leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Sat Apr 26, 2003 9:49 am Post subject: Nephrologist
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When your Nephrologist comes around to see in you in the unit does he speed read your lab results into his recorder? A whole month's labs in 15 seconds - hard to imagine that he is even thinking about your results when dictating that quickly into his recorder. It is clear to me it is just to have 'documentation' that yes, I saw patients labs - here listen to this tape - I obviously looked at them.<
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>One of the major problems with dialysis in the USA is that the only way the Nephrologist can make more income per patient is to keep the patient as 'sick' as possible. Keep anemia low - bill for more EPO. Keep Calcium low - bill for Hectoral(Vitamid D injection). Keep Iron low - bill for Iron. Put patient in hospital (KahGing) get to bill for hospital visit.
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leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Sun Apr 27, 2003 11:31 pm Post subject: From American Medical News
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Quality care not tied to financial return<
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>www.ama-assn.org/sci-pubs...sd0505.htm
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Mon Apr 28, 2003 12:34 am Post subject: Neph. visits
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My neph. does't visit me in the unit; I go to his office once a month, which is fine by me because there is more privacy, and anything we discuss will not be overheard by staff. Also, he can't really do a proper exam in dialysis center. Lin.<
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patient
Joined: 29 Oct 2002
Posts: 137
Posted: Mon Apr 28, 2003 8:49 am Post subject: My neph
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doesn't do the recorder thing wow. He can never remember where he left off last time with my issues. Misses lab values. Most of all, he runs away from me as fast as he can - he's so afraid he won't be able to answer my questions that he runs off before I have a chance to open my mouth lol. I wish I could videotape this and show it to everyone. It would be a real comedy if it wasn't so pathetic. You'd see me saying, "Hi doc bye doc". What is a proper exam in dialysis, Lin,- I never had one
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LuLuW
Joined: 27 Apr 2003
Posts: 46
Posted: Mon Apr 28, 2003 10:52 am Post subject: You're right, the U.S. gov't thrives on us being sick
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Sad, but true. I'd hate to think that any nephrologist would actually manipulate a patient's labs so that they will need more medication. I shudder at that thought, and obviously that would go against the Hippocratic Oath and "do no harm." However, in this country where the old mighty dictates policy, who knows? I'm pretty confident in my neph. His bedside manner isn't that spectacular, but he's efficient and I trust his judgement. He prolonged putting me on dialysis as long as he could, and I've later learned he could have suggested it much earlier. He also pushed me right into the pre-transplant process with a quickness. He gave me all the necessary phone numbers, points of contact, and filled out the necessary paperwork. In fact, the original plan was for me and my donor to complete the whole process before dialysis was even necessary. If he were interested in making money off of me being in dialysis, he wouldn't have done so. I dig that.
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aprnjam
Joined: 28 Apr 2003
Posts: 85
Posted: Mon Apr 28, 2003 5:57 pm Post subject: Income from Dialysis
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Unfortunately the majority of insuance companies and Medicare do not pay the full billing for anything associated with dialysis. They pay what they determine to be the "reasonable and allowable" charges. For Medicare these are as low as $20 per visit. For Epo, it's only $18, when the cost is $135 per injection. So the doctor is not making anything on it all. If you are hospitalized, and on Medicare, the hosptial is reimbursed on the Diagnosis Related Grouping (DRG) system which means that the hosptial gets X amount of dollars for a particular diagnosis. For instance if you are hospitalized for 10 days with pneumonia, and your bill is $16,000, Medicare only pays $3,800, and the hospital has to write off the remainder. The doctor gets $28 per day for the visit, no matter how many times he sees you in that day. So the doctor is not making any money on keeping you "sick." The less he see's you the more he makes.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Mon Apr 28, 2003 11:40 pm Post subject: proper exam
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my point patient was that when a doc. visits JUST in the unit a proper exam can't be done. When I go to his office he can ask me anything without other pts. or staff hearing. He takes my bp, listens to heart, and palpates kidneys (I have pkd), and feels neck, checks ankles,ect.. When the other nephs. visit pts. they barely stand still, just kind of walk by and say "how are you today?" It reminds me of when one is in the hospital and a doc sticks head in door and sais hello, and then you get an exhorbitant bill that sais "medical consultation", yeah right! Lin.
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