Cuts Could Mean Loss Of Dialysis Care For Thousands Of Americans

[ianch]

Remember too that there will be less complications when treatment is started @15% function verses 6%, so this may assist with the number of people suitable for homeD.   

[Bill Peckham]

As of 2010 http://www.kidneys.co.nz/resources/file/NZ%20Stds%20%20Audit%20Report%202010%20Final.pdf

"The prevalent dialysis modality has changed little in recent years, with peritoneal dialysis (PD) usage ranging from 22% at Palmerston North to 53% at Waikato (national average 35%). Home haemodialysis usage ranges from 10% in Hawke’s Bay and Taranaki to 41% and 44% in Christchurch and Dunedin respectively (national average 18%)"

There look to be 15 units in the country (pop ~4 million).

[rocker]

A couple of major misconceptions here.

Someone is paying every time a tech shows up, and probably a lot more for 2am so I'm struggling to get the financial benefit of HomeD here.   I think I have had 1 tech visit in 9 months for recalibration (+ their annual 3hr service), and I have not called the support team in over 7 months.  that's 1,200 hours of treatment.

The techs "there at 2AM" are on the phone.

I guess I'm just saying that if the US is suggesting that funding may need to be reduced due to escalating costs then perhaps a focus should be on getting the best efficiency and productivity out of the process.

That's not what the government is saying.  The government is saying that care has already been cut by providers, therefore their reimbursement will be cut accordingly.

[rocker]

DaVita is threatening to close some urban and rural clinics that are most dependent on Medicare and Medicaid payments.

Indeed, and this is called hostage-taking rhetoric.  Or "Buy me that candy or I'll hold my breath until I die!!"

In the context of the rest of medicine, many docs today refuse Medicare and Medicaid patients because of a simple fact.

I hear this urban legend over and over and over.  Where are the stats?  What are the actual numbers?

I live in one of the most Medicare-heavy areas of the country, and I have yet to encounter a single doctor that won't take Medicare.  In fact, most doctors advertise heavily and compete for Medicare patients.  Why?  Because when patients have Medicare, and doctors perform a procedure approved by Medicare, they KNOW THEY WILL BE PAID, and they pretty much know when.

This is ridiculously untrue of private "insurance".  Every doctor whom I've had the opportunity to chat with about this has stories of cases where a procedure was performed and then an "insurance" company refused payment - because some picayune procedural detail, unique to that particular company and that particular policy, was not done correctly. I had one doctor tell me "Yeah, I put in a 12 hour day.  Six hours seeing patients, and then six hours on the phone with insurance companies trying to get them to authorize payment for the treatment the patient needs."

And people always tell me that they've heard about doctors who won't take Medicare anymore - but no one has ever been able to actually name one that doesn't.  I'm sure there are probably a few out there, somewhere. But consider this - where I've never encountered a doctor who doesn't take Medicare, I've encountered any number of doctors who said "Sorry, we don't take your insurance."

So which is the bigger issue?

These government payments for healthcare do not cover in many cases even the overhead for a doctors visit. Medicine today is quite complex and doctors must have folks in their office who bill, collect, keep data bases, fix their computers, compliance officers to keep up with all of the Federal, state and local regulations in addition to all of the medical staff. When you consider the overhead costs of running a modern practice, there is good reason many of my colleagues have decided to avoid these government run programs. They simple cannot afford to do so with such minimal compensation.

Yes.  And the vast majority of extra employees with every doctor I know are insurance billing specialists. They have to have entire staffs whose only job is to try to keep up with the ever-shifting rules of private insurers.

There will be real consequences of the CMS cuts for one simple reason, the current payment system does not effect the market cost involved. It is an artificial payment in many ways even though yes, the prior system was quite abused by the industry especially with the separately billable items such as EPO.

Nevertheless, simply digging in and saying the LDO's deserve what is coming to them belies the message that it is not Kent Thiry who will suffer when the cuts hit nor will DaVita.

For the thousandth time - the cuts in patient care have already happened. The cuts in reimbursement are a response, not a cause.

I am constantly amused that people seem to believe that these huge corporations, who everyone admits are wholly driven by profit, have not already made all the cuts they can possibly make to increase their profit margins.  Do they think the companies are that stupid and inefficient?

  - rocker

[Hemodoc]

Dear Rocker,

Let's look at some of the specifics.

1) It is a well documented fact that the number of doctors who are refusing all Medicare is rising. In addition, for those that still accept Medicare, many are closed to new Medicare patients. As many as 20% of primary care docs will not accept new Medicare patients even though they continue to see their old patients with Medicare leading to great difficulty for new Medicare enrollees to find a primary care doc.

2) Medicare is heading for bankruptcy and large cuts loom over the docs every year to the tune of at least 25% threatened cuts that keep getting temporary reprieves. Many docs look on the inevitable fact that one day the cuts will take place and are making adjustments to their practice accordingly.

http://www.healthcarereforminsights.com/2012/11/28/medicares-2013-fee-schedule-compared-to-2012/

In fact, many are retiring early who remain in private practice because of the implementation of ACO's.

3) With ObamaCare, there will be a huge doctor shortage brought on by adding millions to the books while at the same time many as noted above are retiring early.

4) You are quite wrong about docs knowing that they will be paid with Medicare.  A friend of mine who is a Family Physician in rural CA didn't get paid by Medicare for 18 months for services already rendered. Sorry, you are mistaken. Many procedures are disallowed and many only get a fraction of the going rate. 

5) Many docs looking at the long term outcome of Medicare are moving to other more sustainable income possibilities. One of my friends from the world of Army medicine is now involved in a very lucrative concierge practice outside of Boston. That is just the reality of finances in medicine today. If you wish to remain in primary care and be an independent practitioner, doing so depending on Medicare is not a viable financial option especially when you consider the rate of indebtedness many of my colleagues have from medical school and add that to the costs of running an office.

Sorry, but your views of the medical community on Medicare are not the views I hear from within the physician community.

[Hemodoc]

Lastly, the topic at hand on cuts to medicare and loss of service I believe is more than just an idle threat from DaVita. It is interesting that the dialysis advocacy is greatly divided on this. Some contend that the industry is over paid and the cuts are justified and others are focussing on the potential harm to patient care.

I have no doubt that DaVita will dramatically shift to protect their own profits in a much more vigorous manner than they will devote time and effort to protecting individual dialysis patients. If you study their business philosophy, their "village" does NOT include the patients. Following this line of thought, who will they protect more, the folks "in" their "village" or the cogs in the wheels that are the dialysis patients when reimbursement falls by nearly 10%?

I have no doubt that the cuts will be passed on in a much greater fashion to the patients than to anyone in the DaVita village itself, although the lower fringes of the "village" are obviously expendable as well. Whatever you believe about the current reimbursement rates, the LDO's will shift their burden to the patient population. When Kent Thiry states he will shut down the centers with a high Medicare/Medicaid mix, why do you believe that is just smoke and mirrors? I suspect that is exactly what the consequences of a 9.4% cut in dialysis reimbursement will cause. In such a situation, people will die and suffer greatly especially in rural and inner city areas poorly served already.

[rocker]

Dear Rocker,

Let's look at some of the specifics.

Specifically, that every complaint you make about Medicare is a problem that is orders of magnitude larger with private "insurance".

1) It is a well documented fact that the number of doctors who are refusing all Medicare is rising.

I can't seem to find your "documentation" of this.  Is it in another thread, perhaps?

And as I point out above, whatever the number is, that number is overwhelmed by the number of doctors who will not take any given private insurance plan.

2) Medicare is heading for bankruptcy

Aren't we all, given the right set of circumstances?

3) With ObamaCare, there will be a huge doctor shortage brought on by adding millions to the books while at the same time many as noted above are retiring early.

And this......this just sickens me.  This is the single most reprehensible argument against expanded coverage that I have seen.

Because to make this argument, you are saying that there are millions of American citizens who do not have access to a doctor right now - and that situation is preferable to having the insured perhaps wait a bit longer for an appointment.  Who cares about the lives of millions of Americans - compared to your personal convenience?

4) You are quite wrong about docs knowing that they will be paid with Medicare.  A friend of mine who is a Family Physician in rural CA didn't get paid by Medicare for 18 months for services already rendered. Sorry, you are mistaken. Many procedures are disallowed and many only get a fraction of the going rate. 

Oh, I guess all of the doctors who have told me this are idiots.  If only they knew "your friend."

And yes, of course many procedures are "disallowed".  I don't want my tax dollars paying for snake oil, do you?

5) Many docs looking at the long term outcome of Medicare are moving to other more sustainable income possibilities.

And virtually every doctor has made the decision not to take any number of private policies.

Sorry, but your views of the medical community on Medicare are not the views I hear from within the physician community.

Why Pete, I can't imagine that we hang out with people who have differing opinions. How could that be?

[rocker]

I have no doubt that DaVita will dramatically shift to protect their own profits in a much more vigorous manner than they will devote time and effort to protecting individual dialysis patients. If you study their business philosophy, their "village" does NOT include the patients. Following this line of thought, who will they protect more, the folks "in" their "village" or the cogs in the wheels that are the dialysis patients when reimbursement falls by nearly 10%?

I am baffled as to how you could think that this is not the current situation.  This is always how they have behaved - and yet people are arguing that this behavior should be rewarded, lest they kill even more people.

I have no doubt that the cuts will be passed on in a much greater fashion to the patients than to anyone in the DaVita village itself, although the lower fringes of the "village" are obviously expendable as well. Whatever you believe about the current reimbursement rates, the LDO's will shift their burden to the patient population. When Kent Thiry states he will shut down the centers with a high Medicare/Medicaid mix, why do you believe that is just smoke and mirrors? I suspect that is exactly what the consequences of a 9.4% cut in dialysis reimbursement will cause. In such a situation, people will die and suffer greatly especially in rural and inner city areas poorly served already.

For the thousand and first time, the cuts in care have already happened.  The reimbursement cut is because of that.

[Hemodoc]

Rocker, more than happy to give you quite a few links to back up my opinions. However, please show me that docs are happy with reimbursement rates with Medicare. Certainly there is fraud and abuse in the medical world, however do you even know what a primary care doc is paid for a full physical for a new Medicare patient?

Most docs have given up on pure private practice. When I got out of the Army in 1996, the recruiters didn't have a single private practice option available within the entire state of CA. Most docs are part of PPO's or some other insurance plan already. Pure private practice is becoming a very lonely venture with the exception of certain specialties where cash pay for services is expected.

As far as Medicare refusals by docs, finding that answer will only take you a few minutes of your time. Yes, it is well documented.

If you are unaware of the Medicare fiscal crises, not much sense having a debate on that issue with you.

For your information, dialysis companies make most of their profits off of private insurance, it is their preferred payor. In fact, many units "cherry pick" based on private insurance situations. If you believe that they prefer Medicare patients, I don't have much to say to you.

I retired from my renal disease thank you. Personal convenience had nothing to do with that decision. Failing to understand the doctor shortage that the ACA will exacerbate  even more leaves me astounded you are unaware of this. Nevertheless, you diminish the fact that many docs are fed up with all of the regulatory changes making medicine a very difficult profession any longer. Would you like to learn a bit about physician burnout or just demonize my profession?

Sorry Rocker, your answers truly do not reflect the reality of practicing medicine in this nation.

ObamaCare is a huge disaster and a train wreck heading down the tracks. It is not likely that the GOP will overturn this unique American tragedy. 85-90% of people had "good" health care coverage prior to ObamaCare through their employers. Obama will certainly change the framework of our employer based health care. There are many who now have health care but their employers will choose to pay the IRS fine instead of paying much more for the ever rising health care premiums. In addition, are you aware that most of the new jobs in recent years are part time positions where no healthcare benefits are offered? 

Although these folks will be able to go to the exchanges, many will earn "too much" to qualify for subsidies but not be able to afford the premiums even in the exchanges. on top of that, if you can't find a doc to take care of you, id doesn't matter how much insurance coverage you have.  My friends at Kaiser are quite worried about how to care for the significant number of new patients the ACA will open up. The fact that you dismiss these real issues is quite astounding and leaves little room for any meaningful debate.

In any case, not likely I will change your extreme views but your reality is far from the reality of practicing medicine today.

Have a great day.

[rocker]

Rocker, more than happy to give you quite a few links to back up my opinions.

Still waiting.  However, links to opinion pieces with the same opinion as yours are not helpful. We all know people that share our opinion on a topic.

However, please show me that docs are happy with reimbursement rates with Medicare.

Show me anyone who thinks they are paid too much.

Most docs have given up on pure private practice.

This is an undeniable trend, and a sad indictment of corporate "medicine".  I used to know a few doctors who had private practices - they have all, one by one, been acquired by large medical corporations seeking monopoly over care.  When you have a monopoly over lifesaving care, people will pay whatever you ask or die.

As far as Medicare refusals by docs, finding that answer will only take you a few minutes of your time. Yes, it is well documented.

And yet again you sidestep the fact that this problem is many times larger for private insurance.

For your information, dialysis companies make most of their profits off of private insurance, it is their preferred payor. In fact, many units "cherry pick" based on private insurance situations. If you believe that they prefer Medicare patients, I don't have much to say to you.

I never said anything remotely like they "prefer" Medicare patients.  We all prefer the customers who pay us the most. Whether we deserve it or not. That's hardly rocket science.

I retired from my renal disease thank you. Personal convenience had nothing to do with that decision. Failing to understand the doctor shortage that the ACA will exacerbate  even more leaves me astounded you are unaware of this.

I suppose that I shouldn't be shocked that there are so many people that are callously dismissive of other human lives, but I still am a little.  Or at least, that people are willing to be so open about it.

Granted, we wouldn't have gotten very far as a species without a survival instinct.  But once you are surviving, many people's concern turns to helping others.

But obviously, not everyone's.

So I'm curious as to how you justify your life being so much more important than others', particularly given that you're retired?

Obama will certainly change the framework of our employer based health care. There are many who now have health care but their employers will choose to pay the IRS fine instead of paying much more for the ever rising health care premiums.

And where "But all that riffraff will want to see doctors now!" is the most disgusting argument against Obamacare, this is by far the most baffling.

I am an employer.  I have never been compelled by any law to offer health insurance, and yet I did. Why is that?  Was I just that stupid, to offer more than the law required?

I believe it had a lot more to do with the fact that in the jobs I offered, a number of benefits were considered standard offerings.  A business simply could not attract quality employees without offering insurance. In addition, my employees were highly skilled, and not interchangeable.  It would damage my business to have an employee out for an extended period of time, so it was in my best interest to see that they had access to good healthcare.

And, you know, I actually knew and cared about my employees and their families. But compassion doesn't appear to have a role in your worldview.

So all that said, what part of that changes so radically if there is now a punishment for not offering insurance?

Really, it's like saying that no one will drive over 60 if there are no speed limits, but if you set the speed limit to 70 suddenly everyone will drive at over 100mph just so they can pay the fines.

[Hemodoc]

Dear Rocker,

You are a bit bizarre my friend. Where have I ever stated my life is more precious than anyone else? Think what you may my friend, I grew up very modestly and I live very modestly. I was blessed with a wonderful career I worked very hard to attain that was cut short by renal disease as has happened to many. ObamaCare had nothing to do with my retirement. Not sure what absurd accusation you are trying but failing to make, but so be it. God is always good to me no matter the circumstances but you my friend are barking up the wrong tree.

There is no point in correcting your failed understanding of medicine and the practice of medicine. Because I disagree with Obamacare and the outrageous governmental intrusion into private matters you accuse me of a worldview without compassion. Wow. That is NOT how I practiced medicine for nearly 20 years as hundreds of my patients would testify to you, but to what end. Your accusations are silly and without any due justificatioin.

I have spoken quite a bit and written on the issue of health care and I do not in any manner represent the radical views you attribute to me. You mistakingly believe I support the for-profit dialysis corporations which couldn't be further from the truth. For your information, I support a non-profit health care system in the private sector. The Swedish model comes the closest to what I believe is the best system. ObamaCare does not come close to that model my friend.

Have a great day, we will just agree to disagree. Take care.

[Zach]

Nephrology News & Issues
http://www.nephrologynews.com/articles/109681-davita-income-rises-35-in-second-quarter-of-2013

DaVita income rises 35% in second quarter of 2013

DaVita HealthCare Partners Inc. reported that income for the second quarter of 2013 rose almost 35% to $197.4 million, or $1.84 a share, compared to $146.7 million, or $1.53 a share, in the same quarter last year.  Last year's results included the transaction expenses associated with the acquisition of HealthCare Partners Inc., and a legal settlement.

Operating income for the newly acquired HealthCare Partners segment of the business was $81 million, nearly $22 million less than the company guidance.

DaVita made 5,867,973, U.S. dialysis treatments in the second quarter of 2013, or 75,230 dialysis treatments per day, representing a per day increase of 7.6% over the second quarter of 2012. Non-acquired dialysis treatment growth was 5% over the same quarter last year.

# # #

[Bill Peckham]

Nephrology News & Issues
http://www.nephrologynews.com/articles/109681-davita-income-rises-35-in-second-quarter-of-2013

DaVita income rises 35% in second quarter of 2013

DaVita HealthCare Partners Inc. reported that income for the second quarter of 2013 rose almost 35% to $197.4 million, or $1.84 a share, compared to $146.7 million, or $1.53 a share, in the same quarter last year.  Last year's results included the transaction expenses associated with the acquisition of HealthCare Partners Inc., and a legal settlement.

Operating income for the newly acquired HealthCare Partners segment of the business was $81 million, nearly $22 million less than the company guidance.

DaVita made 5,867,973, U.S. dialysis treatments in the second quarter of 2013, or 75,230 dialysis treatments per day, representing a per day increase of 7.6% over the second quarter of 2012. Non-acquired dialysis treatment growth was 5% over the same quarter last year.

# # #

Interesting non acquired year on year growth was 5%, which is higher than overall growth - I'm hearing it is in the 3% range this year. The obvious business response to the bundle is to increase the number of treatments per dialyzor, it would be interesting to know the number of incneter treatments received by a patient starting and finishing the year using dialysis, I would guess that that number is increasing.


But the main thing is the EPO. As Rocker has pointed out, often, the service cuts have already occurred, less EPO is being delivered while the providers are being paid as if they were delivering the expected 5,200 units/treatment. DaVita is saving the expense of 3,000 units of EPO/per treatment while their reimbursement continues as if they're still delivering it, of course their profits are up.

[Bill Peckham]

Looking at the advocacy around these cuts, most of it organized through KCP, I have to ask: Are they trying to keep the cuts in place?

I read nearly every comment to CMS on the proposed bundle and CMS's detailed response to those comments when they published the final rule. About half of the 1,200 or so comments were along the line - the bundle is bad. Don't bundle! Those comments had zero impact in improving the final rule. The final bundle rule was improved by engaging with CMS within the framework of the legislation.

You can make solid arguments against the rebalancing. You could say that the bundle is working, anemas are being managed with less EPO because the providers can direct resources to things like nursing: to for instance transition people from catheters. Or higher quality water to again decrease inflammation. And since inflammation decreases the impact of EPO, decreasing inflammation is better than just giving more EPO.

You could talk about the perversity of dialysis payments before the bundle and that this rebalancing is taking us back to the days when the composite rate was too lean and separately billable meds were supposed to make up the difference. The rebalancing as it is currently proposed will make the bundle a lean payment for the treatment and a lean payment for separately billable portion. It's the 2010 payment without the drug add on.

You could argue that since Medicare is fixing one problem with payment rebalancing they should also fix another - the leakage issue around comorbidities. Basically Medicare assumed there would be x number of people with comorbidities that add to the value of their bundled rate but after 2 years it is clear that the units are not finding all the people CMS says they should find. If CMS set aside an amount of money based on what the units have found vs what they think the units should find, it would add about $5 to value of the bundle.

I think you could also develop an argument that the bundle has resulted in a cost shift from private payers to Medicare - when the bundle went into effect EPO use among private payers fell too, but they weren't bundled so EPO revenue from private payers fell as well - now that that shift has happened units do not have the leverage to regain the lost revenue from the private payers. The bundle has made the providers more reliant on CMS thus CMS should be very thoughtful in their actions, and the incremental approach is called for, so I would recommend as a fall back position that the cut get implemented over time, for instance that the inflation adjustment be reduced by 1% for the next 10 years.

To me those are all arguments that have a chance of impacting the final rule. Saying this cut is bad and we'll close units if this cut goes through, has zero chance of impacting the final rule. If DaVita has to close units in SC and other bad Medicaid paying states, that's not really Medicare's problem so much as it is a problem for the voters in those states. Medicare will base its final rule based on the framework of the proposed rule which is based on the legislative language. I would have thought that the members of KCP would have used this time to put forward winning arguments rather than whining complaints.

[NDXUFan]

Dear Rocker,

Let's look at some of the specifics.

1) It is a well documented fact that the number of doctors who are refusing all Medicare is rising. In addition, for those that still accept Medicare, many are closed to new Medicare patients. As many as 20% of primary care docs will not accept new Medicare patients even though they continue to see their old patients with Medicare leading to great difficulty for new Medicare enrollees to find a primary care doc.

2) Medicare is heading for bankruptcy and large cuts loom over the docs every year to the tune of at least 25% threatened cuts that keep getting temporary reprieves. Many docs look on the inevitable fact that one day the cuts will take place and are making adjustments to their practice accordingly.

http://www.healthcarereforminsights.com/2012/11/28/medicares-2013-fee-schedule-compared-to-2012/

In fact, many are retiring early who remain in private practice because of the implementation of ACO's.

3) With ObamaCare, there will be a huge doctor shortage brought on by adding millions to the books while at the same time many as noted above are retiring early.

4) You are quite wrong about docs knowing that they will be paid with Medicare.  A friend of mine who is a Family Physician in rural CA didn't get paid by Medicare for 18 months for services already rendered. Sorry, you are mistaken. Many procedures are disallowed and many only get a fraction of the going rate. 

5) Many docs looking at the long term outcome of Medicare are moving to other more sustainable income possibilities. One of my friends from the world of Army medicine is now involved in a very lucrative concierge practice outside of Boston. That is just the reality of finances in medicine today. If you wish to remain in primary care and be an independent practitioner, doing so depending on Medicare is not a viable financial option especially when you consider the rate of indebtedness many of my colleagues have from medical school and add that to the costs of running an office.

Sorry, but your views of the medical community on Medicare are not the views I hear from within the physician community.

Good post, as a trained Economist, we agree.

[NDXUFan]

Rocker, more than happy to give you quite a few links to back up my opinions.

Still waiting.  However, links to opinion pieces with the same opinion as yours are not helpful. We all know people that share our opinion on a topic.

However, please show me that docs are happy with reimbursement rates with Medicare.

Show me anyone who thinks they are paid too much.

Most docs have given up on pure private practice.

This is an undeniable trend, and a sad indictment of corporate "medicine".  I used to know a few doctors who had private practices - they have all, one by one, been acquired by large medical corporations seeking monopoly over care.  When you have a monopoly over lifesaving care, people will pay whatever you ask or die.

As far as Medicare refusals by docs, finding that answer will only take you a few minutes of your time. Yes, it is well documented.

And yet again you sidestep the fact that this problem is many times larger for private insurance.

For your information, dialysis companies make most of their profits off of private insurance, it is their preferred payor. In fact, many units "cherry pick" based on private insurance situations. If you believe that they prefer Medicare patients, I don't have much to say to you.

I never said anything remotely like they "prefer" Medicare patients.  We all prefer the customers who pay us the most. Whether we deserve it or not. That's hardly rocket science.

I retired from my renal disease thank you. Personal convenience had nothing to do with that decision. Failing to understand the doctor shortage that the ACA will exacerbate  even more leaves me astounded you are unaware of this.

I suppose that I shouldn't be shocked that there are so many people that are callously dismissive of other human lives, but I still am a little.  Or at least, that people are willing to be so open about it.

Granted, we wouldn't have gotten very far as a species without a survival instinct.  But once you are surviving, many people's concern turns to helping others.

But obviously, not everyone's.

So I'm curious as to how you justify your life being so much more important than others', particularly given that you're retired?

Obama will certainly change the framework of our employer based health care. There are many who now have health care but their employers will choose to pay the IRS fine instead of paying much more for the ever rising health care premiums.

And where "But all that riffraff will want to see doctors now!" is the most disgusting argument against Obamacare, this is by far the most baffling.

I am an employer.  I have never been compelled by any law to offer health insurance, and yet I did. Why is that?  Was I just that stupid, to offer more than the law required?

I believe it had a lot more to do with the fact that in the jobs I offered, a number of benefits were considered standard offerings.  A business simply could not attract quality employees without offering insurance. In addition, my employees were highly skilled, and not interchangeable.  It would damage my business to have an employee out for an extended period of time, so it was in my best interest to see that they had access to good healthcare.

And, you know, I actually knew and cared about my employees and their families. But compassion doesn't appear to have a role in your worldview.

So all that said, what part of that changes so radically if there is now a punishment for not offering insurance?

Really, it's like saying that no one will drive over 60 if there are no speed limits, but if you set the speed limit to 70 suddenly everyone will drive at over 100mph just so they can pay the fines.

Rocker, HemoDoc has never, ever supported For-Profit Dialysis companies.  In fact, we have argued on many issues over the years on different boards.  I was with Davita for five years.  If you think Kent Thiry would not protect his wallet over a dialysis patient, you are drunk and have been drinking.  Davita DOES NOT have compassion for any dialysis patient. If you believe that, you are nuts.  HemoDoc has been very, very critical of the dialysis industry and rightly so......  As a trained Economist, what Obama is telling you is a big fat lie.  I have been on Home Dialysis for seven years and I am a former police officer.  So, if you think I am easily frightened, you would be extremely misguided.  I argued with Davita, day and night, and twice on Sundays.  In fact, it was just one loud arguement.  Yes, I have been in management, just like you.  Look at the numbers, do you think the employer is going to pay a fine of $2,000 or health insurance costs that are thousands upon thousands of dollars?  Many employees are not highly skilled, not like the majority of people in your company, that is not reality.  What happens to a business who pays an employee much more than that employee produces???  The company goes out of business.  What Obama is doing is not compassion, he cares more about how he thinks of himself, that the actual reality of what he is doing to people on dialysis and the average individual.  I hate to inform you that most law school grads, like Obama, have little to no knowledge about Basic Economics.  Yes, I am in law and I was an Economics major.  Obama also knows nothing about science, most of my family is in the hard sciences, Chemistry and Physics. Obama bashes certain groups, because it wins votes, it is just that simple.  In fact, one of Obama's advisors was a board member at Davita and cashed in, making millions of dollars, was Obama's advisor compassionate?   

 "President Obama’s health-care czar and deputy chief of staff, Nancy-Ann DeParle, made more than $2 million in compensation and stock sales as a DaVita board member from 2002 to 2008."   

http://www.5280.com/magazine/2012/09...earth?page=0,4


WASHINGTON—President Obama has named former DaVita director Nancy-Ann DeParle to be the nation’s health czar, who will coordinate the administration’s health policy.

DeParle, 52, will serve as counselor to the president and director of the White House Office for Health Reform. Her position is not subject to Senate confirmation.

Obama made the announcement after he nominated Kansas Gov. Kathleen Sebelius to be the secretary of health and human services. Tom Daschle was originally pegged to fill both roles, but had to bow out after he revealed that he owed more than $140,000 in back taxes.

At a White House news briefing, Obama’s press secretary Robert Gibbs said DeParle will “head health care reform here in the White House.”

DeParle became a director for dialysis provider DaVita 2001. She has also served on the boards of Boston Scientific Corp., Cerner Corp. and Medco Health Solutions. DeParle was also a senior advisor to private-equity firm JPMorgan Partners and an adjunct professor at the WhartonSchool of the University of Pennsylvania.

She was appointed Tennessee Commissioner of Human Services in 1987 at age 30 and oversaw 6,000 agency employees that provided adult rehabilitation services, food stamps, child welfare and cash assistance.

Between 1993 and 1997, DeParle was the Associate Director of the White House Office of Management and Budget. And in 1997, President Clinton appointed her as the Administrator of the Health Care Financing Administration, which is now the Centers for Medicare & Medicaid Services.

She has also served as a member of the Medicare Payment Advisory Commission, which advises Congress on Medicare payment policy.
http://www.renalbusiness.com/news/2009/03/obama-names-former-davita-director-health-czar.aspx   


Hey Rocker, who do you think is going to benefit from this appoinment, do you think it will be dialysis patients? 

[rocker]

Rocker, HemoDoc has never, ever supported For-Profit Dialysis companies. 

I don't understand how this is in any way related to this thread, nor how you imagine that I thought that.

He has, however, argued against the cuts, and takes their hostage rhetoric seriously.  I am for the cuts, and think their rhetoric is bull.

If you think Kent Thiry would not protect his wallet over a dialysis patient, you are drunk and have been drinking.  Davita DOES NOT have compassion for any dialysis patient. If you believe that, you are nuts.

Since I have said more or less exactly that, I'm not sure what you're arguing...?

Yes, I have been in management, just like you. 

I didn't say I was "in management".  My husband and I own a business.  We are those "small businesspeople" that politicians like to pretend they're pandering to. But the "concerns" politicians claim we have are generally not remotely close to reality.

Look at the numbers, do you think the employer is going to pay a fine of $2,000 or health insurance costs that are thousands upon thousands of dollars?  Many employees are not highly skilled, not like the majority of people in your company, that is not reality.

Right, that's not what HD said.  Of course the McD's and WMs are going to do that - they don't care about their employees.

What in fact HD said was that companies that now provide insurance (NOT WM and McD's, but companies that care about employees) would stop doing that and pay the fine instead.

Which is ludicrous.

What happens to a business who pays an employee much more than that employee produces??? 

This is, ummmm, kind of a silly question. If an employee is not doing the work they were hired to do, they are fired.  If, however, your business model is so bad that no employee can produce enough to cover their costs - then you have a deeply flawed business model and will quickly fail regardless of law.

[CebuShan]

I guess, Rocker, that you will not like hearing this but, I have been invited to go to Washington DC as part of an advocacy group to argue AGAINST the proposed cuts to the ESRD program.  And, Yes, I am going!

Anyone who thinks that it will only be ESRD effected is in for a huge surprise. No, it will only START with the ESRD program...

[rocker]

I guess, Rocker, that you will not like hearing this but, I have been invited to go to Washington DC as part of an advocacy group to argue AGAINST the proposed cuts to the ESRD program.  And, Yes, I am going!

Anyone who thinks that it will only be ESRD effected is in for a huge surprise. No, it will only START with the ESRD program...

I don't begrudge anyone their opinion.  I advocate for my own, and give the reasons why.  I hope your trip is pleasant, and that your opinion is heard.  I do love DC - so many beautiful museums and public spaces.  Hope you have time for some sightseeing!

This is a complex issue, and cannot be boiled down into a few posts on a message board.

[MooseMom]

[quote author=NDXUFan link=topic=29264.msg464816#msg464816 date=1376476489

  What Obama is doing is not compassion, he cares more about how he thinks of himself, that the actual reality of what he is doing to people on dialysis and the average individual.  I hate to inform you that most law school grads, like Obama, have little to no knowledge about Basic Economics.  Yes, I am in law and I was an Economics major.  Obama also knows nothing about science, most of my family is in the hard sciences, Chemistry and Physics. Obama bashes certain groups, because it wins votes, it is just that simple. [/quote]

These are the kinds of sweeping statements that make people tune out.  You do your arguments no favors when you indulge in this sort of rhetoric.  No president knows everything about every subject, which is why they have advisors. 

I doubt the President "cares more about how he thinks of himself", but it is probably true that he, like every other politician in Washington, cares too much about the health insurance industry and other corporate interests.  Unfortunately, he has to put forward ideas and legislation that will actually get through Congress.  So, to get a more accurate view, I suggest that in your post, replace "Obama" with "Congress".

[MooseMom]

This may be a simple question regarding a complex subject, but it seems to me that most politicians are telling us that entitlements need to be cut.  So, why are any of you surprised and/or outraged that cuts will be made to the ESRD program?  It's an "entitlement", isn't it?  Aren't there a lot of people out there telling us that government shouldn't be involved in our health care?  And don't a lot of people vote for these politicians who run on this sort of platform?

[Hemodoc]

Rocker, HemoDoc has never, ever supported For-Profit Dialysis companies. 

I don't understand how this is in any way related to this thread, nor how you imagine that I thought that.

He has, however, argued against the cuts, and takes their hostage rhetoric seriously.  I am for the cuts, and think their rhetoric is bull.

Actually, you are quite wrong once again Rocker. I have not yet taken a formal position on the cuts. When I do, I will write a post on my blog. I have voiced concern that the threatened shut down of clinics by DaVita is likely not an idle threat and that the 9.4% cut will passed to the patients, not the share holders. That is my opinion of how DaVita and the other LDO's will likely respond to protect their profits which is their motivation for staying in this business.

That places advocacy in a very divided position where we have no doubt that the greed and profiteering of these companies is out of control and at the same time that the burden of these cuts will be placed on the backs of the patients even further than they are now.

Yes, the dialysis industry does hold a dagger to our throats in their threats, but as history would tell us, the game that they have played will result in further pain, suffering and misery for an untold number of patient as they have done for over 40 years already. Just as Obama is intentionally making the sequester cuts hurt as much as possible to gain political advantage over the GOP (even though the sequester was his idea), so likewise do I believe that LDO's will do the same.

So what is the correct response to the cuts. 1) support the cuts and risk the outrage when DaVita and other LDO's follow through with their threats or 2) oppose the cuts and support the greed and profiteering of the LDO's.  What my friend is the right path that will unite dialysis patients, that will protect dialysis patients and that will improve care for dialysis patients in America?

[rocker]

This may be a simple question regarding a complex subject, but it seems to me that most politicians are telling us that entitlements need to be cut.  So, why are any of you surprised and/or outraged that cuts will be made to the ESRD program?  It's an "entitlement", isn't it?  Aren't there a lot of people out there telling us that government shouldn't be involved in our health care?  And don't a lot of people vote for these politicians who run on this sort of platform?

As nearly as I can tell, MM, the definition of "entitlement" that they use is "anything that does not directly benefit me."

[MooseMom]

As nearly as I can tell, MM, the definition of "entitlement" that they use is "anything that does not directly benefit me."

Ya think?  I'm just baffled.

[jeannea]

I just want to say with this whole argument about doctors denying patients and not being paid, be careful not to confuse Medicare and Medicaid. You will find statistics for both but it's easy to see something like "25% of doctors refusing patients" and see the Medi part and just assume. Some changes are happening to Medicare and some to Medicaid.

Unfortunately, in a general way nothing will change. The system has a lot of flaws now and it will have a lot of flaws later. For some people things will get better. For some people things will get worse. For some people it will be pretty much the same. Being on dialysis sucks and will continue to suck.