DialysisEthics2_Forum
Other => Historical Posts => Topic started by: admin on September 19, 2009, 02:24:22 PM
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Nosing In
Joined: 26 Apr 2003
Posts: 3
Posted: Sat Apr 26, 2003 2:53 am Post subject: The right Thing to do
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The right thing to do is to offer patients individualized treatment times based on their needs and the modality of their choice to accomplish this. Very few centers are headed in this direction and most use the reasoning of cost. I don't know if this is applicable or not because I do not have access to all the information that it would take to make an honest judgement. I realize private insurance pays more but does this only offset the amount that medicare/medicaid pays? Are the non-profits who cannot buy in hugh bulk quanties or have to buy FMC or other machines making the "big profit" some try to point out here? Can the small centers, in rural areas, with only a few stations afford to start home programs under the current payment system. I doubt it as right off the top it would take additional staff. What would you suggest non-profits and rural communities get paid more and the big players as FMC; Gam
o and the like get paid less. Does this apply to all their centers even those in rural areas? It may not mean much to most of you but up until about 7 years ago people in our area had to travel 2 hrs. just to get to a center. A small hospital in our area opened up a dialysis center. It has 9 stations. At times they are full and do OK other times they are not full and scrape to get buy. I don't think DE or any of its advocates should be judging what is paid as it doesn't appear that anyone is willing to look at the whole picture. I think the advocates here should stick to what they know and what is important for every patient and that is standards of care and patient rights and modality choice. This should apply to all patients rather their sitting in a unit that is making millions or sitting in a unit making ends meet. Reading the post "from Patients" about the money issue based on "their" knowledge of it; is nothing more than "junk mail."
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Feel
Joined: 26 Apr 2003
Posts: 1
Posted: Sat Apr 26, 2003 3:50 am Post subject: The small companies arent doing bad at all.
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You may think that this is junk mail. Read the transcripts. Read the archives, it has been stated many times that the small units will be squeezed out of the market. They chose to stay silent and to allow this mass buying and they stood silent. They chose to instead of helping with the conglomerants,that somehow this would just go away.<
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>The fact remains, many of these clinics are making money and are not as poor as they put on. What is the administration costs of these units? The physicians are paid up to$500.00 to $700.00 just to have you as a patient. Then they are given an extra $70,000.00 as a composite rate per patient. Now this does not include the extras that are on the patients bill. RCGI even charges for heprin and this use to be free (composite). I have put on the number to find out what is in the composite rate that you yourself can call. This composite rate pays for new dializers,machines,saline and workers wages.....Now how many business can say that.<
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>Lets get real and if the government pays for the supplies and the machines for the clinics,and for home hemo,plus the water purifier. Now what are they out,except they cant do reuse and they cant use the machine on the assembly line. So business wise,it is why this isnt offered. It appears that the intelligent reason would be that it would cut their cost of wages,but no reuse in many cases (large profit) and the employees cost would not be much. It simply may appear as "junk mail" to you. But the number is above. The small clinic has set itself up. They are not in the mass buyings that the big ones are in. They simply stayed silent and are paying the price. They could of stop this,but that would cut out on their games also. So please review what the actual cash outlay is for these companies and decide realistically and not the hype your told. Ask what the administration rate costs are,and realize that you cant "jiffy lube" if a machine is setting in someones house. Medicare will rent it for the patient or out right buy it. <
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>Talk about junk mail, it is true that the physician gets up to $100,000.00 from the non-profits per patient. If these companies are doing so poorly,then their own greed overcame their ethics. They simply dont care about patient care. Who does the physician belong to? You the patient or the investor in the stock market. <
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>This is the facts and this industry has done it to themselves. Long ago, we told the small companies that they need to help out and stop this insanity. They stayed silent and they are the ones will lose to the big stores and the days of the Mom and Pop stores will be gone. These private companies make plenty. Much goes to their pile instead of the patient. I would like to start a business that the government pays the majority of the costs, gives me access with my medical license to make money off each patient who walks through my door. <
>I personally work with many physicians that are in specialties and their referals are cut down and their practices are thin, as they have the nurse practioners etc doing the evaluations and not sending patients to the specialists. Its about money. Many of the physicians I know, would love to be able to profit off their patients and to make the cash these doctors are making. Hard to get the kleenex out on this.<
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>You have to have an open mind and be willing to find out these facts on your own. You have to be able to call the number and find out the truth. I stand by this and this industry will be changing. Maybe the expose~ may change your mind,as that would be a neutral party that has been investigating for a year now. But I guess in all truth it depend on whether your industry and are afraid of the truth and in denial,or you hope we are wrong. It appears that the small hospital could of done home hemo for those patients.<
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Pollyanna
Joined: 18 Mar 2003
Posts: 22
Posted: Sat Apr 26, 2003 4:01 am Post subject: Where are the trains
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Small companies it seems can offer home hemo. If the doctor is payed each month, why should this doctor expect more?<
>If I understand correctly. The government pays the bulk,the physicians if they were in any other speciality,would get nothing but the cost of the appointment and or surgery.<
>Now these Neph's chose to open up these clinics,or can refer the patients to other clinics and still make the monthly money as any other doctor would in any other speciality.<
>So it appears that they are in it for the profit. It appears that they make a choice to refer out or make more money. This is unlike any other doctor.<
>How can FMC afford to pay out 486 million to the government and still operate with profit? Lets be honest,the Nephs are exceeding the payment than other specialities are doing. <
>It appears to be their choice. More on one machine is more money in the pocket.<
>
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Patients
Joined: 15 Mar 2003
Posts: 2
Posted: Sat Apr 26, 2003 4:10 am Post subject: Poor Doctors
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Sounds to us like the doctors are well compensated. Have it on good confidence that our doctor pulls in between 1 and 2 mill annually!
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Bill
Joined: 15 Feb 2003
Posts: 7
Posted: Sat Apr 26, 2003 4:27 am Post subject: $$$
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My nephrologists must be doing ok. They live in grand homes, drive luxury vehicles and travel extensively. In fact, they skip rounds, because they are off on their latest trip. Unless they're living off charge cards it doesn't look like they're hurting.
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Safe Harbor
Joined: 26 Apr 2003
Posts: 1
Posted: Sat Apr 26, 2003 5:12 am Post subject: Imagine
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What would happen if the Nephrologists lose the "safe harbor"? Do you realize that the government can change that ruling in one day. There is a clause in the Anti-Kickback and the Stark Law
being able to revoke this "safe harbor" anytime they chose.<
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>How will Public Awareness help in taking this away from them. It is going to be hard for this group to have any sympathy.<
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>Not bad for 'nobodies'. That could become a reality. This would make them doctors like every other doctor.<
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>I wonder if they will have to sell their grand homes and luxury vehicles. Hope they are saving plenty. <
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>This could be do'able! Think of that! Patients may actually get better care. This physician now belongs to you and not to be able to sell or profit from you.<
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>What could happen to the stock,if this is taken away?The doctors would own their own prescription pad once again and the companies would not be able to do the one size fits all and would be in violation if they didnt honor the prescription. Hmm!@
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Nosing In
Joined: 26 Apr 2003
Posts: 3
Posted: Sat May 03, 2003 3:29 am Post subject: Facts
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I don't know who posted the eleborate post about the conditions and the money made by nephrologist but although they insisted they were posting facts. It simply isn't true in the rural non-profit communities. No nephrologist in our area is making more than $350.00 not 500-700. Nor does anyone of them receive $100,000.00. They do not get paid for referring patients to a dialysis center because there is only 1 dialysis center to go to. I am not an industry person and I can definitely see that objective postings that don't rant and rave about the industries profits aren't looked at for their merit.<
>No wonder the small centers didn't respond to your call for help.
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Oh dear
Joined: 03 May 2003
Posts: 2
Posted: Sat May 03, 2003 4:24 am Post subject: round 3
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Okay here we go again.<
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>The phone number of Mr. Richter is on the site. In one of the local postings. I would suggest that you call and ask the following questions. Now this is up in CMS<
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>1. Does EVERY Nephrologist get (depending on the area) $700.00 or $500.00 a month to acknowledge me as s/he"s patient? <
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>2. Does this Nephrologist need to keep any progress notes or even have to see me the patient each month.<
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>3 How much does my Nephrologist get as a "composite" rate per year? What is that "composite rate" include and pay for?<
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>4. Does the governement pay for the machines? Does the patient,clinic get the choice of either having the government rent or they will they buy them outright.<
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>5. The small companies dialize their own patients and receive all of the above. The physician is who tells their patients where to dialize. If a patient wants to go to another clinic, usually they have to find another doctor.<
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>6.Now this is the only group of physicians that have the "safe harbor" under the Stark Law and the Anti-kickback Law. Which if you read this carefully, states that the government can take away this safe harbor at anytime.<
>This is why I feel that the small companies arent helping. They wouldnt be able to profit off the patients either.Could the safe harbor go, if too much of this story gets out on the corruption of this industry? Hmm! They did it to themselves, and the press will have a field day.<
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>I would suggest that you dial up the phone and find out for yourself. That is unless you already know the answer.<
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>This does not include all the 'padded" costs in the CMS Bills. I am afraid that many of these clinics for profit, some put non-profit , but many of the big companies do pay for the patients.<
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>It appears that your doctor is a rare
eed,but I would ask him if he owns the clinic or has a partner ship in it. He still is making money. Any other doctor you go to makes an office visit off the patient, and a surgery payment. A nephrologist can make a monthly salary and also make money off the dialysis treatments. Remember that the government guarantees payment,unlike anyother doctor. I would ask the Neph the above question. In fact ask them all....but I would suggest that you dial the number yourself.If he doesnt make money off the treatment. He is still getting a monthly salary above. <
>It appears that you need to check to see if we are wrong. They simply must send their patients elsewhere.<
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>Our argument was that the small companies are complaining that if that "safe harbor" is taken away, they will suffer from it now or in the future. They are complaining that the big companies are bigger and get bigger
eaks in prices. I state simply that they should of seen this coming down and remained silenced, as they will not be getting the
eaks. I saw it coming and tried to warn the little guy to watch out. It appears that this day is arriving...Just dial the number and ask the governent..;they even send out a booklet.<
>Arlene<
><
>
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Nosing In
Joined: 26 Apr 2003
Posts: 3
Posted: Sun May 04, 2003 1:13 am Post subject: Information
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Thank you for the contact information; I will investigate this a little further. In our rural area the Drs. don't have any ownership in the centers. The centers are owned and operated by the hospital. The Dr. doesn't get paid for referring patients or payment from the dialysis treatments simply because there is no other place a Dr. could refer a patient too. The hospital doesn't pay the kickback because the doctor isn't in a position to demand it. If the Dr. were to ask for a kickback, he would loose his practice as the hospital wouldn't allow him the priviledges of practicing in the hospital and he would have no place to send his patients for hospital care. It isn't the nephrologist complaining about the income they receive. The rural hospital owned centers are the ones who claim to have a hard time keeping a float. Without the buying power and the smaller amount of patients to profit from there are rough times. Which probably proves itself as one of the hospitals recently sold it's center to FMC. My concern in this isn't just dialysis; I work with an advocacy group for rural health and one of the major issues that we run into is not having enough centers to dialyze patients. When we contact other small hospitals to ask about opening up centers they claim they couldn't make a profit and when we talk with the hospitals about expanding their current centers they also claim they have trouble just staying afloat with what they have. In our area there is not the guarantee that the patient population will be there. At times the centers are completely full, at other times the centers have to many openings. I do think they are concerned about the composite rate being increased and don't hold your view that they are already making too much.
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Contact
Joined: 04 May 2003
Posts: 2
Posted: Sun May 04, 2003 5:00 am Post subject: Congressman Pete Stark in DC's Office.
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You also might like to contact Congressman Pete Stark. You will then understand that they are immune from the Stark Law and the Anti-kickback. They will send you a copy and you will see where this group has the "safe harbor" and can profit from their patients. It also states in the law that the government can take away this "safe harbor" at anytime. They will send you a copy of the actual law.<
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>It sounds as if your physician doesnt have ownership. But he could sell the patients if he chose too. He sounds like a physician that has your best interest at heart. <
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>Many patients arent so lucky.That is what we are fighting for. If you have a great unit, em
ace your physician....not all have sold out.