How to pick an in-center hemo clinic?

[LorinnPKD]

Hi everyone,

I'll be starting in-clinic hemo this summer.  I'm visiting several here in town next week and I'm putting together a list of questions to ask to help me decide, so I'm asking the forum for help!

About me: I'm 40, PKD, no other health issues.  I'm familiar with in-center hemo and how it works in general because this runs in the family.  I have an A/V fistula that's supposed to get the OK in early July. 

1. What questions did you/did you wish you had asked when selecting a clinic?
2. What factors did you think were important but didn't end up being that important?
3. What factors ended up being more important than you initially thought?
4. Did CMS star ratings play into your decision? (My neph is recommending a particular Davita center that is a two-star when we have three- and five-star CMS ratings at other clinics here in town.)

Would love to get your thoughts and input and experience!  My thanks to all of you!

[PrimeTimer]

Here are some questions I thought of.

Does the center support a home-hemo and/or home PD program?
Does the center offer extended hours or nocturnal?
Does the center use new/disposable dialyzer filters for each and every treatment or reuse them?
What is the center's nurse/staff-to-patient ratio?
Which hospitals does the Nephrologist have privileges at?

I would also do an online search to find out a center's infection and mortality rates.

[kickingandscreaming]

If there is a not for profit clinic near you I would choose that one.  Your neph is probably recommending the DaVita center because he/she has privileges there.  There might be  better ones but you might have to switch to a new neph.  I agree with all the questions Prime Timer suggested.  Good luck.

[Simon Dog]

Does the center support a home-hemo and/or home PD program?

Cinics here in MA must have an affiliation agreement with a clinic with a home program if they do not have one (though the reg is silent as to the home modalities that must be supported).  See 105 CMR 145.340 - 145.360 and 145.800 - 145.850 for details.   Other states may have similar regulations in place.

Does the center use new/disposable dialyzer filters for each and every treatment or reuse them?

What are the "economic limitations" in place restricting the size of filter you will be allowed for treatment?  (for example, FMC makes it hard to get anything bigger than a 180 unless you fail to meet CMS guidelines with a 180 - no "extra good dialysis for you")

[kristina]

Hi everyone,

I'll be starting in-clinic hemo this summer.  I'm visiting several here in town next week and I'm putting together a list of questions to ask to help me decide, so I'm asking the forum for help!

About me: I'm 40, PKD, no other health issues.  I'm familiar with in-center hemo and how it works in general because this runs in the family.  I have an A/V fistula that's supposed to get the OK in early July. 

1. What questions did you/did you wish you had asked when selecting a clinic?
2. What factors did you think were important but didn't end up being that important?
3. What factors ended up being more important than you initially thought?
4. Did CMS star ratings play into your decision? (My neph is recommending a particular Davita center that is a two-star when we have three- and five-star CMS ratings at other clinics here in town.)

Would love to get your thoughts and input and experience!  My thanks to all of you!

Hello Lorinn (... and ... you have put together some good survival-questions!!)
Here are my answers:
The most important point for me was (and still is) : How clean is "my" center ?
i.e. : How clean and how patient-friendly are the dialysis-nurses?
i.e.: How well can we communicate with each other
and how helpful are the nurses in order to teach me about my very own treatment?
i.e.: How well are we all working together as a team?
Good luck and best wishes from Kristina.

[iolaire]

My primary question is which nephrologist I want (because of trust) and which clinics they work in.  From what I can tell nephrologist have set shifts and clinics.  So you Dr might recommend the DaVita clinic because the Dr works at that clinic.

Secondly would be which clinics have the shift you want.  i.e. if you are working are you doing afternoon shifts?  Of the two sets of days at my center T/T/S only has two shifts, I'm on M/W/F on the third shift that is not offered on T/T/S.  I'd want this same shift if starting out.

I would then look at the center Star grades its an indication of either the patients the centers have or how they care for those patients.

Finally I'd seriously consider the closest center possible.  You will spend a lot of time there and don't want to sped too much time commuting.

That being said, there is a center within about 8 blocks of my work, but I commute an hour to a center that is closer to my home.  Its hard for me to get home on my own from my center.  The downtown center by work would be easier to get home from via public transportation.  (Public transportation is my choice I don't care to own a car, only my wife had a car which we share.) 

My center has the nephrologists in the same practices that I visited pre dialysis, but a different nephrologist then I used to meet with.  Since I had to get a new doctor initially starting dialysis it would have been better for me to pick the center near my work and find a different nephrologist under a different nephrologist group.

[Simon Dog]

Secondly would be which clinics have the shift you want.  i.e. if you are working are you doing afternoon shifts?  Of the two sets of days at my center T/T/S only has two shifts, I'm on M/W/F on the third shift that is not offered on T/T/S.  I'd want this same shift if starting out.

If the shift you want is full, find out how many people are the waiting list for that shift; how many people that shift accommodates; and your clinic's annual mortality rare.   You should then be able to get a reasonable estimate of the wait time.  I know when I went from clinic to home hemo, there was one patient who heard about my impending departure and was very aggressive about  asking for my chair time.