I Hate Dialysis Message Board
Welcome, Guest. Please login or register.
November 22, 2024, 11:12:02 AM

Login with username, password and session length
Search:     Advanced search
532606 Posts in 33561 Topics by 12678 Members
Latest Member: astrobridge
* Home Help Search Login Register
+  I Hate Dialysis Message Board
|-+  Dialysis Discussion
| |-+  Dialysis: General Discussion
| | |-+  History of Dialysis "Business" shows why advancement is stagnant
0 Members and 1 Guest are viewing this topic. « previous next »
Pages: [1] Go Down Print
Author Topic: History of Dialysis "Business" shows why advancement is stagnant  (Read 3578 times)
kickingandscreaming
Elite Member
*****
Offline Offline

Gender: Female
Posts: 2268


« on: May 27, 2016, 09:03:25 AM »

Interesting article provides a lot of context.
Here's one of many "money" quotes:
Quote
With their ownership stakes in brick-and-mortar facilities and facing a stagnant Medicare reimbursement rate, nephrologists embraced cost-containment in unexpected ways.  A ‘one-size-fits-all’ mentality became the norm for dialysis care. Virtually no one foresaw that most nephrologists would utilize the cheapest, fast, and often iatrogenic dialysis treatment for nearly all their patients.  Kt/V (or urea kinetic modeling) was widely embraced as the gold standard of care, providing patients with minimal hemodialysis treatments based on two outcomes:  ‘not dead’ and ‘not in the hospital.’  Two hemodialysis treatment shifts were made to fit into one 8-hour staff shift.  Only a small percentage of clinics provided treatment times that began after 5 pm. 

Ownership stakes in brick-and-mortar dialysis facilities by nephrologists also effectively killed the development of breakthrough technologies for dialysis.   Advances in dialysis care had to fit within the brick-and-mortar facility model, both physically and financially. While smaller, portable, wearable, and easy-to-operate dialysis devices would have greatly benefitted working-age patients, these technology breakthroughs would have been financially devastating for nephrologist owners and the dialysis corporations. Stagnant technology sustained the wealth generation pathway for nephrologists for decades.  Promising technology, such as the small, portable REDY machine that utilized sorbent technology developed by NASA, disappeared from the U.S. market.    Hemodiafiltration, an advanced renal replacement therapy that appears to offer many advantages over standard dialysis treatments, is widely utilized in Europe and Japan.  It is virtually unknown in the U.S.   Few would foresee that many nephrologists would not refer patients for home training or for transplantation in order to keep chairs filled in their dialysis facilities.

There's lots more at: http://www.renalweb.com/writings/StagnantDialysis.htm
Logged

Diagnosed with Stage 2 ESRD 2009
Pneumonia 11/15
Began Hemo 11/15 @6%
Began PD 1/16 (manual)
Began PD (Cycler) 5/16
Athena
Sr. Member
****
Offline Offline

Posts: 592


« Reply #1 on: May 28, 2016, 06:01:44 AM »

An extremely valuable article K&S and something every patient should read and try to fully comprehend.

The constant question on my mind is why aren't any good lawyers & journalists in the medical field looking at this? Sounds like it's a very lucrative sordid little industry that needs to be exposed at last.
Logged

Find Cure for CKD now! Please like my facebook page of the same name. Thank you.
Simon Dog
Administrator/Owner
Elite Member
*****
Offline Offline

Gender: Male
Posts: 3460


« Reply #2 on: May 28, 2016, 07:52:16 AM »

Medicare supports the mediocrity.  The standards state that all patients should receive "adequate" dialysis; not the "best possible" dialysis.

It's hard to prove that the cost cutting in the business (specifically the 3x/week in center protocol) is substandard or actionable when it is explicitly established by the feds as an acceptable treatment level.

Fortunately, the system does not seem to be too fussy about how many home treatments patients do.
Logged
kickingandscreaming
Elite Member
*****
Offline Offline

Gender: Female
Posts: 2268


« Reply #3 on: May 28, 2016, 07:59:13 AM »

Don't you just love the standards that they set for success?  "Not dead" and "Not hospitalized."  Wow!  Such aspirations! :sarcasm;

The field will never advance as long as there is this conflict of interest at the heart of it.  There is no incentive for advancing things as that might kill the golden goose.  Or the cash cows that we patients unwittingly are.  It's quite a racket.

I'm deeply conflicted.  On the one hand, I'm grateful that there is a system in place that allows me to prolong my life (if I choose to) and that I don't have to cough up the huge sums of money involved.  On the other hand I see how rife with corruption it is.  Of course, our entire western medical model is totally money-driven these days.  Not just nephrology.
Logged

Diagnosed with Stage 2 ESRD 2009
Pneumonia 11/15
Began Hemo 11/15 @6%
Began PD 1/16 (manual)
Began PD (Cycler) 5/16
Simon Dog
Administrator/Owner
Elite Member
*****
Offline Offline

Gender: Male
Posts: 3460


« Reply #4 on: May 28, 2016, 10:30:29 AM »

Its a mixed bag.  Some countries have better systems (I've read that a neph is always on duty in Italian dialysis clinics), however, the US is pretty good at making sure everyone who need it gets some (note I said some, not optimal) dialysis.   In some other countries, it's cash up front or no hose (this is, however, true for transplants in the US).
Logged
Athena
Sr. Member
****
Offline Offline

Posts: 592


« Reply #5 on: May 29, 2016, 07:57:08 AM »

If everyone in our society were asked whether they would accept having the bare essential minimum of medical treatment that will just keep them alive but not working (which most dialysis patients are unable to do as stated in this article), then the answer would be a strong NO.

As a non-dialysis CKD patient, I already have logged my answer into the system for all to see.

Having the very best of available medical treatment is a given in just about every other disease category known to man. Kidney patients are no different in wanting the very best treatment that is possible.
Logged

Find Cure for CKD now! Please like my facebook page of the same name. Thank you.
Michael Murphy
Elite Member
*****
Offline Offline

Gender: Male
Posts: 2109


« Reply #6 on: May 29, 2016, 09:19:52 AM »

One of the reasons for the slow development of better treatment options is that the keystone development requirements have not occurred until recently.  Enhanced filteres have made implantable artificial kidneys possible.  New methods of collagen frame work makes cloning a viable option.  New nanotube methodology means even better filters.  We are on the cusp of major changes. 
Logged
Athena
Sr. Member
****
Offline Offline

Posts: 592


« Reply #7 on: May 30, 2016, 06:05:48 AM »

One of the reasons for the slow development of better treatment options is that the keystone development requirements have not occurred until recently.  Enhanced filteres have made implantable artificial kidneys possible.  New methods of collagen frame work makes cloning a viable option.  New nanotube methodology means even better filters.  We are on the cusp of major changes.

I hope so Michael - we need a new breakthrough in kidney disease treatment in particular! For too long, renal medicine has lagged behind all the other medical disciplines. They all work together synergistically - but until some brilliant minds put their new knowledge to some renal good use, we'll only keep hearing about how they beating the odds against certain types of cancers, how spinal cord injury patients are regaining feeling in their legs, how HIV is about to be cured, etc.
Logged

Find Cure for CKD now! Please like my facebook page of the same name. Thank you.
plugger
Sr. Member
****
Offline Offline

Gender: Male
Posts: 654


I only look like a sheep - but I ain't

WWW
« Reply #8 on: June 02, 2016, 08:50:08 AM »

I like my doctors to be doctors and my bean-counters to be bean-counters.  Now with this clear violation of the Stark Law we have doctor/bean-counters who have an interest in continuing assembly-line medicine - get them in and out as fast as you can, use the cheapest labor, and keep high patient/staff ratios.  However the dialysis companies managed to get an exemption from this truly great law.
Logged

Proud member of DialysisEthics since 2000

DE responsible for:

*2000 US Senate hearings

*Verified statistics on "Dialysis Facility Compare"

*Doctors have to review charts before they can be reimbursed

*2000 and 2003 Office of Inspector General (OIG) reports on the conditions in dialysis

*2007 - Members of DialysisEthics worked for certification of hemodialysis
technicians in Colorado - bill passed, renewed in 2012 and 2019

*1999 to present - nonviolent dismissed patients returned to their
clinics or placed in other clinics or hospitals over the years

On my tombstone: He was a good kind of crazy

www.dialysisethics2.org
Pages: [1] Go Up Print 
« previous next »
 

Powered by MySQL Powered by PHP SMF 2.0.17 | SMF © 2019, Simple Machines | Terms and Policies Valid XHTML 1.0! Valid CSS!