Medicare may institute Capitation for dialysis patients

[RightSide]

My neph has informed me that there is a move afoot by Medicare to institute a type of Capitation for dialysis patients.  That is, the dialysis center will be given a fixed budget for treating patients.  And all treatment (including prescription medications) will have to come under that budget.

The effect will be to discourage nephs and nurses from treating anything that isn't directly related to dialysis.  Up till now, if I had a bad sore throat or a bad boil on my skin, my neph (who like all nephs knows internal medicine) was willing to take a look at it.  But from now on, if this goes into effect, he won't be able to afford to do so.  I will need to have a separate Primary Care Physician (who is not affiliated with the dialysis center) for such things. 

Also, till now my neph was willing to order routine screening tests for cardiovascular disease and diabetes, as well as prescribe meds for those conditions, since those are often comorbid to renal failure.  But if this Capitation goes through, he will no longer be able to, and I will need to see other physicians for those.

Personally, I would be very surprised if this went into effect in 2010, a mid-term election year.  But I've been surprised before.

[willowtreewren]

CMS had a public input period that ended recently. The NxStage forum organized informational "chats" about this bundling issue and helped us send comments about it.

There are many issues with the whole picture. We will just have to wait and see at this point.

Aleta

[Rerun]

It will also stop dialysis centers and Nephrologists making huge amounts of money from Medicare by loading up patients with Epogen.

[calypso]

It will also stop dialysis centers and Nephrologists making huge amounts of money from Medicare by loading up patients with Epogen.

Might also stop them from pushing for hemo over PD because hemo costs more and makes them more money, even if PD is better for the patient.
Of course now they will opt for the cheaper alternative over the more expensive one even if THAT one is better for the patient!
Either way the attitude of money being more important then people's lives needs to change.

[Malibu]

We are on home hemo.  Our Neph does not treat anything other than kidney related.  No change for us there.  But we do have issues with other things in this bill.

[sullidog]

I hope it doesn't pass, my neph is very good and will help me with other issues if he knows about them.
Troy

[BigSky]

It will also stop dialysis centers and Nephrologists making huge amounts of money from Medicare by loading up patients with Epogen.

Problem is they need to make money somewhere.  As it is they lose money on dialysis because doesnt even cover the actual cost of the procedure.

If this bundling passes as written it will be VERY bad for dialysis patients.  Only a government moron could come up with such a plan.

[Rerun]

It will also stop dialysis centers and Nephrologists making huge amounts of money from Medicare by loading up patients with Epogen.

Problem is they need to make money somewhere.  As it is they lose money on dialysis because doesnt even cover the actual cost of the procedure.

If this bundling passes as written it will be VERY bad for dialysis patients.  Only a government moron could come up with such a plan.

Then how can Kent Thiry make $26million in one year?  They are making money! They are making money off sick people and tax payers and it needs to STOP!

[cloud393]

I agree with Rerun.  If money weren't being made, they wouldn't be in business.

[Bill Peckham]

It will also stop dialysis centers and Nephrologists making huge amounts of money from Medicare by loading up patients with Epogen.

CMS was mandated by Congress to expand the bundle when Congress passed the Medicare Improvements for Patients and Providers Act.

I'm betting the final rule doesn't include oral drugs but there is no doubt it will include EPO. The concern now is that because providers get the same payment no matter how much EPO you use there will be a lot of pressure to minimize your EPO dose.

This in some ways is good e.g. you need less EPO if the water/dialysate is higher quality, better iron management results in needing less EPO but keeping people anemic is another way to do it. Once the payment changes the units will be paid to keep your Hemoglobin between 10 and 12 (a hematocrit between 30 and 36) but there are ways I can imagine this could be gamed by the units to your detriment. We'll need to watch closely once the payment changes on 1/1/11.

IHD will be a good place for people to report changes in how they receive dialysis and their medications.

[BigSky]

Then how can Kent Thiry make $26million in one year?  They are making money! They are making money off sick people and tax payers and it needs to STOP!

That would be because they make money off the other services they offer in addition to the dialysis procedure.

You complain about no tape and stuff now, just what do you think is going to happen when medicare requires more services for less money on something they already do not even pay for?

If it goes through as written it will include oral drugs.   The majority of dialysis patients drug costs per day far exceed what medicare bundling increases are proposed to be to cover those drugs.

Units will divert from having such drugs prescribed and push other therapies.    IE Tums for everyone regardless of calcium levels and blood transfusions for hemoglobin.   So instead of keeping PRA's low and getting people off dialysis, it will just screw everyone and keep more on dialysis.

[RightSide]

If money weren't being made, they wouldn't be in business.

They make money by cost-shifting.  Whatever Medicare doesn't cover, they charge private insurers that much more.

Some of us have both Medicare and private insurance.  If Medicare pays less, they charge the private insurers more.

[Phraxis]

At risk of raising the ire of BigSky, again the issue demonstrates the superiority of a single pay government system such as the one we have in Canada. BEST PRACTICES determines the care a patient receives -- heck we even send them to the US if they need a specialized heart surgery such as a Premier recently did.

Cost is always an issue because there is unlimited demand for medical services -- case in point, the pharma's invented a condition ED and developed drugs to treat it. (I mean should seventy year old's with dementia really be having sex?)

[Bub]

Rightside, I think you misunderstood.  The new medicare bill will support DECAPITATION for dialysis patients to reduce medicare expenses.

[BigSky]

At risk of raising the ire of BigSky, again the issue demonstrates the superiority of a single pay government system such as the one we have in Canada. BEST PRACTICES determines the care a patient receives -- heck we even send them to the US if they need a specialized heart surgery such as a Premier recently did.

Cost is always an issue because there is unlimited demand for medical services -- case in point, the pharma's invented a condition ED and developed drugs to treat it. (I mean should seventy year old's with dementia really be having sex?)

Actually what is shows are the problems of a single payer system.  Medicare is a form of single payer healthcare.  Also the single payer system of Canada is hardly superior when it has to rely on the medical technology of another country to treat its people because its own technological advances are hindered by the very single payer system you are touting.

[RightSide]

At risk of raising the ire of BigSky, again the issue demonstrates the superiority of a single pay government system such as the one we have in Canada..... (I mean should seventy year old's with dementia really be having sex?)

Medicare (in the U.S.) is a single-payer system.  The major difference is that it's only available for retirees and the disabled.

Should 95 year old's be getting dialysis?

In the U.S., if that 95 year old guy or gal is otherwise doing well, we say "Of course!"  You can live as long as you fight to keep living.

In Britain, the NHS is likely to say no.

What is Canada going to say?