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Welcome to DialysisEthics.org - A Patient Advocacy Organization
Standards of Care PDF Print E-mail
Written by Administrator   
Sunday, 05 August 2012 06:09

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We are asking people to write their government representatives and tell them kidney dialysis desperately needs:

Standards of Care!

1) Longer time on dialysis

"In Japan and Germany, one of the pay for performance targets for dialysis is that 85% of those on dialysis must be getting at least 4 hours of treatment 3x/week (this would translate to 2 hours x 6 days a week). I think that would be an excellent goal worth working toward here, particularly in light of the DOPPS (Dialysis Outcomes & Practice Patterns Study) data among 22,000 or so dialyzors that found a 30% drop in the risk of death for folks who got at LEAST 4 hours of treatment. IMHO, there is no excuse for anyone to be getting less than this, regardless of body size. It is not possible to get too much dialysis (though it is possible to remove too much water and leave people feeling wretched--this is actually quite common)."
(click_for_Home_Dialysis_Central_post)


Other things we have on our list so far are:

2) Patient Staff Ratios

We've heard for years a ratio of 1 RN and 3 techs for 9 patients would be the proper staff to have.  States such as Vermont have worked to get this implemented.

3) End reuse

This is the practice of taking the filter that cleans the blood, putting harsh chemicals through it, then reusing the filter again at the next treatment.  Numerous reliable studies have shown this to be a dangerous practice.

4) End staff non-compete agreements

"The mud began to fly last year when the second-largest group of Denver kidney doctors, called nephrologists, ended their exclusive affiliation with DaVita and partnered with a Massachusetts dialysis company entering the Denver market."  "DaVita quickly sued doctors, plus a nurse battling breast cancer who quit her job at a DaVita dialysis center and took one with Liberty."

"DaVita says it "paid millions" in 1998 to the doctors of Western Nephrology in Denver to retain them as medical directors of six dialysis centers in the metro area for 10 years. The doctors signed non-compete agreements, promising not to join forces with DaVita rivals or steal any of the California-based company's nurses."

(click_for_Denver_Post_article)

 

5) A notarized "Request for Advocate" - signed by the patient - will be honored!

Sometimes the relationship between a patient and members of staff can become heated, not all patients can afford or wish for a lawyer.  Bringing in a third party, experienced, and level-headed advocate can defuse the situation and get to the root of the problem.

P.S. For individual patient advocacy we recommend you contact dialysisadvocates.com

 

6) Patient will normally be allowed a dialyzer of their choice

If the dialyzer is a brand not normally used by the clinic, it will be obtained by the clinic possibly at a small premium?  If the nephrologist of the patient has serious objections to the choice, it must be stated in writing and could be subject to arbitration

 

7) Blood samples (labwork) will be processed at local labs


Processing bloodwork at a local lab will save time and potentially catch serious problems more quickly.  Faster processing may also help in getting a better snapshot of what is actually going on in the body and give more accurate information with which to make better medical treatment decisions.

 

8) Blood Transfusions will be done in a hospital


It appears at least one dialysis company is taking advantage of allowing dialysis clinics to do transfusions: "Some providers are associated with a significant increase in transfusion rates over the one-year (2011) time period (the rate increased 46 percent in DaVita units), while others show minimal changes (4 and 7 percent in Fresenius and hospital-based units, respectively)." Click_for_HemoDoc_article

9) The requirement that state inspection teams have to report complaints to the ESRD networks should be eliminated

Surprise state inspections are no longer a surprise when the networks tip off the clinics.  For more on this see: dialysisadvocates.com And also take a look here: http://dialysisadvocates.com/discussions/?mingleforumaction=viewtopic&t=10

 

10) Patient dismissals should be outlawed!

We give dialysis to prisoners - doing otherwise would be the same as denying food and water, and would be considered cruel and unusual punishment.  Yet we routinely let the dialysis clinics dismiss non-violent patients for doing no more than questioning their care, leaving them to a slow and agonizing death.  Meet some patients who nearly met this fate: http://dialysisadvocates.com/patient-stories/

 

11) Cameras should be put in the clinics

See patient stories at http://dialysisadvocates.com/patient-stories/ And listen to: http://www.blogtalkradio.com/nnia1/2013/11/13/lets-talk-dialysis

Need more info?  Try our quick intro

Last Updated on Wednesday, 27 November 2013 06:09
 
Introduction PDF Print E-mail
Written by Administrator   
Saturday, 29 January 2011 21:37

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Hi, my name is Chris and I've been a member of DialysisEthics since 2000 and I help coordinate the activities of this patient advocacy organization.  The website has been down for awhile but we believe this has been an excellent time to bring it back.

(Click_for_more_Intro)

Last Updated on Wednesday, 07 March 2012 16:53
Read more... [Introduction]
 
Kidney patients at for-profit dialysis centers less likely to get transplants PDF Print E-mail
Written by Administrator   
Friday, 16 December 2011 09:30

Nephrology News and Issues

 

 

John Hopkins

Kidney patients at for-profit dialysis centers less likely to get transplants

 

12/13/2011

Kidney disease patients treated at for-profit dialysis centers are 20% less likely to be informed about transplant options and referred for the potentially lifesaving operation than those at nonprofit centers, new Johns Hopkins research suggests. A report on the research appears online in the American Journal of Transplantation.

Older, obese, uninsured and Medicaid patients were also less likely to be given all of their options, the research showed, and overall, the uninformed were 53% less likely to be placed on a waiting list for a new organ or to receive a kidney from a living donor.

"Transplantation is not for everyone, but it is important that every dialysis patient be assessed and informed about the risks and benefits of getting a transplant," says study leader Dorry L. Segev, MD, PhD, an associate professor of surgery at the Johns Hopkins University School of Medicine.

For their study, Segev and his colleagues examined the Centers for Medicare & Medicaid Services Form 2728, recently modified to require reporting of transplant education in the hopes of encouraging physicians to at least evaluate and consider every patient for transplantation. On the form, nephrologists are asked if they informed patients about transplant options, and, if not, to select a reason. The team examined data collected by the United States Renal Data System and found that of the 236,079 adults in the United States who developed end-stage renal disease between Jan. 1, 2005 and Sept. 24, 2007, more than 30% had not been informed about transplantation at the time the form was filled out. The primary reason, given by 42% of providers, was that they had not yet assessed whether the patient was even a candidate for transplant.

Patients at for-profit centers and those with Medicaid or no insurance were more likely to be unassessed, suggesting that financial pressures to keep patients on dialysis at the centers could be driving the disparity, Segev says. For-profit centers are also less likely to be affiliated with transplant hospitals, and many lack personnel trained specifically to conduct transplant education.

 

Nephrology News and Issues:

(click_for_article)

 

John Hopkins:

(click_for_article)

For this and other articles on for-profit dialysis see:
http://www.dialysisethics2.org/forum/index.php?topic=660.0

 

Last Updated on Sunday, 28 October 2012 06:42
 
Get the lowdown on your clinic! PDF Print E-mail
Written by Administrator   
Monday, 27 December 2010 18:56

Propublica logo

 

 

Dialysis Facility Tracker

Updated Dec. 22, 2010

By Robin Fields, Al Shaw, and Jennifer LaFleur, ProPublica, Dec. 22, 2010

This site is for dialysis patients and others who want to learn about the quality of care

at individual dialysis clinics. Among other things, you can learn how often patients

treated at a facility have been hospitalized, report certain types of infections or are

placed on the transplant list. The information is submitted by facilities and collected by

contractors of the Centers for Medicaid and Medicare Services, the federal agency

that oversees most dialysis care.

Related story: Dialysis Data, Once Confidential, Shines Light on Clinic Disparities »

 

All_of_Propublica_expose

Last Updated on Monday, 27 December 2010 20:58
 
Organ Donation PDF Print E-mail
Written by Administrator   
Friday, 28 January 2011 10:22

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Myths and Facts About Organ Donation

Recently a bill was started in the Colorado statehouse to have automobile drivers become possible organ donors unless they opt-out.  The bill was shelved due to "ethical" concerns.  This incident very much highlights the need for more information for those who have concerns about this bill.  So in an effort to enlighten, a list of myths and facts has been started about organ donation.  (Click "read more" link below)

 

Last Updated on Saturday, 19 February 2011 11:31
Read more... [Organ Donation]
 
NonProfit vs. for-profit PDF Print E-mail
Written by Administrator   
Thursday, 09 December 2010 19:22

New Study Shows Higher Mortality Risk at For-Profit Dialysis Chains

dialysis non-profit
by Robin Fields
ProPublica, Dec. 9, 2010, 2:03 p.m.

5:01 p.m.: This post has been updated.

 

Patients treated at dialysis clinics run by the largest U.S. for-profit chains have a higher risk of death than patients treated by the biggest nonprofit chain, a study released today in the journal Health Services Research concludes.

The outcome gaps are substantial: Patients at the largest for-profit chain were found to have a 19 percent higher risk of death than patients receiving care at the nonprofit; at the second-largest chain, the risk was 24 percent higher.

"The difference is very significant," said Yi Zhang, who led the study conducted by the Medical Technology & Practice Patterns Institute, a Bethesda nonprofit. "It's not five or seven percent. It's pretty dramatic."

The study also found that patients had a 13 percent lower mortality risk if they were treated at nonprofit clinics, regardless of chain ownership, than if they received care at for-profit clinics.

The study's findings are likely to stir debate because U.S. mortality rates for dialysis remain among the highest in the industrialized world -- one in five patients dies each year -- and because more patients than ever are getting their care from for-profit chains.

More than 80 percent of American dialysis clinics are run for profit. Chain ownership has increased more than 11-fold since the early 1990s. Two for-profit companies -- Fresenius Medical Care North America and DaVita Inc.  -- now control about two-thirds of the market for dialysis care.

In a recent ProPublica investigation, some doctors, patients and advocates voiced concern that industry consolidation has winnowed down care options, thus reducing competition, and questioned whether providers' efforts to make money had affected quality.

Today's study does not identify chains by name, but Fresenius and DaVita ranked first and second in number of clinics in 2004, the start of the study period. Since then, they have acquired the two chains that were next in size. The largest nonprofit chain is Nashville-based Dialysis Clinic Inc.

A Fresenius spokeswoman said the company would not comment on the study's findings until it had a chance to examine them fully. DaVita officials said the study reflected an outdated version of reality.

"This study examines seven-year-old data, and significant changes in the way dialysis care is delivered have been made in the more than half a decade since, with continued overall improvement in patient outcomes," the company said in a written statement.

More recent information from the federally funded U.S. Renal Data System  (USDRS) shows that large dialysis providers achieve better mortality outcomes than nonchain or hospital-based facilities, the DaVita statement added.

The MTPPI study excluded patients treated in hospital centers -- a key difference with some previous studies -- because they tend to treat patients with more complicating conditions, government data show.

In comparing chains to each other, however, the study's results largely mirror those in reports by the USRDS showing that Dialysis Clinic Inc. has lower mortality and hospitalization rates than other large dialysis providers.

The study tracked about 34,900 Medicare patients who started dialysis in 2004 at 3,601 free-standing clinics, following them for two years. Medicare pays for most dialysis under an entitlement created in 1972.

Researchers compared outcomes at the five largest dialysis chains -- four for-profits and one nonprofit -- and at nonchain clinics. They adjusted data for differences in patient mix, as well as for facility size, staffing, geographic disparities and income inequality.

In addition to lower mortality risk, the study found that patients at the nonprofit chain had the shortest hospital stays and were most likely to be in the recommended range for anemia, despite being given the lowest doses of anemia-treatment drugs. Its clinics also were staffed differently, with more nurses relative to patient-care technicians, who are unlicensed and, typically, lower paid.

Update: DCI did not comment on specific findings but released a statement from founder and board Chairman Dr. H. Keith Johnson saying the chain's "non-profit status allows us to devote a larger proportion of our resources to improving the care we offer to our patients."

 

Propublica_articles

Last Updated on Monday, 27 December 2010 18:45
 
Kidney Dialysis - a troubled industry PDF Print E-mail
Written by Administrator   
Tuesday, 09 November 2010 20:39

In Dialysis, Life-Saving Care at Great Risk and Cost

dialysis arm
Three times a week, patients are tethered to a machine that cleans their blood. (Credit: Roberto Bear Guerra)

by Robin Fields
ProPublica, Nov. 9, 2010

In 1972, after a month of deliberation, Congress launched the nation's most ambitious experiment in universal health care: a change to the Social Security Act that granted comprehensive coverage under Medicare to virtually anyone diagnosed with kidney failure, regardless of age or income.

It was a supremely hopeful moment. Although the technology to keep kidney patients alive through dialysis had arrived, it was still unattainable for all but a lucky few. At one hospital, a death panel -- or "God committee" in the parlance of the time -- was deciding who got it and who didn't. The new program would help about 11,000 Americans, just for starters. For a modest initial price tag of $135 million, it would cover not only their dialysis and transplants, but all of their medical needs. Some consider it the closest that the United States has come to socialized medicine.

Rest_of_article

Last Updated on Tuesday, 28 December 2010 11:02
Read more... [Kidney Dialysis - a troubled industry]
 
About Patients or Profits? PDF Print E-mail
Written by Administrator   
Saturday, 04 December 2010 00:00

CounterPunch logo

 

First Do No Harm ... to the Shareholders

The Patient as Profit Center


By CARL GINSBURG

Nothing you are about to read will change at all no matter what Congress and the President finally agree to do in the never-ending circus of health care reform. A stratified system where privilege rules, and others wait, stays in place, unscathed. Primary doctors will not increase, nor will preventive care, nor will government assistance as envisioned by President Obama make a meaningful difference in the lives of anyone. Most doctors want nothing to do with Medicaid patients—indigent or otherwise. You see, in the end, doctors decide who they see.

Rest_of_article

Last Updated on Sunday, 02 January 2011 21:28
Read more... [About Patients or Profits?]
 
USA Today article - Kidney Dialysis PDF Print E-mail
Written by Administrator   
Monday, 02 November 2009 20:23

Dialysis treatment in USA: High costs, high death rates


By Rita Rubin, USA TODAY

 

Deb Lustman was late getting to work a few days every week, and often felt she wasn't thinking as clearly as she once did.

The reason: Lustman, 50, was spending four hours a day, three days a week, undergoing kidney dialysis at a dialysis center, where a machine filtered toxins and fluids from her blood. Normally, that's the job of the kidneys, but for reasons doctors have never figured out, hers had failed.

 

home dialysis

Steve Lustman helps his wife, Deb, as she inserts a needle into her arm to start dialysis at home in Magnolia, N.J. Only 8% of dialysis patients in the USA treat themselves at home.

Nine months into her treatment, as soon as her doctor raised the possibility of home dialysis, Lustman decided to switch. So, in July 2008, after she and her husband learned the ins-and-outs from a nurse, she began dialyzing five evenings a week at her Magnolia, N.J., home, with her two Maltese, Sophie and Jake, often lounging next to her. Now Lustman, an optician, dialyzes on her own schedule, not the center's, and she's not late for work anymore. And, she says, "I'm healthier."

Rest_of_article

Last Updated on Monday, 27 December 2010 21:09
Read more... [USA Today article - Kidney Dialysis]
 
Pump Speeds and Mortality PDF Print E-mail
Written by Administrator   
Saturday, 16 October 2010 17:42

dsen logo

 

Do We Need to Abandon High Ultrafiltration Rates in America?

By Peter Laird, MD

Dialysis practices around the world differ significantly from the practice patterns observed in America and many have long believed this is in part the explanation for our higher dialysis mortality.

I recently spoke with a manager of a dialysis unit and his experience with horrified Japanese patients who couldn't believe the blood flow rates used in America compared to Japan. Japan, Europe, Australia and New Zealand have long recognized the survival benefits of longer, slower and gentler dialysis compared to our American style violent sessions.

(Rest_of_the_story)

 

Last Updated on Thursday, 23 December 2010 19:16
Read more... [Pump Speeds and Mortality]
 
DaVita proves need for Stark Law PDF Print E-mail
Written by Administrator   
Monday, 02 November 2009 19:42

Rivals wary of dialysis giant DaVita's aggressive business style


By Jennifer Brown
The Denver Post
Posted: 07/14/2009 01:00:00 AM MDT
Updated: 07/14/2009 08:40:38 AM MDT


News that Fortune 500 company DaVita Dialysis is moving its headquarters to Denver socked its competitors like a punch in the gut.  To its rivals, the kidney-care giant is a bully armed with high-powered attorneys who use lawsuits as tools to intimidate.

Joe Corrigan, Denver Dialysis Patient

Joe Corrigan, 87, undergoes dialysis at a Western Nephrology center in Westminster. He has relied on treatments for nearly three years. (Helen H. Richardson, The Denver Post)

DaVita executives counter that they are simply strong competitors — they act as aggressors only when doctors or nurses or other dialysis companies break promises and double-cross them.

Either way, a string of DaVita-filed lawsuits around the country — with two major battles boiling in Denver and Colorado Springs — shed light on the ruthless competition over dialysis patients in an industry that costs Medicare alone more than $8 billion per year.  For years, DaVita's competition in Colorado's two largest cities was almost nonexistent.

Rest_of_article

Last Updated on Tuesday, 28 December 2010 11:07
Read more... [DaVita proves need for Stark Law]
 

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