Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Wed Aug 27, 2003 12:14 am Post subject: Maybe
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they are afraid that eventually (with Medicare needing to hold the line) that they will be paid less also. Right now there would be a bigger profit but if there were cutbacks the ins. cos. would follow suit and pay less also. Lin.
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Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Wed Aug 27, 2003 1:36 am Post subject: Cost
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Lin, I think the money retoric is getting a little old. Home programs are done with a profit. It just requires effort both on the patient side and the center and effort seems to be lacking within the general population.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Wed Aug 27, 2003 3:00 am Post subject: Studies
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show that it's cost effective but whenever pts. ask about it at the centers they go to they are usually told it's not offered because it costs more to do than in center. I'm just trying to figure out why staff sais that, and why it isn't offered more. I've also been told it's not offered because of a lack of interest on the part of patients. I'm just wondering which story is correct, is it cost? or is it lack of interest? Perhaps you know. Lin.<
>
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Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Wed Aug 27, 2003 4:31 am Post subject: What I do know
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Lin, This is what I do know. I know that it take money to be put up - up front to get the programs going. Just like when I want to expand my business I have to put money up to buy the equipment I need to do so. However after the equipment is purchased and I begin to sell the product I bought it for I make a profit and eventually the equipment pays for itself. Same way with home programs there is an up front cost to get one going but after they are set up and running and enough patients involved they pay for themselves and turn over a profit. Maybe the staff is saying they don't have the money "up front" to start a program. Patient interest is certainly a problem. So far only a small percentage of dialysis patients seem to want a home program. I don't know if they lack ambition or just don't understand it, or even want to.
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Home Hemo
Joined: 23 Jun 2003
Posts: 22
Posted: Wed Aug 27, 2003 9:08 am Post subject: Home Hemo Costs
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The machine I have at home is a machine that was in a center. It is a Fresenius 2008H. When the centers bought all new Fresenius 2008K's, they reconditioned the 2008H's for home use. There may be some additional costs for supplies since they are ordered by the patients, and not in bulk by the centers. However, there is very little cost for nursing, etc. You might talk to the nurse not more than once a week, if that. The machine is only serviced twice a year, so unless there is a problem, there is no need for the biomed to come out. Labs are drawn by the patient and Fed-exed to the lab. From what I can see, coming from a center to home hemo is a very profitable venture for a center. It is pretty labor intensive (setting up and
eaking down), which may be one of the reasons people don't chose to do it. It may just be easier to go to the center, have your dialysis, and you are done until the next treatment. I'm not sure patients realize, that even though it's a little more work, they are in the privacy and comfort of their own home, they don't have to drive anywhere, and best of all, their labs are much, much better. Doctor's can also order an extra treatment for home hemo patients and they can run as long as they want to. Patients also have much more control over their treatments. Since most centers have waiting lists, it seems to me like it would be much more cost effective to educate their patients, and get more of them on home hemo. This would open up more slots at the centers and they would make that much more money. I just think it's mostly a lack of people to educate patients that would be willing to do home hemo, if they knew how much better they would feel.
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Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Wed Aug 27, 2003 3:54 pm Post subject: Good Points
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Home hemo you made some very good point but I would take your last statement one step further. The reason I see for not educating the patients isn't a lack of staff but a lack of home hemo programs. <
>How can they tell patients how good it is then turn around and say but we don't offer it. It's easier not to
ing the subject up.
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jfwag
Joined: 11 Jan 2003
Posts: 140
Posted: Thu Aug 28, 2003 2:00 am Post subject: Excellent...
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post Home Hemo. Brings back alot of memories. Everything you say is correct, especially when some people realize the "labor intensive" aspect. It is not for everyone and takes some dedication.
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Dave
Joined: 07 Jul 2003
Posts: 10
Posted: Thu Aug 28, 2003 8:42 am Post subject: HH
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Why are hh patients allowed to dialyze an extra tx? <
><
>In-center can be better than being at home. Its get's you out of the house and if you have a nice staff and pleasant unit there's lots of people to talk and joke with which makes the time go by faster. There are staff around to help you if something goes wrong. I guess hh is preferable to those who aren't in good units?
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patientwife
Joined: 18 Jul 2003
Posts: 47
Posted: Thu Aug 28, 2003 5:43 pm Post subject: Choices
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It's about choice, for whatever reason, and respect for same.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Thu Aug 28, 2003 11:59 pm Post subject: Nail on the head!
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Very good point Marty! Sure there may not be people interested, but even when there are they are discouraged from doing home hemo. You already know the hastle I endured, but to make matters worse (for people with limited transportation) they moved the training unit to a busy city and in a bad section of town, a place where no one would go. It's like they purposely place home hemo out of reach, that way they can say it's offered, but know too that no one will apply. They now only have a few people in it so of course it's not worth it.<
>I think part of it is attitude too. When I go to the unit suddenly I'm made to feel like an air head. I worked in healthcare for over twenty years and so certainly I was capable of caring for others, and learning. Yesterday staff had a fit because I offered to remove my own needles and tape myself up, not rocket science mind you! They have the attitude that ONLY they can have the expertise and knowledge required to do such things. Well, maybe I was being a b.... but I said "gee if they can take people off the street and train them to be techs. I think they can train me, so when are they starting a selfcare program here?" Off course no one answered me! <
/>>I know too what you mean about pts. not wanting to get involved in their own care. In the unit I go to there are probably only a handfull of pts. like myself that take the time to become educated. Some aren't capable, but even of the ones who are they just want someone else to do everything for them. I grew up believing that one should do whatever they can for themself, and be thankfull they are able to.<
>For me ( and I'm sure for many others) slow nocturnal would give us a chance to dialyze by night, and go to work by day, something that is next to impossible now. Perhaps that's the key to more programs, convincing the gov. to lean on dialysis providers so that we can become tax paying citizens once again! As for the startup costs, yes it's true they have them, but FMC is incurring start up costs for all the units they are purchasing in the area where I live. They buy a unit and then replace the machines with new ones, and too replace/upgrade water tx. systems plus hire new staff. I don't know why they wouldn't want to have a home hemo program. Lin.<
>
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Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Fri Aug 29, 2003 12:04 am Post subject: Home Hemo
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Dave, Home Hemo is better for everyone unless you can't do it; or you really want the Social Life of a dialysis center. I don't know where you got the idea there was no one to help you but your wrong. A tech and nurse are always on call specifically for our needs. Home hemo patients can get extra treatments because to get it doesn't require the center to rearrange and reschedule patients. A lot of centers are full now and would have no time slot for an extra treatment. However I agree with patientswife it is about patients having a "choice" of what treatment they want. I think you should check out some other boards on home hemo and you will find more dialysis is benefical to all patients.
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jfwag
Joined: 11 Jan 2003
Posts: 140
Posted: Fri Aug 29, 2003 3:01 am Post subject: Dave...
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...just from my own experience in Home Hemo (I was performing it) my S.O. had an above the knee amputation and other medical problems. Transportation was a horror show and because of sheduling at the unit we could only get a 4 hr. TX. (social life was not much to speak of) When we got home we immediateky went to 4.5 hours and almost 5. She didn't have to wake up at a certain time travel, wait dialize, wait again and then travel more. If she didn't want to wake up at all she could sleep through the whole TX and then get up and go about daily life. For us it worked out fine. With the extra time on the machine blood test were remarkedly improved with a month and only got better. The stress level went down also. It's not for everyone by any means but for some it is a godsend.
