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Home Dialysis: A Fresh Look at Reimbursement Methods. Nephrology News & Issues. 21(3): 43-47, 52. February 2007.

Recently renewed interest in home dialysis as a method of kidney replacement therapy has also increased the confusion of clinic administrators who have to report for reimbursement for home dialysis under Method I and Method II. This article looks at which patients are affected, what home dialysis Method selection means, and how some dialysis programs use Method selection to improve the bottom line of the home program. Methods I/II apply only to home dialysis patients who have Medicare. Methods I/II refer to how a home dialysis patient gets supplies and equipment and also refers to who will be billing Medicare. Under Method I, the dialysis program provides dialysis equipment and all the supplies needed for dialysis, whether hemodialysis or peritoneal dialysis. Nursing, dietary, and social work support are included, just as they are for an in-center hemodialysis patient. Phone calls and periodic home visits are also included. Under Method II, a separate supplier provides dialysis equipment and all the supplies needed for dialysis. The supplier maintains the equipment and arranges for and pays for antibiotics taken at home for peritonitis or catheter infection. Nursing, dietary, and social work support are still provided by the dialysis unit under Method II. The author walks readers through the process that can be used to determine which Method will help control costs to the dialysis facility. Readers are referred to the Cardiovascular Risk, Blood Pressure, and Kidney Damaged-stage renal disease calculator on the Centers for Medicare and Medicaid Services website to help calculate the patient-specific rates (www.cms.hhs.gov). 3 figures. 7 references.

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Home Hemodialysis Fact Sheet. Pitman, NJ: American Nephrology Nurses Association. 2007. 4 p.

This fact sheet from the American Nephrology Nurses' Association (ANNA) provides information about patients who are undergoing home hemodialysis (HD) as treatment for end-stage renal disease (ESRD). Home HD is a renal replacement modality that allows patients to perform treatments in their own home. The fact sheet outlines the different types of home HD available, the benefits of this treatment option, challenges patients may encounter, patient selection and their care partner, training program considerations, and ongoing patient management, including the role of the visiting nephrology nurse. The fact sheet emphasizes that performing treatment in the home environment allows the patient to change or increase frequency of therapy to improve their overall health status and quality of life. Readers are referred to the ANNA website at www.annanurse.org for more information. 1 table.

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In a Bundling Era, Finding a Fair Price for ESRD Services. Nephrology News & Issues. 21: 37-40. March 2007.

This article considers the impact of the Medicare Modernization Act of 2003 (MMA) and the subsequent development of a bundled reimbursement rate that is applied to everyone, from large dialysis organizations with thousands of patients, to mid-sized and small-sized providers. The prospective payment for bundled services would be divided into two components: the dialysis composite rate, which serves as the base for payment, with adjustments for case-mix; and a second payment to cover an extended bundle of services, also influenced by case-mix. The bundled payment system was supposed to be released in a demonstration format in January 2006; the demonstration was delayed because of the Centers for Medicare and Medicaid Services’ (CMS) concerns about developing a fair case-mix model to integrate with the bundled payment. The author reviews the history of reimbursement for end-stage renal disease (ESRD) services and then explores how the bundled services plan was developed. The author also explains the financial modeling used to predict facility Earnings Before Interest Taxes Depreciation Amortization (EBITDA) breakeven. 2 figures.

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In Control With In-Center Self- Care. In Control. 4(3): P1, P4. September 2007.

This newsletter article describes in-center self-care, a method of dialysis delivery in which the dialysis patient shares responsibility with the clinic staff for running their dialysis treatments. The amount of responsibility the patient takes can vary depending on their interest and skill level, but many self-care patients do virtually all their own care, from set-up, through dialysis, recordkeeping, and preparing the station for the next patient. Staff members teach patients how to do much of their own treatment, and they are available to assist patients who have questions or encounter problems. Topics include self-cannulation, the benefits of self care, and ways to incorporate self-care aspects into regular dialysis care. The article includes a five-item quiz about in-center dialysis self-care; the answers are elsewhere in the newsletter.

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In-Center Self-Care: New Interest in an Old Idea. In Control. 4(3): S1, S4. September 2007.

This newsletter article describes in-center self-care, a method of dialysis delivery in which the dialysis patient shares responsibility with the clinic staff for running their dialysis treatments. The amount of responsibility the patient takes can vary depending on their interest and skill level, but many self-care patients do virtually all their own care, from set-up, through dialysis, recordkeeping, and preparing the station for the next patient. The author reports on the success stories of a number of clinics in implementing in-center self-care and the research studies that provide the evidence base for this success. Another section considers the use of in-center self-care as a bridge to eventual home care for these patients; patients build confidence by completing their own care in a monitored setting and become more willing to implement home dialysis. A final section reports on the potential benefits for the dialysis clinics and staff. 10 references.

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Increasing Self-Care Dialysis Adoption: The Role of Patient Education and Identification. At Home with AAKP. 1(1): 15-18. October 2007.

This article is from a new magazine about home dialysis for patients with kidney disease. In the article, the authors consider the role of patient education and identification as strategies to increase self-care home dialysis. The authors note there is still a widely held belief that self-care dialysis options, including home hemodialysis and home peritoneal dialysis, are significantly underutilized. Estimates show that approximately 9 percent of dialysis patients in the United States are using home dialysis. The authors review the benefits of self-care dialysis, which range from improved medical status to broad quality of life benefits. Self-care therapies have the ability to realize the potential of dialysis as an enabling therapy for patients, as it was originally intended, allowing them to continue to live productive lives, including the flexibility to remain employed. The authors explore the reasons why home dialysis is underutilized and offer suggestions for patient selection for home dialysis. The role of predialysis patient education is considered. The authors conclude that patients must be educated on the therapy options available, prior to their need for dialysis. Predialysis patient education can help patients with chronic kidney disease (CKD) stabilize and maintain their health while delaying the need for dialysis. The article is illustrated with full-color photographs of kidney patients and home care settings.

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Integrated Care: Planning for Change. InControl. 4(4): S1, S4. December 2007.

This newsletter article helps readers understand the steps that might need to be taken for a patient who changes from one type of kidney replacement therapy to a different type; for example, a patient may change from peritoneal dialysis to in-center hemodialysis, or to one of various home hemodialysis options, or vice-versa. The author describes an “integrated care” approach in which patients may be helped to anticipate transfer from one option to another over time, instead of seeing changes as “failures.” Topics include the importance of patient preferences, the medical benefits of different treatments, reduced costs, and the role of a multidisciplinary care team to help implement integrated care. The article concludes that recent growth in home hemodialysis options and expanded access to daily and nocturnal hemodialysis have prompted a renewed interest in integrated care. 8 references.

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International Comparisons. American Journal of Kidney Diseases. 49(1): s223-s235. January 2007.

This chapter of international comparisons is from a special supplemental issue of the American Journal of Kidney Diseases that presents excerpts from the 18th annual report from the U.S. Renal Data System on the ESRD program in the United States; data through 2004 is included. The Annual Data Report (ADR) also presents information on patients with chronic kidney disease (CKD) and assesses care of at-risk populations and international comparisons of ESRD. This chapter presents data from 37 regions and countries, offering a worldwide perspective on ESRD and the ways in which practitioners choose to treat it. Data is provided on incidence, prevalence, ESRD caused by diabetes, dialysis, and transplantation. The highest reported incident rates of ESRD are found in Taiwan, Mexico, the United States, and Japan; figures are based on patients on dialysis. The lowest rates are reported in the Philippines, Iceland, Finland, Norway, and Russia. The authors focus on concerns about the worldwide rise in rates of diabetes. 11 figures. 6 tables.

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Introduction. American Journal of Kidney Diseases. 49(1): s10-s16. January 2007.

This introductory chapter is from a special supplemental issue of the American Journal of Kidney Diseases that presents excerpts from the 18th annual report from the U.S. Renal Data System (USRDS) on the end-stage renal disease (ESRD) program in the United States; data through 2004 is included. This Annual Data Report (ADR) also presents information on patients with chronic kidney disease (CKD) and assesses care of at-risk populations and international comparisons of ESRD. The introduction describes the sections in the report: an overview, the healthy people 2010 goals, CKD, the incidence and prevalence of ERD, patient characteristics, treatment modalities, clinical indicators and preventive health, morbidity and mortality, transplantation, pediatric ESRD, cardiovascular special studies, ESRD providers, the costs of CKD and ESRD, and international comparisons. This introductory chapter also explains how readers can get more information on the USRDS website at www.usrds.org. The website outlines the administrative oversight responsible for this project and describes how to read and understand the disease mapping used for the ADR. 9 figures.

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Kidney Failure: Choosing a Treatment That’s Right for You. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2007. 36 p.

This booklet helps readers recently diagnosed with kidney disease to understand their options for treatment. The author reviews the basics of how the kidneys work and what happens when they fail. The booklet reviews each of four treatment options: hemodialysis, peritoneal dialysis, kidney transplantation, and refusing or withdrawing from treatment. The choices made can have an impact on the patient’s diet, ability to work, and other lifestyle issues. The author discusses paying for treatment of kidney failure, noting that Medicare and Medicaid pay much of the cost of treatment for kidney failure. Readers are encouraged to work closely with their health care providers; a list of suggested questions for them to ask is provided. The booklet concludes with a list of organizations through which readers can get more information, a brief description of the goals and activities of the National Kidney and Urologic Diseases Information Clearinghouse (NIKUDIC), and a list of publications in the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Kidney Failure Series. 6 figures. 1 table. 5 references.

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