Medicare should routinely reimburse 183 dialysis treatments a year

By Bill Peckham

I didn't recognize this post that Zach commented on today; even worse I don't really remember responding to Lori's comment but then I saw the date. I was preoccupied in Chicago at the time, August '08 is a lost month. But it's a good post that touches on related questions.

Zach's comment today comes back to the point of Peter's post - the question of dialysate flow rates (Qd). I haven't heard anything to suggest that NxStage is moving to higher flow rates. I will say that nocturnal seems to diminish the relative impact of low Qd. My guess is that every other day nocturnal on the NxStage using the same weekly amount of dialysate would feel better than 6 day a week 2 hour runs.

I think compared to doing 6x week with 20 liters of dialysate, you'd feel better doing 35 liters every other day for 7 to 8 hours (240 liters/2 weeks vs. 245 liters/2 weeks). This offers an opportunity. The nation's Medicare Administrative Contractors (what use to be called Fiscal Intermediaries) should be directed to pay for every other day dialysis - 182 or 183 payments a year instead of 156 currently routinely reimbursed.

It is bad Medicare reimbursement policy to routinely require a dialysis weekend every week. It may be that the dialyzed would continue to choose to dialyze three days a week; it may be that units would continue to close one day a week. No matter. It should not be a decision made by reimbursement policy.

Comments

[roman]

It looks very reasonable to provide dialysis every other day. Dialysis weekends are really badly tolerated by some patients, mainly those with no residual renal function.

[Zach]

Sorry, but back to the issue of dialysate flow rates (Qd)-- I do think Qd matters, even perhaps in nocturnal (extended) hemodialysis.

So does the type of filter. Some dialyzers do not remove the "middle" molecule solutes at all. Some remove a little bit and some remove quite a lot. These dialyzers are commonly referred to as standard flux, high flux and super flux.

These two factors (Qd and dialyzer) need to be included in the discussion.