Liberty Dialysis in Hawaii on Maui is in the Island news. Melissa Tanji at the Maui News has two articles in Sunday's paper: Providing dialysis in rural areas is difficult; Liberty pledges support for Hana dialysis. The focus of these articles is the effort to provide hemodialysis in Hana on the Island of Maui. To understand the issue you should know that Hana is at the end of a famously narrow and winding two lane road; a trip into in Wailuku or Kahana (the bigger towns with dialysis on the island) three times a week is a significant burden. The articles get right to the problem with operating a unit for the three or four Hana resident dialyzors: the poor logistics/economics of a small unit.
Cheryl Vasconcellos, executive director of the Hana Community Health Center reckons operating a unit in Hana for three or four people would cost about $250,000 more a year than reimbursement would provide (which I assume they mean Medicare/Medicaid reimbursement). The obvious solution is to provide home hemodialysis with paid helpers. Conventional hemodialysis means 156 treatments a year - paying someone $60 a treatment would run less than $10,000 per person per year.
According to council member Bill Medeiros there is $55,000 available to support the provision of dialysis in Hana, that's two years right there. So where is the problem? It seems to be that there is a reluctance to call this home hemodialysis.
Gibbons [executive vice president of Liberty Dialysis-Hawaii] told the audience that Liberty will be able to provide dialysis machines, maintenance and support as well as programs and training for people to treat dialysis patients in the rural community.
The effort would be under Liberty’s home dialysis program and would be done in a residence, she added. Although Liberty would not be able to staff the machines in Hana, it would provide free training for those who want to learn how to administer dialysis.
This seems like a routine home hemodialysis situation with one exception, while the treatment would be done in a residence it would not, it appears, be the residence of the person being dialyzed.
A county-managed residence in Hana has already been identified as a site to house the dialysis machines, although there are still legal issues that need to be resolved concerning the residence.
It may be a Conditions for Converage issue; if so good for Liberty Dialysis. They seem to be committed to finding a way for this to work and there does seem to be enough money. One concern: there seems to be a lack of sophistication when it comes to dialysis reimbursement.
The National Kidney Foundation Web site doesn’t provide specifics on the costs of providing dialysis, but it did say the federal government pays 80 percent of all dialysis costs for most patients, while private health insurance or state medical aid also help with costs.
Too bad the NKF won't layout the method we finance dialysis in the US, particularly the issues with the Medicare system of payment. I gave it a try in an opinion piece for KidneyTimes and since the real question is Medicare payment there is the DeOreo article in Blood Purification Finances of the Independent Dialysis Facility. Then the question is how well does Medicaid pay for dialysis in Hawaii? Does Medicaid in Hawaii pay the 20% not covered by Medicare for the so called dual eligibles? How much does Medicaid reimburse when it is primary? 100% of Medicare? 80% of Medicare? More than Medicare? Medicare is primary for 75% of all dialyzors in the US, so that's the big piece but how Medicaid reimburses (about 10% of all dialyzors in the US) is important too and will tell you a lot about what dialysis services to expect in a state.
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