DialysisEthics2_Forum

General Discussion => Main Forum => Topic started by: cschwab on January 21, 2010, 11:29:52 AM

Title: What Works
Post by: cschwab on January 21, 2010, 11:29:52 AM

I've watched over the years what the for-profit motive has done to hospitals (http://dialysisethics2.org/index.php/Healthcare-Non-ESRD/for-profit-hospitals.html), nursing homes (http://dialysisethics2.org/index.php/Healthcare-Non-ESRD/for-profit-nursing-homes.html), health insurance (http://dialysisethics2.org/index.php/Healthcare-Non-ESRD/case-against-private-health-insurance.html), and of course dialysis clinics (http://dialysisethics2.org/index.php/Our-Concerns/new-england-journal-of-medicine-and-john-hopkins-on-for-profit-dialysis.html).  I and others have wondered if going back to the system of small mom-and-pop clinics might be a solution - however then I see articles like the following: New York Times (http://dialysisethics2.org/index.php/Solutions/are-smaller-dialysis-companies-better.html).  And I also remember that places like Lynchburg Nephrology in Virginia was a small for-profit that offered excellent care including slow nocturnal dialysis (who also has a site that's down now that I want to link to it!) - so maybe for-profits aren't always so bad?

So what is the best system for dialysis clinics?  Right now I'm inclined to say large non-profits along with some small for-profits?  Anyway, thought I would throw it out there and see if anybody wanted to comment on it.

Title: Re: What Works
Post by: angieskidney on January 23, 2010, 02:31:16 PM

I have no experience in this area other than being in a dialysis chair in Canada, but to me it would seem that it depends on the mentality of the medical staff in the unit. Where their priorities lie. If money matters more than patient care or if patients matter more than financial care.  Even with that, there has to be a balance.

Title: Re: What Works
Post by: cschwab on January 23, 2010, 05:05:32 PM

You are right, I think care might always vary from clinic to clinic.  But if upper management is looking to cut corners because they are dancing for investors - and also want a big, fat bonus - I think there is going to be more incentive to emphasis the financial side.  I think a lot of attitude filters down from the top, but thank God I still believe there are people who can resist that sort of push.

Title: Re: What Works
Post by: cschwab on January 28, 2010, 06:02:56 PM

I've been going back and forth a bit with a friend - who I respect very much - about business models and my friend is of the opinion for-profit vs. non-profit is more just a tax structure, and the bigger problems lie elsewhere: exemption to the Stark Law (http://en.wikipedia.org/wiki/Stark_Law), and kick-backs that exist in the dialysis field.  Also it is probably more important who is running the business.

I've also seen some fine work done by such places as Lynchburg Nephrolgy - a for-profit, and the big for-profit dialysis companies are coming along in such areas as slow nocturnal dialysis - a bit slowly, but coming along.  I should acknowledge that the changes I've mentioned could go a long way in improving care: eliminating the exemption to the Stark Law and stopping kick-backs!

DaVita_proves_need_for_Stark_Law (http://dialysisethics2.org/index.php/More-Featured-Items/davita-proves-need-for-stark-law.html)

Title: Re: What Works
Post by: angieskidney on January 29, 2010, 08:16:40 AM

Quote from: cschwab on January 28, 2010, 06:02:56 PM

eliminating the exemption to the Stark Law and stopping kick-backs!

DaVita_proves_need_for_Stark_Law (http://dialysisethics2.org/index.php/More-Featured-Items/davita-proves-need-for-stark-law.html)

I sure hope so! (http://kidneykorner.com/smfbb/Smileys/AKCSmilies/fingers_crossed.gif)