Stayin’ alive

A kidney dialysis/transplant diary

The cost of quality care

Things have changed in dialysis care in the last few years, according to reading I’ve been doing (Check out Bill Peckham’s blog, Dialysis From the Sharp End of the Needle, for informative discussion and links to further information.) and my doctor friend who has an abiding interest if not a specialty in nephrology. 

Many of the changes are due to changes in Medicare coverage for treatments and rising costs to the centers providing dialysis.  That Medicare covers dialysis is a blessing to those of us – the vast, vast majority – who need the treatments to live but could not afford them without the subsidy of the government. So I thank god, whomever or whatever she may be, that the assistance is there. I’m not ready to say goodbye to life yet.

But even the smallest decrease in Medicare help, the seemingly inconsequential cost saving measures used by a center, can affect the treatment patients receive. Case in point, gloves and adhesive wound covers. Little things that can ripple into bigger concerns.

Thanks to

I’ll get to the case in a second, but first a brief bit of background. Medicare, my Friend Doctor says, used to pay on a per treatment basis: you got three treatments a week, Medicare paid for three treatments a week. Several years ago, Medicare switched to paying per patient rather than per treatment. What does that mean to the patient? If you need more than three treatments a week, forgiddaboutit. Medicare ain’t going to pay for it and it’s unlikely the dialysis center is going to absorb that extra cost, and believe me, it can be considerable, especially if figured in “retail” medical dollars instead of the adjusted rates provided to insurance concerns, Medicare among them.

 The cost cutting measures by the individual centers are understandable, but one of the more recent at my center has me itchin’ to do some bitchin’.

A couple of weeks ago, one of the techs or nurses complained about the gloves in the new “put on” and “take off” packs.  The packs are tidy little diaper-tucked bundles that contain the sterilizing solution, a mask for the patient, guaze pads, etc., for cleaning access sites, catheter and fistula. She said she hated the new gloves because they were difficult to put on and tore easily “but the new packs are cheaper.” Uh huh.

As for the patients, the new adhesive wound covers, a nurse said last night, are causing problems for many patients including me.  I’m always a little sensitive to adhesive and I’d noticed that the adhesive on the catheter patch the last several times was driving me to scratch – as best I could – incessantly, digging as deeply into my flesh as possible.

That’s not good. It can cause irritation and possible infection, which is especially dangerous since the catheter is so close to the heart and taps directly into the jugular vein.  I try not to scratch, even when the itch is driving me bonkers, but sometimes you just have to scratch to retain your sanity.

But, the nurse last night said, the packs are $2 each cheaper than the old ones. I suppose $6 a week for the 100 or so patients that dialyze there is nothing to sneeze at, but it does add the tiniest of burrs under the saddles of patients who are already pretty nearly maxed out with discomfort, fatigue, disillusionment and depression.

And the nurses/techs and their gloves? If I had to change gloves as many times as they do, I’d be itchin’ to be pitchin’, too.


June 3, 2008 - Posted by | diabetes, dialysis, fistula, health, kidney, renal diet, renal recipes, transplant, weight loss


  1. Thanks for the information. My Father has developed large sores on his fistula arm the last couple of weeks, from the tape they are using, but didn’t understand why. Now I understand why it is happening all of a sudden.

    Comment by SteveA | June 3, 2008 | Reply

  2. Thanks for the plug. Dialysis financing wont change this year but I think it’s all in play going forward. We need to make sure the benefits are weighed along with the costs. A thoughtfully efficient delivery system would be well worth the price.

    Dialyzing daily makes the type of tape important because the wrong tape will end up creating scabs. It’s a fine balance between too sticky=scabs, not sticky enough=it doesn’t do the job. I buy my own band-aids – happily the cheaper they are the less they irritate my skin. The gloves sound penny wise, pound foolish.

    Comment by Billp | June 3, 2008 | Reply

  3. I am not entirely sure where you live, but as for California and the “non-profit” dialysis clinic I am employed by, if you need a fourth tx that week it has to be signed off by the doctor with a certain “code” or reason, such as “fluid overload” or “high potassium”, then it is paid for.

    Treatments after the fourth have to be eaten by the clinic, or paid for by a research project which is what most of our patients do. We have lots and lots of “six time a weekers” in a research project that have been doing leaps and bounds better then their “three day a weeker” co-horts.

    If you need the extra treatment, you need the extra treatment, we should not be playing with peoples lives to save a few bucks.

    Kim, CHT, student nurse

    Comment by Kim | June 3, 2008 | Reply

  4. Thanks for commenting, folks.

    Kim, I know from reading Bill’s blog that he highly advocates more treatments per week as the way to lessen some of the aggravations of dialysis. My question to you: How long are the treatment times for those dialyzing 6 times a week?

    Comment by iowakitkat | June 4, 2008 | Reply

  5. Well it depends on the patient and the Doctor and well you know the drill, a lot of factors, but, from what I have seen, it ranges between 2 hours and 2.5 hours.

    Like, for example, let’s say the patient runs four hours three times a week, they would probably run 2.5 hours a day or even 2 hours depending on if they didn’t gain much fluid inbetween treatments.

    Hope that helps.


    Comment by Kim | June 4, 2008 | Reply

  6. Thanks, Kim … I’m one who might well benefit from another session though the idea of another day with 5 to 6 hours at the center was/is not appealing.
    Coincidentally, I talke with a staff person yesterday who said they had a patient for awhile who was dialyzing 4 times a week and that fourth session was about 2 or 21/2 hours.
    Thanks for the info. 🙂

    Comment by iowakitkat | June 5, 2008 | Reply

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