Kidney Care Quality Improvement Act

[slothluvchunk]

Hello all,
You may all be familiar with this topic - the Medicare compensation to dialysis providers (and how it hasn't been adjusted in something like 30 years).
It's a real problem for dialysis clinics who have Medicare patients.  I blogged about this last week, but thought I should try to get the word out in other places as well.  It's been tossed around on the dialysis_support group as well, but again I'm not sure how many people visit all of these places.

Anyway, there's legislation in the works right now that would allow Medicare to change its compensation to dialysis clinics.  Medicare covers 80% of your dialysis yes - but what's the 100% that the 80% is based on?  It's based on a 30 year old figure of $130 or something.  Other insurance companies are paying much more than this, which is good, because dialysis is an expensive service to provide.
I think it is important for people to realize that not all of these numbers are just made up - the dialysis providers are businesses, and as such need to be compensated fairly for the service they provide.  Not for their profits, but for our level of care.  When dialysis providers lose money on Medicare patients, the result is that they have to cut costs in other places.  This leads to our staffing problems - both in terms of quality, and quantity.
We have fewer techs, and not many of them are being payed appropriately for the importance of their job.  This is why we see lots of "not thinking" taking place on the floor - machines set incorrectly, hands not being washed, etc.

To make this verbose post a bit more succinct - What we're trying to do is simply allow Medicare to adjust its compensation of dialysis for today's economy and cost.  Just like every other insurance provider has done.
The way we do this, is by contacting our congressmen and women and letting them know how we as patients are affected, and that we expect them to do their job and support legislation like this that changes lives for the better.

This can be done here
It takes less than 2 minutes, and they will contact your representatives for you, letting them know your expectations on this issue.

Thanks for taking the time to read all of this - and thanks for your support in getting better care for dialysis patients.

[Black]

I've written twice to all three of my Congressional reps.  Got a "canned" response from all three but none of the three were unfavorable.

[Sara]

How would that impact our monthly premiums for Medicare, and would Medicare have to stop covering certain services in order to pay more for dialysis?

[Rerun]

In 1962 it cost $10,000 a year for dialysis.  In 2006 it cost $10,000 a week for dialysis and that includes epogen.  THAT is the 100% that the 80% is based ON!!!  Medicare is going to go BROKE over dialysis.  NO, what we need to write our congressmen about is putting the DEATH Squad back in place.  If you don't know where you are.......you don't get dialysis.  If you are not a citizen.....then guess what?!!

Hate to tell you, but the techs are not going to get paid more.  DaVita will just extend their Las Vegas Party an extra day.  They can afford to pay these people more now.  They just won't.  Don't let them manipulate you into thinking the techs will get a raise if Medicare adjusts their payments. 

If I write my congressmen they will get the truth from me. 

[BigSky]

In 1962 it cost $10,000 a year for dialysis.  In 2006 it cost $10,000 a week for dialysis and that includes epogen.  THAT is the 100% that the 80% is based ON!!!  Medicare is going to go BROKE over dialysis.  NO, what we need to write our congressmen about is putting the DEATH Squad back in place.  If you don't know where you are.......you don't get dialysis.  If you are not a citizen.....then guess what?!!

Hate to tell you, but the techs are not going to get paid more.  DaVita will just extend their Las Vegas Party an extra day.  They can afford to pay these people more now.  They just won't.  Don't let them manipulate you into thinking the techs will get a raise if Medicare adjusts their payments. 

If I write my congressmen they will get the truth from me. 

You keep saying dialysis costs $10,000 a week.  What is your reference for this?   Time and time again I have read the National average is only $70,000 a year.

[Rerun]

My explanation of benefits (EOB).  I'll fax you a copy if you want. 

That is what they bill.  That is not what they get.  To me a bill is a bill.  I'm not into the games.  If my checking account says I have a zero balance I don't write checks knowing my paycheck MAY get there before funds are drawn.  That is what I see as being billed to my insurance.  Medicare is still secondary for me. 

$42,000 for one month is what DaVita charged my insurance.  Call it what you want.  Did you even read the Las Vegas deal DaVita put on for the Mucky Mucks?  The techs are underpaid, but Medicare has nothing to do with that.

[Sara]

In 1962 it cost $10,000 a year for dialysis.  In 2006 it cost $10,000 a week for dialysis and that includes epogen.  THAT is the 100% that the 80% is based ON!!!  Medicare is going to go BROKE over dialysis.  NO, what we need to write our congressmen about is putting the DEATH Squad back in place.  If you don't know where you are.......you don't get dialysis.  If you are not a citizen.....then guess what?!!
Hate to tell you, but the techs are not going to get paid more.  DaVita will just extend their Las Vegas Party an extra day.  They can afford to pay these people more now.  They just won't.  Don't let them manipulate you into thinking the techs will get a raise if Medicare adjusts their payments. 

If I write my congressmen they will get the truth from me. 

I think that's really easy for you to say, not being in either one of those situations yourself.  Just because people may be suffering from Alzheimers, or mental disease, or they're handicapped other than dialysis, etc., doesn't mean they should be essentially murdered by denying necessary medical care.  Put yourself in their shoes. 

[BigSky]

My explanation of benefits (EOB).  I'll fax you a copy if you want. 

That is what they bill.  That is not what they get.  To me a bill is a bill.  I'm not into the games.  If my checking account says I have a zero balance I don't write checks knowing my paycheck MAY get there before funds are drawn.  That is what I see as being billed to my insurance.  Medicare is still secondary for me. 

$42,000 for one month is what DaVita charged my insurance.  Call it what you want.  Did you even read the Las Vegas deal DaVita put on for the Mucky Mucks?  The techs are underpaid, but Medicare has nothing to do with that.

No need.  That is what your unit bills.  The way you put it you make it sound as if that is the cost is today for dialysis on average in this country.

[Zach]

Hello all,
You may all be familiar with this topic - the Medicare compensation to dialysis providers (and how it hasn't been adjusted in something like 30 years).
It's a real problem for dialysis clinics who have Medicare patients.  I blogged about this last week, but thought I should try to get the word out in other places as well.  It's been tossed around on the dialysis_support group as well, but again I'm not sure how many people visit all of these places.

Anyway, there's legislation in the works right now that would allow Medicare to change its compensation to dialysis clinics.  Medicare covers 80% of your dialysis yes - but what's the 100% that the 80% is based on?  It's based on a 30 year old figure of $130 or something.  Other insurance companies are paying much more than this, which is good, because dialysis is an expensive service to provide.
I think it is important for people to realize that not all of these numbers are just made up - the dialysis providers are businesses, and as such need to be compensated fairly for the service they provide.  Not for their profits, but for our level of care.  When dialysis providers lose money on Medicare patients, the result is that they have to cut costs in other places.  This leads to our staffing problems - both in terms of quality, and quantity.
We have fewer techs, and not many of them are being payed appropriately for the importance of their job.  This is why we see lots of "not thinking" taking place on the floor - machines set incorrectly, hands not being washed, etc.

To make this verbose post a bit more succinct - What we're trying to do is simply allow Medicare to adjust its compensation of dialysis for today's economy and cost.  Just like every other insurance provider has done.
The way we do this, is by contacting our congressmen and women and letting them know how we as patients are affected, and that we expect them to do their job and support legislation like this that changes lives for the better.

This can be done here
It takes less than 2 minutes, and they will contact your representatives for you, letting them know your expectations on this issue.

Thanks for taking the time to read all of this - and thanks for your support in getting better care for dialysis patients.

This statement is so offbase in terms of facts, I don't know where to begin.

There's more to Medicare ESRD reimbursement policies than meets the eye.  Some in Congress, such as Senator Charles Grassley (R-IA) and Congressman Pete Stark (D-CA), might look at the continuing issues of waste and abuse in the dialysis unit and say that the policies need to address these perennial problems.  Back in the late 1980s, the late Senator John Heinz III was also concerned with these same issues.

Before we patients advocate for anything, we need to know the truth, the whole truth and nothing but the truth.
When you call for us patients to write to our officials in Washington, please give the complete facts.

At about $10.00 per 1,000 units, EPO is a perfect example of additional funds made available to the Medicare ESRD Reimbursement program.  Patients in the 1990s received doses of about 4,000 units per treatment.  Today it's not uncommon to find patients receiving 12,000 units per treatment.  There are numerous other examples of separately billable costs to the overall reimbursement for dialysis treatment.

This is not to say that the legislation may have very important benefits for us patients.     

Just please don't be a shill for the recipients of government largess.  Part of the issue is what Rerun said, which is where the money is eventually spent.  We can see where some chains spend their money ... and it's not on patient care.    

[stauffenberg]

The general figure for the cost of hemodialysis treatments I have heard is around US $350 per treatment.  When I went to London, England, in 1998, I had to pay one thousand pounds (US $1400 at the time) for a week of treatment in advance at a very elegant private clinic, but this included a large, refundable fee to insure the dialysis provider against any extraordinary expenses and medical emergencies.

The real problem with dialysis in the U.S. is that it is mainly delivered by private, for-profit clinics, which cut every corner and search out every loophole in the medicare regulations to squeeze the maximum profit out of each treatment session, at any cost to the patient, all in order to increase the wealth of the company shareholders.  In other countries of the industrialized world dialysis is offered by the public healthcare system, which has no interest in profit to interfere with its concentration on the health and well-being of the patient. The right-wing United States government cooperates with the for-profit centers by writing the standards to be met for medicare funding so as to have as many loopholes as the companies want, and by having an extremely lax system of inspection of private dialysis providers. The result of this is that the death rate among dialysis patients in the U.S. is much higher than in any other industrialized country.  In Japan the rate is lowest at 9% per year, in Canada it is about average at 13% per year, but in the United States it is a whopping 26% per year!  The U.S. tries to explain this away by the utterly false claim that American medical practice allows much older and sicker patients to get care than in other countries.  But I have been dialyzed in the United States, in England, in Canada, and studied dialysis treatment at a German clinic in the 1980s, and in all countries the age and the medical condition of the patients was comparable.

The U.S. motto seems to be, what do a few more patient deaths matter, as long as the companies make a profit!  As unbelievable as it may seem, there was a strong movement in Congress after public funding of dialysis was approved in 1972 to shut down the program because it turned out to be too expensive!  Can you imagine what this would have meant?  Thousands of people, as soon as the program lost its funding, would have been removed from the machines and left to die, all to keep the tax rates low!  What a country!

[Rerun]

I like the fact that they are "for profit."  That way they care about the paying customer.  When I was in a hospital affiliated clinic I was just a number and they didn't care that I was trying to work and keep my life.  They didn't care that I was freezing to death and Grandma over there didn't even know she was at dialysis and could have easily been put in the cold spot. 

The U.S. does dialyze older and sicker patients.  OMG they will dialyze anything with a pulse! 

As long as I see clinics spending money on conventions and parties then I feel they make enough money.  I will not promote congress to take more from the Tax Payers.

I would be the first to go if there were a mandatory reduction in dialysis patients.  I'm only hanging on because I am hoping for another transplant.  I think there is too much money spent to keep people alive and for what?  There is a thing called Profit on your returns.  The tax payers are not getting much back for their dollar.

People die.  It is nothing new.  Would we spend this much money on animals to keep them alive.  People are worth more than animals up to a point.  A 96 year old with congestive heart failure and dubieties and cancer and ESRD......nah

Even a new born with severe medical conditions and dialysis to keep them alive is wrong.

[Zach]

The real problem with dialysis in the U.S. is that it is mainly delivered by private, for-profit clinics, which cut every corner and search out every loophole in the medicare regulations to squeeze the maximum profit out of each treatment session, at any cost to the patient, all in order to increase the wealth of the company shareholders.

For-profit vs. non-profit is not the problem.  The challenge is setting high standards of care with measurable outcomes, and providing reimbursement based on those outcomes.  Included in that mix would be consideration for the more expensive patient, i.e. larger patient, sicker patient, perhaps even the longer-term (10 years +) patient.     

[Rerun]

Zach, where did you get Epogen is $10 per 1,000 units.  I think you need to add another zero on the end of that.  I get 15,000 units and it is $1,500 US dollars.  That is $100 per 1,000 units.  If it were $10 per 1,000 units I wouldn't have a problem with the cost of Epogen.  Hell, that's cheap!  My Epogen would be $150 vs. $1,500.

My dose varies from 700 units to 1,500 depending on my HTC.

[Zach]

Here are some facts.       

From Hemodialysis Horizons
Reimbursement for Hemodialysis

This article gives a good, but complicated, explanation of the current goals of the Medicare ESRD Reimbursement Program:
http://www.aami.org/publications/HH/Reimbursement.DeOreo.pdf

 ... Based on year 2000 cost reports from independent facilities, the wage adjusted Composite Rate (CR) covered only 88% of the cost of providing the bundle of services. Providers made up the difference by the delivery of ancillary services that were reimbursed at 132% of cost.

 ... Recognizing that providers made up the deficit of the inadequate CR by the margin on the administration of medications, Congress moved to shift the "profit" from medications to the CR. Congress hoped to make the decision to administer a medication to be based on medical not financial necessity.

 ... Originally, Medicare reimbursed independent facilities for administered medications by paying 95% of the average wholesale price (AWP). Pharmaceutical manufacturers determine the AWP. The AWP is ordinarily significantly higher than the cost of purchasing the medications. Frequently, providers chose one medication over another based on the spread between the cost (including discounts) and 95% of AWP.

 ... Medicare determined to pay the providers a price based on average acquisition price in 2005 (AAP) and on average sales price (ASP). In 2005, Medicare established a fixed price on erythropoietin and nine other drugs most common in ESRD (other medications were billed at ASP + 3%). In 2006, Medicare will pay ASP + 6% for all medications.

 ... In 2005, CMS estimated the difference to be $585 million. That is, the change to ASP + 6% would cost the providers $585 million. They divided this amount by 34.7 million dialysis treatments. This $16.86 per treatment was 13.3% of the base CR. CMS increased this by 1.4% to arrive at a 14.7% “add-on” for 2006. The drug add-on factor is applied to the wage adjusted CR. This change is budget neutral since it moves the money from the ancillary drugs to the composite rate resulting in no net increase in Medicare spending.

DRUG                           ASP + 6%
Erythropoietin, 1000 units      9.25
Calcitriol, 1 ug                        .86
Doxercalciferol, 1ug              2.78
Iron dextran, 50 mg            11.22
Iron Sucrose, 1 mg                 .37
Levocarnitine, 1 gm             11.12
Paricalcitol, 1 ug                    3.97
Na ferric gluconate, 12.5 mg   4.73
Alteplase, 1 mg                   30.09
Vancomycin, 500 mg             3.19

In other words Rerun, EPO: 15,000 units     15 x 9.25 =   $138.75 + .50 for the syringe = $139.25 per treatment of EPO.  And Medicare pays 80% of that amount (if Medicare is your primary insurer).

PS:  Are you sure Rerun that they keep your EPO refrigerated before they inject it? 15,000 units sounds a bit high.  If it's not refrigerated, EPO may loose some of its potency.   I think the dose example in the above article was 6,500 units.   

[BigSky]

Zach, where did you get Epogen is $10 per 1,000 units.  I think you need to add another zero on the end of that.  I get 15,000 units and it is $1,500 US dollars.  That is $100 per 1,000 units.  If it were $10 per 1,000 units I wouldn't have a problem with the cost of Epogen.  Hell, that's cheap!  My Epogen would be $150 vs. $1,500.

My dose varies from 700 units to 1,500 depending on my HTC.

Not sure what is going on with the costs at your unit but epogen here, when we used it, was right around $10.00 per 1000 units also.

[Zach]

When private insurance pays the full cost of dialysis treatment, including meds, they may be charged a lot more than the Medicare Approved Amount.  Sometimes 2x and 3x the price of the Medicare Approved Amount.       

[slothluvchunk]

I began writing a long response to all of this, only to have it evaporate into the ionosphere moments ago.

I take issue with being called a "shill" - as a shill is someone who is "knowing" and part of the act. 
If my information is false, I will apologize for giving misinformation, and will humbly learn the correct situation. 
Zach, you called out my first post as being so full of it you didn't even know where to begin, yet you fail to point out the specific points where I have reported misinformation.
To the best of my knowledge, Medicare has adjusted its reimbursement rates accordingly for most everything it covers, but has failed to do so for dialysis.

I understand that we might not all agree on how DaVita of other for-profit companies will and should spend their money, but again, I'm not aware that what I was saying is blatantly inaccurate.

From Kidney Failure and the Federal Government   Institute of Medicine (IOM):
Although the processes for revising the composite rate are controversial, as discussed below, they are relatively well understood. No formal processes exist for periodically relating changes in the services included under the composite rate to the reimbursement rate itself. Under such an arrangement, providers cannot be certain that reimbursement rates will be set at a level that is sufficient to meet the costs of a continually changing high-quality "bundle of services" that they consider necessary.

As far as I know, this is still the case.  While the list of billable services figured into the composite rate can be changed over time by the HCFA, the reimbursement rate itself does not change.
Epogen is billable separately as an "injectable drug" and is not included in this composite rate reimbursement for hemodialysis or hemofiltration in center.

From the Medicare Reimbursement Manual (Vol. I) Chapter 27 -
2706.1     Base Rates.--The base rates are as follows:

Period covered - August 1, 1983, to September 30, 1986.
 
Description                Labor              Nonlabor           Total     
Hospital                    $ 46.62             $ 80.14            $126.76
Independent             $ 49.96             $ 72.95            $122.91

Period covered - October 1, 1986, to December 31, 1990.
 
Description                Labor              Nonlabor           Total     
Hospital                    $ 45.88             $ 78.88            $124.76
Independent             $ 49.15             $ 71.76            $120.91

Period covered - January 1, 1991, to current.
 
Description                Labor              Nonlabor           Total     
Hospital                    $ 46.25             $ 79.51            $125.76
Independent             $ 49.56             $ 72.35            $121.91


As you can see, the composite rate is based on two separate parts, labor, and non-labor portions of treatment.  Taking an independent for-profit center like DaVita, their total reimbursement under the composite rate has changed less than $1.00 in the last 20 years - and in the wrong direction.
Amazingly, the labor portion of the reimbursement is less than $50.00 - for four hours of service!
I know everyone thinks the clinics are profit-mongers lining their pockets at our expense, but I can tell you from personal experience that I wouldn't be able to keep a clinic running if this is all I was getting reimbursed.  With the material costs associated with the machines and supplies, the costs of the staff and real estate, the utility costs, etc. - it's easy to see that with this rate of reimbursement the gross profit margin would hardly be enough to keep the clinic running.
Hence the disparity you see in drug costs like EPO.  A private insurance provider might already agree to pay a much higher rate on these drugs, and that is precisely why many of you receive high doses of it.
It's a place where the company can recoup some of what they're not getting elsewhere.
Having paid out of pocket for treatment before in other areas, I know that the true-to-date cost of dialysis is much higher than $121.91.

Again, if I'm wrong in this I'd like to know - I don't want to advocate for something that is wrong, my ultimate goal is better treatment for us all.  Perhaps we disagree on the way to do that, but I'm no shill for any for-profit dialysis provider (anyone who thinks so clearly hasn't read my blog ).  I do run a small business though, and I understand a little bit about how much it costs to do business in a competitive world, and I understand that corporations, for profit or not need to be compensated fairly for the service they provide.
All other variables aside, I don't think that independent dialysis providers are being compensated fairly based on the current Medicare Reimbursement Manual section 2702 entitled: Outpatient Maintenance Dialysis Reimbursement .
If there are solid numbers to the contrary, like "Medicare is paying dialysis providers $700 a treatment, and the COS (Cost of Sale) to the provider is only $350, providing a gross profit margin of 50%" then I would look towards other avenues of improving patient care.  As it stands though, the weakest link in the chain right now appears to be this lack of reimbursement, and a business simply can't provide better care for its patients if it's not getting paid for it.
Now, whether they decide to spend that money on staff or on trips to Vegas is up to them, and that is an area where we can hold them accountable.  But I don't want to jump the gun and assume they are going to spend this needed capital on booze and poker.  I'd like to think that somewhere deep down inside, the investors of a company like DaVita, and the CEO's running it have some sort of desire to provide a valuable service to their patients.

Sorry I've gone on so long about this.  I took Zach's response to my original post a bit personally, as if I were in some way ignorant to what was really going on  (sorry if it wasn't meant to be taken personally Zach).
If in the end we shouldn't support this legislation, then I would like to see why not - in the form of data from reliable sources.  If better patient care is truly to be had through some other avenue, then I'm all for it - simply show me the way.
Cheers

[Rerun]

Here is another post from a long time ago that confirms my figures. 

http://ihatedialysis.com/forum/index.php?topic=154.0

You would be very surprised at the difference between the cost to medicare vs. the cost to the private insurer.  Typically under Medicare, dialysis costs about $133 per session and EPO is $10 per 1,000 units.  That very same service by a Davita clinic to a privately insured patient costs $888 for dialysis and $107 per 1,000 units of EPO.  That's one of the reasons insurance rates are so high. 

I only got 1,000 units today.  But, you are right, everything is sky high; rent, utilities, water.  That is why corporations that 'can' take their business to Mexico or china do.  That is why people go to Canada for drugs.

[slothluvchunk]

Rerun, I think your figures are correct, but your assumptions incorrect.

Companies like DaVita are providing a four hour service which is probably worth between $600 and $800 per treatment.
I would imagine that with their Cost of Sale and a decent profit margin, they're right in that range.  In other words, what the other insurance providers are being billed is a mostly fair price. 

I used to have to purchase EPO on my own, without any coverage, directly from them (I live about 10 minutes from Amgen).  This was before my first transplant.  It was so expensive to go get injections, that I decided to buy it in bulk, refrigerate it, and give myself injections. 
It was still extremely expensive though, like over $100 an injection.

I guess the point is:
I too recognize the disparity - and apparently just am coming to a different conclusion with the same data.

perhaps it is just my conservative small-business-owner nature.
I should probably bow out of this thread, I don't seem to be making much sense .... 

[Zach]

The composite rate, in the beginning was set too high.  You do the research, I'm too busy with my own small business.

You are a shill, and you are very ignorant of history, as it pertains to all the waste and abuse (and yes sometimes fraud) in the dialysis industry.  Do you think Congress should just hand over more money without more safeguards?

Over utilization in the Past (WASTE and ABUSE):
EKGs every four months
Nurometer tests every four months
Doppler
IDPN
Home Dialysis overcharging?Home Intensive Care
Various Medications over use.

Medicare did raise the rate, small 1% raises a few times, but it also allowed for the longer period before Medicare picked up as the primary insurer--from 6 months to 30 months.  That provided the clinics with more than enough to make a profit.  Medicare unbundled a lot over the years, too.  Same thing with EPO and other meds.  In fact, many Medicare patients received 4,000 units of EPO in the 1990's, now many of them receive higher doses, sometimes 12,000 and more.
 
There's more Medicare money in higher doses of medicines.  Read the report I posted.

Moving the money around to raise the composite rate and lower the profit motive in perscribing medicine is a good idea.  Also requiring patient out comes as a requirement for additional reimbursement is a good idea.  So the legislation may be a good, but you fail to really explain it.  I would also like to see a requirement of minimum staff to patient ratios (at all times, including meal breaks), and requiring certification of patient care technitions ... but you can bet that Davita may not like those last two.  Perhaps the smaller, independent clinics should be reimbursed at a higher rate, but that's also not going to happen.

Yes, get your facts and history straight, and please don't send us to a Davita site to do their bidding--they have plenty of money to do it for themselves.

[Zach]

Companies like DaVita are providing a four hour service which is probably worth between $600 and $800 per treatment.

You are so far out of the realm of possibility, it's scary!

Hate to tell you, but the techs are not going to get paid more.  DaVita will just extend their Las Vegas Party an extra day.  They can afford to pay these people more now.  They just won't.  Don't let them manipulate you into thinking the techs will get a raise if Medicare adjusts their payments. 

Thanks, Rerun  ditto

[slothluvchunk]

You are so far out of the realm of possibility, it's scary!

How so?  Tell me how...
I keep humbly asking you to tell me where I'm wrong, that I might ammend my statements and learn from them.  Instead you just keep jabbing at me.

It's amazing that as a small business owner you don't see the value-added service a company like DaVita provides?  You must not dialyze in-center then?

I guess you're not one to filter words, or at least look up their meaning before using them.

Or... you are, and are calling me a shill on purpose, knowing full well what it means.

I asked you to tell me where I was wrong if I was, as my goal was to improve care for dialysis patients.
Instead you call me a name, and fail to produce the evidence.  You then cite again this EPO issue, which is a non-issue, as my original post is about the legislation having to do with dialysis reimbursement rate, which does not include injectable drugs i.e. EPO.


...


Still waiting for all those figures I was wrong on - you know, cold hard data.

Somehow I was able to duck away from my small business long enough to do the same courtesy for you. 

--don't bother responding, I'll just hope others can read this on their own and make their own decisions.

[Rerun]

Even if you are right.  The cost to keep people alive on Dialysis is too high for the return.  We need congress to bring back a Board that decides if the patient is worth the thousands of tax payer dollars to keep alive.  Sounds hard, but it needs to happen so that Medicare doesn't go broke.  It is like a drain on a power supply.  Unplug a few appliances and the lights get brighter and the other appliances run smoother.

[Zach]

"Kidney Care Connections is a community education service of DaVita"

Main Entry: [2]shill
Function: noun
Etymology: perhaps short for shillaber, of unknown origin
Date: circa 1916
1 : one who acts as a decoy (as for a pitchman or gambler); also : one who makes a sales pitch
2 : PITCH

You are a pitchman for Davita.

It's amazing that as a small business owner you don't see the value-added service a company like DaVita provides?  You must not dialyze in-center then?

I've been on in-center hemodialysis since 1982.  Another fact you got wrong.

I stand by my second post on this thread:
http://ihatedialysis.com/forum/index.php?topic=1344.msg16403#msg16403

[BigSky]

You would be very surprised at the difference between the cost to medicare vs. the cost to the private insurer.  Typically under Medicare, dialysis costs about $133 per session and EPO is $10 per 1,000 units.  That very same service by a Davita clinic to a privately insured patient costs $888 for dialysis and $107 per 1,000 units of EPO.  That's one of the reasons insurance rates are so high. 

If you were up to giving yourself injections you might check with your insurance to see if they will pay for epo through a pharmacy.  It would cost them much less.

Companies like DaVita are providing a four hour service which is probably worth between $600 and $800 per treatment.
I would imagine that with their Cost of Sale and a decent profit margin, they're right in that range.  In other words, what the other insurance providers are being billed is a mostly fair price. 

Not even close. 

That amount is called GREED. 

I have nothing against DaVita as I have never dealt with them.  However that amount is pure and utter greed by a corporation.  It is because of companies like DaVita and certain lawyers that cause our medical care system to cost so much.  A strict cap should be put on what medical should cost like is done in much of the world.  As it is the US is a free for all and that is why we pay more for medical care than everyone in the world.  From testing to drugs.

What is even more scary is a article  I read that is suggesting that in the very near future insurance companies are going to start asking their customers to go overseas to have medical procedures done in an effort to cut costs.  Estimated at 20% savings having such stuff done overseas.