jfwag
Joined: 11 Jan 2003
Posts: 140
Posted: Fri Feb 21, 2003 7:32 am Post subject: This has ...
--------------------------------------------------------------------------------
...bothered me a little. I jumped on board this bill because we were doing home hemo and I figured well this might not fit into what the center's want but it would fit us perfectly. I don't know how the centers will rearrange schedules but I also suspect that some patients might not want more. I have known many that looked at me when I talked about "more" and what this bill can do, like I had two heads. This bill I believe, though gives, "The Option" to do more dialysis, not "requiring" it. For the home patient, on Medicare and no scheduling difficulties, it is the perfect fit. It might be only a start and the companies in various articles have complained that funding is the main obstacle. This should solve some it I would think. Hope I make sense. Oh well.
********************************************************************
Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Fri Feb 21, 2003 12:08 pm Post subject: It's hard to sit lol
--------------------------------------------------------------------------------
But I just had to weigh in here! Perhaps if the "quality" issues were addressed it would make the bill more important than it already is. Medicare and the companies should be INSISTING a certain urr or kt/v should be obtained! The current standard of 65 % is not adequate for anyone, let alone those on dialysis who still work and or run a household. The current standards for anemia management aren't up to snuff either. I don't care what they tell me, a hemoglobin of 11 is not adequate for a younger dialysis pt. who wishes to live an active and productive life! They are paying the same for a good tx., and a poor tx., to the tune of thousands of dollars a year per pt.. The units can deliver any standard of care they wish and still charge the same, and get the same, and that is not right! Lin.
********************************************************************
Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Sat Feb 22, 2003 5:26 am Post subject: Totally Confused
--------------------------------------------------------------------------------
This bill is only to cover the cost of more treatments and I don't understand why everyone is getting up in arms about it. If your doing fine on 3x 4hrs, no one is going to force you to change. This is to help those patients who require more dialysis and those who need a "gentler" dialysis. Lin, the most adequate in-center treatment will not help a patient who cannot handle rapid fluid removal. Nor will it help someone who's access is not capable of delivering a high blood pump speed. Nor can all patients tolerate the stress it puts on the heart running at a higher pump speed. This shouldn't be looked as an either or. Either we get adequate in center treatments or we get more treatments. It's just not the way it is. This is to address the issue of getting more treatments for patients who need more. Adequate dialysis also needs to be addressed but it shouldn't be put out as an alternative to getting payment for more treatments. If this passes it will only solve one of the many problems that go on with dialysis but if it gets done that's one problem solved and out of the way. I guess I'm missing something as I just don't get the attitudes being expressed here.
********************************************************************
jfwag
Joined: 11 Jan 2003
Posts: 140
Posted: Sat Feb 22, 2003 6:01 am Post subject: Marty...
--------------------------------------------------------------------------------
...you are not missing anything. I thought I was too, but you have made it clearer in my mind. The bill "IS" the costs and this is what the companies need. Sorry if people feel that the companies get to much but...we can work on that one later. This bill must past as at least a starting point. Like Marty has said a "gentler" dialysis session is needed! (for those who need and WANT IT) If you don't want it that is fine. Believe me before Lois' passing I needed to do a lot of "mental" educating as to why she would be better off doing longer sessions. She knew this but still the "having to sit on a machine" longer bothered her. We couldn't do it anyways since Medicare only payed for 3X's/week. This bill would of increased the # per week, in bed, in home at peace....Ahh I am getting a....
********************************************************************
What Is
Joined: 22 Feb 2003
Posts: 3
Posted: Sat Feb 22, 2003 5:15 pm Post subject: DE's position
--------------------------------------------------------------------------------
on this bill?
********************************************************************
Here
Joined: 23 Feb 2003
Posts: 3
Posted: Sun Feb 23, 2003 3:36 am Post subject: is a summary and link
--------------------------------------------------------------------------------
The ?Kidney Patient Daily Dialysis Quality Act of 2001? is a bill that was introduced into the United States House of Representatives by Washington State congressional leaders Jim McDermott (D) and Jennifer Dunn (R). If passed, it will allow the Medicare program to pay for more frequent hemodialysis (five or more times per week) both in-center and at home. Currently, Medicare only pays dialysis providers for hemodialysis treatment three times per week. (This is a little old, and I'm not sure what modifications have been made, if any)<
><
>thomas.loc.gov/cgi-bin/qu...:h.r.1759:
********************************************************************
Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Sun Feb 23, 2003 7:04 am Post subject: Not up in arms!
--------------------------------------------------------------------------------
Hi Marty, others, I'm not up in arms, and it's my fault for not being clearer about my thoughts! I'm absolutely in favor of the bill, but at the same time think that if for some reason it doesn't pass we still need changes in current tx.. Yes, getting more txs. would be better for many, but if the bill doesn't pass we need to insist that those currently on 3 txs. a week have the best tx. that is possible. The anemia and clearance standards we currently have are in my opinion pitifull! I'm in favor of the bill, but I also believe along with the bill we need to insist that jiffy dialysis with undersized inefficient dialyzers and clearances of 65% be done away with; we can do so much better. Perhaps if things were changed in center some people might not have the need for extra txs..<
>There are a few pts. at the center I go to that must come in for extra txs. because they have huge fluid overloads. The center couldn't handle that many pts. getting extra txs. as they already run four shifts a day. Home pts. I guess wouldn't have much of a problem adding extra txs.. <
>If and when the bill passes what would be done to alleviate the problems with adding on extra txs.? More home hemo programs? Slow nocturnal in-center? More centers opening up? All of the above? What are your thoughts? Lin.<
>
********************************************************************
Could someone
Joined: 23 Feb 2003
Posts: 1
Posted: Sun Feb 23, 2003 9:46 am Post subject: state
--------------------------------------------------------------------------------
DE's position on the bill?
********************************************************************
plugger
Joined: 11 Jan 2003
Posts: 258
Posted: Mon Feb 24, 2003 1:32 am Post subject: HR1759
--------------------------------------------------------------------------------
I did write in favor of this bill. But I also mentioned my concern that total weekly hours would be cut back. It seems to me, there is point where any gain caused by frequency, could be offset by a reduction in total weekly hours. I remember there was a study by the NIDDK where they thought the current dialysis dose was just fine and dandy (B.S.). I'm a bit concerned that something like that could be used to justify cutting hours down. But despite my concerns, I'm in fair of the bill because I believe it will overall help more people, than it will hurt (and as I stated before it is
a step-in-the-right direction)<
><
>P.S. To the above poster, I'm not sure you will get an official DE position. You might get a lot of individual opinions from people who make up DE. (but I might be wrong) <
><
>www.congress.org/congressorg/home/
********************************************************************
Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Mon Feb 24, 2003 2:30 am Post subject: My concern too!
--------------------------------------------------------------------------------
I guess I have a suspicous mind! I'm in favor of the bill too, but wonder if there could be something written into it to prevent companies to giving extra txs. because of low clearances ect.. They can provide good txs. in alloted times with the proper dialysis rx.. but would not like to see them shortening times, using smaller dialyzers ect. and then turning around and adding txs to make up the difference. My clearances weren't that great so I added an extra half hour to tx. time and now clearance is 87%. Of course pts. with heart problems ect. who can't tolerate txs well should get extra txs.. Would not have wanted anyone to say to me that I needed to come in for an extra tx.. Consider too that since Medicare pays for transportation for many pts.. they will also have to pay extra for that. It's a good bill but before it passes may need some fine tuning. Lin.
********************************************************************
Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Mon Feb 24, 2003 2:33 am Post subject: What will happen
--------------------------------------------------------------------------------
If this bill passes, I think you will see a much higher pecentage of patients feeling well. I also think you will see the technology advances in the equipment improve at a much faster rate. I think you will also see more honesty in the discussion of home hemo and at least have an opportunity to see if it fits you. When ever anyone decides to train for home hemo, they always have the option of going back in-center if they or the staff don't think they can handle it. I think it will open up time in centers to allow patients who currently need more dialysis to get it. I don't think hrs will be cut to a deteriment to the patients as the KT/V and URR standards will not change. Although I do agree with Lin they should be raised. The one thing we do know for sure is slow nocturnal does give patients a higher quality of life; they have much more energy, don't have the dialysis fatigue, and they have few if any restrictions on what they eat or drink and last but not least it is done while they are sleeping so life can be lived without the hugh interruption dialysis sometimes creates. This may set forth a dialysis prescription per individual patient and get away from the idea of 1 size fits all. If this bill doesn't pass, I fear there will be many more years passed before patients have choice and access to what works best for them. I also fear if this bill doesn't pass many centers and nephrologist won't even think about starting home hemo programs. These are just my thoughts, hopefully based on logic and common sense.
********************************************************************
Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Mon Feb 24, 2003 2:44 am Post subject: First thought
--------------------------------------------------------------------------------
was that the passing of this bill would open up the way for slow nocturnal programs. That would not only be good for us pts. but would help out the units/companies too. As more and more pts. enter dialysis units will become overburdened and need to find a way to take care of all the pts.. A nurse at the unit I go to said when they have meetings they're told the wave of the future will be home dialysis because it will be the only way companies can keep up.<
>My latest clearance was 87%, but I'm thinking if slow nocturnal gets even higher clearances I would be almost normal again! Younger pts. could keep up the pace of a job and family, and older pts. would be up and moving, instead of not feeling well sitting in wheelchairs and lying on stretchers. <
>They are still talking about starting a slow nocturnal program in the unit I go to; if the bill passes it may just come to pass. Lin.
********************************************************************
plugger
Joined: 11 Jan 2003
Posts: 258
Posted: Mon Feb 24, 2003 4:11 am Post subject: HR1759
--------------------------------------------------------------------------------
(I meant to say I'm in favor of the bill - I haven't had my morning coffee yet)<
><
>www.congress.org/congressorg/home/
********************************************************************
Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Mon Feb 24, 2003 8:20 am Post subject: I knew that!
--------------------------------------------------------------------------------
Scarey, huh lol
********************************************************************
plugger
Joined: 11 Jan 2003
Posts: 258
Posted: Fri Feb 28, 2003 12:45 am Post subject: I blame it on my one kidney too!
--------------------------------------------------------------------------------
I did add a new link on my website to Home Hemodialysis Today. It has some great articles, speeches, etc. (that Dr. Kjellstrand speech I like to quote is in there). Also I talked to my minister, and he has agreed to let me speak in front of the congregation. I don't have a date yet, but should be soon. I just have to print up some flyers. This could be interesting. With me, if it doesn't involve projectile vomiting, I've given a good speech.<
><
>sky.prohosting.com/cschwab<
><
>www.congress.org/congressorg/home/
********************************************************************
Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Fri Feb 28, 2003 3:09 am Post subject: Say it aint so!
--------------------------------------------------------------------------------
Boy, did I get a visual on that one lol! Good luck, and I hope you won't have that problem. Maybe you can look out at the congregation and picture them all in their underwear. I don't like to get up in front of people and speak either but sometimes the need overcomes the fear!!! Lin. (overcoming my phobias one at a time!)
