Imagine my surprise. Dialysis would become a political weapon. (In light of this weekend’s events, this statement seems superfluous.)
A little history… If you check my blog, you can see that on 13 and 14 September, I reported that home hemodialysis would probably have a resurgence. This was based upon the proposed (and since promulgated) reimbursement methodology to be adopted by HCFA (Health Care Financing Administration; i.e., Medicare). By November, most of the providers had opted in to the new reimbursement program. Done deal, right?
Well, in a word, no. This weekend, some tea party bloggers (http://bit.ly/ihnOcv
) began a series of diatribes against the practice. Like this was brand new. Oh, and they are trying to peg this as part of their complaints about ObamaCare- even though this program has been in the works since the President was Geroge Bush Why are they reacting now?
Moreover, this program means that Medicare will allow patients who WANT to dialyze at home, under the provision of a licensed provider, to do so. NorthWest Kidney (Seattle) has been doing this, to the best of their ability, for some 40 years. NWK slowed down this practice when Medicare decided that paying for this option would not include assistance (patients don’t have the money, generally, to pay for this). This new reimbursement policy lets a patient effect nocturnal dialysis at least thrice weekly.
The data for home dialysis demonstrate better patient characteristics than the thrice weekly treatment at a clinic, which is typically limited for four hours or less; a treatment regimen that generally provides adequate or less-than-adequate results. Patient treatment at a clinic requires transport to and from a dialysis center- more time out of the patient’s life and a lower capability to work (as in a job). And, most patients cannot drive home right after a dialysis treatment; they have to wait for 30 minutes or longer (more time out, even harder to hold a job).
Who is asking these people to blog this canard? It has to be a directed and concerted effort, since the frequency went from zero to dramatic numbers (within an hour of one another)- and the “stimulus” (Medicare approving payment for home dialysis) is old. (I will keep the conspiracy theories out of this blog.)
Let home dialysis treatment reign- for those who want it and can safely effect it.
(By the way, there was a mid-sized [for dialysis] company that provided safe and effective home dialysis treatment for about a decade- and there was a concerted effort to shut it down. It almost happened- but before that worked, the largest dialysis firm bought them and dissected their parts.)
Thanks a lot. It has been cool seeing
Thanks man. This was interesting knowing
Thanks a million. That has been fun knowing
+ I am so glad you left your comments and enjoyed my blog postings. Thanks, RAAckerman
Ray, I am on dialysis twice a week, about three hours per session. I am also a member of the Tea Party. We cannot afford the $100 Trillion in debt coming at us. Why is dialysis part of CMS? The free market would long ago have found a cheaper, less intrusive alternative; but politically connected gigantic companies with a cash cow can spread money around to keep things exactly as they are now. So the medium size company that had promising technology is no more, and life goes on for the executives and investors of said large company, and their political benefactors. Do you think anything new will come along, given these circumstances? Do you think HHS and/or the FDA will allow anything new? It would be mighty dangerous to the $28 billions flowing into the in-center dialysis cash cow. I’m not optimistic.
So, let me ask you just a few simple questions.
1. Can you afford the costs for dialysis for yourself? Remember, if the government were not involved, the price would exceed $ 120K a year (and does for many first year patients who have “insurance”). And, if you can, what about the untold others who could not possibly do so?
2. The “free market” has found cheaper and better alternatives. That’s why dialysis still costs about the same as it has since 1980. Some of those savings are not very useful- such as cutting the number of nurses and technicians to keep the costs low. But, more efficient dialyzers, better dialysates, improved ancillaries? Do you think they were not developed by the “free market”? My biggest complaint in this area was the concept that erythropoietin was an “orphan drug” and got special patent treatment- and how the drug was used to eke out more money for each treatment.
3. The “free market” you extol has afforded two companies the ability to virtually monopolize the entire market. Yet, you rail against their powers in the marketplace!
I could go on. However, I fear that your philosophy is inconsistent. You want an unfettered free market, but that unfettered market afforded way too much consolidation against which you also rail. The Tea Party members (or at least the mouthpieces) are among those stopping the use of stem cells- one of the best, great hopes for improvements for the field. It’s hard to be optimistic when the philosophy you espouse works against the aims you desire.