James
Joined: 13 Aug 2003
Posts: 3
Posted: Wed Aug 13, 2003 5:58 am Post subject: Home Hemo
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There are no home hemo or nocturnal programs in my area. I asked my nephrologist if it was possible for me to travel to the closest location to train and be covered by him at home for 3 day a week nocturnal. The first words out of his mouth were that Medicare would not cover it! He said one of these days he plans on starting a program, but probably not for years. Wouldn't Medicare cover 3 day a week nocturnal? That would be twice the hrs. I'm getting now. My doctor treated me just like his property. He had no interest in my choice or my longevity. I didn't feel he was in my corner at all.
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leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Wed Aug 13, 2003 1:37 pm Post subject: none
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Unfortunately, it seems that the patients are nothing more than a revenue source to some of the Doctors.
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ridgerunner
Joined: 11 Jan 2003
Posts: 101
Posted: Thu Aug 14, 2003 2:58 am Post subject: home hemo
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the govt pays for the training and also the machine in fact the clinic could make more as there is no labor . the only thing you can do is to try to find a place that supports a home program.
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James
Joined: 13 Aug 2003
Posts: 3
Posted: Thu Aug 14, 2003 4:25 am Post subject: hh
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Is it the unit/company that must support hh, the doctor or both? For what reasons would the unit or doctor not support hh? Are you sure Medicare pays for 3x week nocturnal? I know it doesn't pay for 6x nocturnal, but what about 3x?<
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>With the nocturnal programs that have computer monitoring, how far a distance away can you be? There is a hh program 2 hrs away from me, but I don't know if its a nocturnal program. Can a regular hh training program train me to do nocturnal or do I need a nocturnal training program with the computer backup?
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Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Fri Aug 15, 2003 2:18 am Post subject: From Our Experience
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Maybe my information can help you out. I enrolled my father into a slow nocturnal program. We are 285 miles (about 5 1/2 hrs.) away from where the program is located. We lived in a Motel during training and came home on weekends. Medicare does pay more than 3x and with medical reasons 4x. The places who have slow nocturnal are paying for the extra treatments out of their pocket. This is the reason for bill HR1004. It is to allow for paying for more than 3x per week. Medicare only pays for 1 nephrologist. In our state if you are into a home program the nephrologist in charge of the program is required to see you once a month. <
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>Because of the distance we are away from the center providing our slow nocturnal dialysis we were required to keep a nephrologist closer to home; therefore if dad needs medical care we have a nephrologist at home who knows his history and dialysis.<
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>To accomplish this the nephrologist in charge of the slow nocturnal program does NOT charge us for seeing dad. He let's the nephrologist in our area bill Medicare for being dad's nephrologist.<
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>When I started down the path for getting my dad into a program our home nephrologist encouraged <
>me to do so but however would not remain dad's nephrologist at home. I had to search and I mean search our area to find a npehrologist who would support us; I think they were all uncertain of how the payment would work.<
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>We go to the slow nocturnal center once every 4 to 5 weeks and during this trip we pick up small supplies such as needles, tape, gloves, masks etc. I would not want to be much further away as on our nocturnal clinic day. I leave the house at 7am and don't get back until 7pm.
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Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Fri Aug 15, 2003 2:21 am Post subject: Correction
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Medicare ONLY pays for 3x per week unless their is a Medical reason for 4x. Those who receive daily or slow nocturnal hemo are connected to a center willing to pickup the cost of the extra treatments.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Fri Aug 15, 2003 9:03 am Post subject: Computer monitoring
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Hi James, You asked about the monitoring so I just wanted to add that the program I looked into allows for computer monitoring so that you wouldn't need a helper. I live in NW NJ and it is an FMC program. The computer monitoring is in a central location now in midwest, but is suppose to relocate to pa.. The monitoring is not located at the training unit. It doesn't matter how far away you are, as their assistance is by phone not in person. <
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>Hi Marty, Long time! Hope your dad is well. Lin.
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Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Fri Aug 15, 2003 11:30 am Post subject: Slow Nocturnal
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Hi Lin dad has been fine. I just haven't been around much lately getting back into the life I had before I hit the campaign for home dialysis. I want to add to your post. What you said is true, you can be monitored from anywhere so distance isn't a problem in that respect. But what one has to consider is the location of the backup center in case your machine is down and you need to get an in center treatment. Or your access needs to be checked because something is wrong. Or you have a situation where you need to do your run in a way that your not used too. I know when dad had a colonoscopy they had us go in-center because they wanted to do a run without heparin and felt safer having someone do it who had, had the experience. I don't see any problem with getting into a slow nocturnal program that is a distance away but I think if your going to do that you should have a nephrologist and center close enough to you to take care of situations that require immediate care.
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Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Fri Aug 15, 2003 11:36 am Post subject: Slow Nocturnal
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Hi Lin dad has been fine. I just haven't been around much lately getting back into the life I had before I hit the campaign for home dialysis. I want to add to your post. What you said is true, you can be monitored from anywhere so distance isn't a problem in that respect. Distance becomes a problem if your machine
eaks down and you have to go in-center for a treatment until it is fixed. Or if you have an access problem that has to be dealt with right away. Or if you need medical treatment for other issues and they need to keep in touch with your nephrologist. This is why we have a nephrologist besides the slow nocturnal nephrologist. We see our home nephrologist once a month so he is always on top of what is going on and can provide us with in-center treatments if needed or even give us antibotics during dialysis. This is also where dad would go if he should need his access checked. Being to far away doesn't permit one to deal with these situations in a timely fashion.
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ridgerunner
Joined:
11 Jan 2003
Posts: 101
Posted: Fri Aug 15, 2003 1:10 pm Post subject: dialysis
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there is no difference in noctornal or day dialysis. i guess if you do it in the morning it would be morning dialysis mid day would be noon dialysis. being you are doing slow gentle treatment you use no more supplies except for water and power but being i sleep i cut the lights off so i guess the power use would be the same. as far as montering the machine alarms will tell you when something is wrong. time you got a call or the montering called 911 it would be too late. slow gentile treatment was the way it started. only the high speed jiffy lubes came with the demand for more profits. speeds kills either on the highway or on dialysis. i recieved no special training but may be that i am in the health field gave me a different outlook. i think some one should be in the house. why i can think of no medical reason.
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James
Joined: 13 Aug 2003
Posts: 3
Posted: Fri Aug 15, 2003 5:25 pm Post subject: getting under a doctor's care
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Well I guess I'm up a creek for now, because I could go somehwere to get the training, but my doctor won't cover me. No one has said, why won't my doctor cover me? He said 3x week nocturnal is not good enough. But don't some of the nocturnal programs run 3x week? Are there any insurance worries for doctors if something goes wrong in nocturnal? <
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>ridgerunner,<
>Do you really think the computer monitored nocturnal is just a gimmick? I've heard about deaths on nocturnal in Europe. Shouldn't someone be alert at all times? I've seen blood leak out the bottom of a patient's dialyzer with no alarms sounding.
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Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Sat Aug 16, 2003 12:50 am Post subject: ????
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James, I find it strange you have read about deaths in Europe on slow nocturnal when to my knowledge they are "just" getting this started over there. Could you post where this information came from. <
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>Yes, slow nocturnal can be run 3,4,5,6,7 times a week. The number of times a patient runs depends on their labs and how they feel. One of the great things about slow nocturnal is that you get so much dialysis you can skip a treatment occasionally without any harm being done. I believe most of the Fresenius slow nocturnal patients run on the 3x a week schedule and they are getting twice the amount of dialysis the in-center patients are getting and reporting to feel much better.<
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>Have you checked with a slow nocturnal program? In our case the slow nocturnal nephrologist called our local nephrologist and explained to him the payment and program and after that it was a go.........
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