cks
Joined: 30 Jun 2003
Posts: 12
Posted: Tue Nov 18, 2003 10:25 am Post subject: Three issues
--------------------------------------------------------------------------------
leadsag, Certificate of Need requirements are State requirements. I'm not sure which states have Certificate of Need regs but I do know that they vary from state to state.<
><
>I think there are a couple of discrete issues being covered in this thread. One the Stark Law exemption. Two the pricing of dialysis units. Three the question does Medicare buy or rent dialysis machines.<
><
>Regarding issue three, I think that was confusion over Method I and II. Issue one - the Stark Law exemption allows Doc who own a unit to refer patients to the unit, it has nothing to do with issue two or with the stock market. If the exemption was no longer allowed Nephrologists who have ownership in clinics would have to either sell out or stop seeing dialysis patients ? can?t say if that would be good or bad but I have never really seen the issue discussed on DEO. The argument I have seen on DEO implies that Docs get paid for having privileges at a provider, I?ve not seen evidence of that.<
><
>Regarding issue two, how to value an unit? and When you by a share of Davita etal, are you really buying a piece of a person with CKD? Interesting questions. Would you say there are differences in how a dialysis unit is or should be valued compared to other medical entities? Say a hospital or day surgery center? or a Nursing home? Couldn?t you also say that if you buy a share of Nursing Home stock you are buying a piece of an elderly person? What is the alternative?<
>
**************************************************
leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Tue Nov 18, 2003 10:33 am Post subject: CKS
--------------------------------------------------------------------------------
When you buy a share of stock.....<
>I think when you buy a share of stock you are buying a share of that company. You are investing in that companies operation. The patients in this case are not an asset but actually more of a supply item or a revenue source. <
><
>I disagree with some others that post on here that patients are bought or sold. The price might be set based on the historical revenue or customer base which happens to be the patients but I do not feel that the patients are being sold.<
><
>The Certificate of Need is what I was talking about - just didn't know the correct term.<
><
>I feel if the Nephrologist did not have the exemption they would be more interested in the welfare of the patient rather than the profit of the unit. I recently saw a very unethical example of this take place with a patient at the unit I am a revenue source for.<
>
**************************************************
cks
Joined: 30 Jun 2003
Posts: 12
Posted: Tue Nov 18, 2003 11:37 am Post subject: Stark Law Exemption
--------------------------------------------------------------------------------
That sounds about right Leadsag. With regard to the Stark Law exemption - there can't be that many doc owned units out there these days. Less than 5% I'm guessing. I'm surprised this issue is such a priority at DEO.
**************************************************
Issue
Joined: 18 Nov 2003
Posts: 1
Posted: Tue Nov 18, 2003 1:22 pm Post subject: Conflict of Interest
--------------------------------------------------------------------------------
Its called a conflict of interest. THis is the only group of physicians that are immune from this law. Others for good reason are not exempt.<
>It for many reason is a priority, as if you read the GAO report,patient care sucks here. Who does the physician belong to? the investor or the patient.<
>Many things are wrong in this industry,it has been one that is not been for the patient. It hasnt been about medicine,but about profit.
**************************************************
plugger
Joined: 11 Jan 2003
Posts: 226
Posted: Tue Nov 18, 2003 2:09 pm Post subject: Alternative
--------------------------------------------------------------------------------
CKS,<
><
>Are you asking what is the alternative to selling stock to fund these companies? How about non-profit clinics. Stockholders love earnings and profits. Unfortunately profits and good patient care don't always go along. Wall street can't see much past the next quarter's earnings. If a company wants to boost the bottom line, how can they do it? Let's see, how about understaffing? How about providing minimal training? Wouldn't want staff asking for raises! How about running as many patients as you can through a station during a day? Shorten those times! The CEO has gotta get that bonus!
**************************************************
plugger
Joined: 11 Jan 2003
Posts: 226
Posted: Tue Nov 18, 2003 2:30 pm Post subject: P.S.
--------------------------------------------------------------------------------
Oh, did I forget lack of choices in treatment? Another way to squeeze out some moola!
**************************************************
cks
Joined: 30 Jun 2003
Posts: 12
Posted: Tue Nov 18, 2003 2:44 pm Post subject: Re: Plugger
--------------------------------------------------------------------------------
I agree, non-profit=better patient care. That was how the industry was orginized in the early '80s but then the community owned units were sold to the for profits. The real villans in ESRD are the community hospital Boards that agreed to sell their dialysis units. These units were built through donations - donations that were designated for kidney patients - but the proceeds from the sale of the units went to everything but kidney patients.<
><
>Plugger, I think the non-profit horse has left the barn. The billions of dollars it would take to buy back all the for profit units is beyond Bill Gates' reach and CMS isn't interested.
**************************************************
Coerced Patients
Joined: 18 Nov 2003
Posts: 1
Posted: Tue Nov 18, 2003 4:26 pm Post subject: For Michelle, Investigative auditor
--------------------------------------------------------------------------------
Michelle,<
>Dialysis patients feel beholdent to their dialysis healthcare team for their care, even when the care is substandard. If our DaVita staff didn't stick the needles into our arms and start the tx, we would not be alive! <
><
>The average patient does not know that the care we receive is substandard. Most are elderly and are from a generation that blindly follows the doctors' and staffs' instructions. Even most younger patients tend to believe what they are told as they are busy with the responsibilities of life and don't have the time to study the tx to be sure what their health team is advocating is correct. Add to this the weariness one feels from a life on dialysis (when txs are out of balance) and the fact that most people are not proactive, and you've got a situation where the majority of patients are very pliable in DaVita's and other companys' hands.<
><
>Condition the patients through the DaVita newsletters that DaVita is this wonderful, caring company that loves to educate it's patients include in every issue how important it is to write your Congressman for higher remibursements, and then have the pcts go around to each patient handing them reimbursement form letters saying "We want you to sign this so we can send them all into DaVita so we'll get paid better and give you better services", is the utmost in COERCION and UNETHICAL DECEPTION!!!! At the very least, it's in very poor taste and bad character. But this is more than that -- it's BLACKMAIL!!!!!<
><
>Going back to my original point, evey patient who recieved this letter had to feel obligated and indebted to sign it. Either that, or the question mark had to come up in their minds, "If I don't sign this, they (unit management) will know it and they will treat me derrogatorily or maybe kick me out???" <
><
>Michelle, the DaVita newsletters are nothing more than propaganda and preconditioning of the patients to set them up to elicit their cooperation in squeezing more milk out of the
COW(s). DaVita, and other companies like it, should be thoroughly investigated for the incompetent level of care they provide while all the while screaming "More Reimbursements!". The U.S. Government must protect the dialysis population from these theiving companies!!!!!!!!<
><
>A Dialysis Patient, (name witheld at risk of being "dumped" from my txs (which = my life!!!!) for speaking out. <
><
>
**************************************************
