its drawbacks, but I am thinking that PD might fit my lifestyle better. What is most people's view of how the two compare?   

Anne

[Simon Dog]

Started PD, proved inadequate in my case; on in-center HD now looking forward to home HD.

I'd give just about anything to be able to do PD instead - vastly less impact on my life.  I can handle HD, but PD was much easier to deal with.  YMMV and not everyone who has tried both shares the same viewpoint.

[AnnieB]

I'm all moved in...and now am in process of picking up where I left off. I'll be seeing my neph this Friday, and talking to him about the different tx again...there is a Davita not far from here that does both PD and nocturnal in-center, so I'm looking into which might work out best. Since I live by myself, nocturnal home hemo doesn't seem like it's really an option...I am also going to see about getting on the list. My eGFR has been running between 13 - 15, and so far I've been lucky not to have any major symptoms aside from fatigue, but who knows how long that will last?