Dialysis from the sharp end of the needle

GAO reports CMS plans to end medical exception payments under expanded bundle

By Bill Peckham

RenalWEB links to a 32 page GAO report (pdf link) that looks at the impact of expanding the Medicare payment bundle (due to happen in 2011) on the provision of home dialysis. The GAO paid particular interest to the costs of providing more frequent home hemodialysis. The headline is that CMS Should Monitor Effect of Bundled Payment on Home Dialysis Utilization Rates.

That's a good idea but the real news is on page 16 and 17 of the report (pages 20 and 21 of the pdf):

Indeed, under the current partially bundled payment system, we found that some home dialysis providers now have been granted medical necessity exceptions to receive Medicare reimbursements for additional dialysis treatments beyond three per week. CMS officials told us that they are unlikely to allow these additional reimbursements under the expanded bundled payment system.

That is bad news for the future of frequent home hemodialysis.

Dialysis & CKD Blog Report 5/22

By Miriam Lippel Blum

Here are the CKD related blogs updated since my update on 5/19.   If you have or know of a blog that should be on the list let Bill know. Comments in parentheses are my reactions or opinions.  Have a nice Memorial Day Weekend, Evaryone!

• Dialysis from the sharp end of the needle has a blog report.
• Kaply, Inc. Tracy gets her iron replacement IV and it makes her ill; she has a bad migraine and is in a bad mood.
•  Toastiest His car, a Prius, dies and he needs another (I never knew the plural of Prius was Prii.); and there is no more free Crystal Light at work due to the recession. (That's better than getting downsized.)
• Birdman describes his evaluation for another transplant, is told he's a good candidate pending the outcome of a cardiac catheterizaton  (We hope all goes well.)
• Hasten down the wire opines on the credit card industry. (I got a "charge" out of this post.)
• The Life of a 20-Something With Lupus enjoys a beautiful day and sees the eye doctor.
• PKD Notes describes how cysts grow in polycystic kidneys and some of the clinical trials out there now that aim to stop them.
• CHRONIC POSITIVITY - Life with Polycystic Kidney Disease updates about his sister's condition 3 weeks post-transplant. She's having a rough time with nausea, walking, and breathing.
• Life on dialysis ... and now life after my transplant! gets a kudo letter from a member of Parliament, has more plans for her organ donation awareness campaign; catches a cold from a really cute baby.
•  On the Road to a Cure has a link to a short survey on lupus to generate discussion for a program on issues that impact people with lupus around the world; It's still Lupus Awareness Month send e-cards to inform people about lupus.
• Really, I'm as Old as I Feel? Rob's sister moves in, and coordinating everyone's dietary issues is a challenge.
• I Am. Are you? writes about current misconceptions and confusion about organ donation and registration.
• Dialysis Postings talks about hypertension and kidney disease.
• Bud's Ramblings He would like to have a house on a scenic mountain, pulmonary doc did a CAT scan and may prescribe a vibrating vest to help break up congestion in his lungs.
• Precious Bodily Fluids gave two talks on the problem of chronic kidney disease on the elderly, specifically whether CKD was over diagnosed (yes it is) in this population and can it be safely ignored (no it can't), provides a link.
• Renal Fellow Network describes milk-alkali syndrome in which hypercalcemia, metabolic alkalosis, and acute renal failure can occur simultaneously.
• Uremic Frost reports that drinking large amounts of cola-based drinks may result in severe hypokalaemia; Natalie Cole gets her kidney (I hope she helps bring more attention to CKD and transplantation.); a study showing that treatment with dipyridamole plus aspirin reduces  the risk of stenosis and improves the duration of primary unassisted patency of newly created AV grafts.
• My Wife Has Lupus - Support for individuals whose family or friends have lupus reminds us that May is Lupus Awareness Month and has suggestions to spread awareness of it. 
•  As The Pump Turns  is starting a political blog.
• Living with PKD posts the 30 Rock video.
• I need a kidney Jason Hamlin is a new blogger who is searching for a kidney. He chronicles his CKD and dialysis story, as well as talking anout 30 Rock. (Welcome to the renal blogosphere, Jason.)
  
• DailyHemo - Home Dialysis Advocates has two videos on fistula maintenance, a free online book on vascular access, a video on healthcare decision making, and a video of techs playing dialysis supplies Jenga. (Or,what to do with all your boxes when you're really bored.)
  
• Encompass Network Partners A study showing promising treatment for peripheral arterial disease;  and an overview of the disease.
• Kidney Community Emergency Response has information on Hurricane Preparedness Week, May 24 - 30.  Hurricane season begins June 1. Be Prepared!
• The Renal Unit has current renal twitters, news, and blogs.

Dialysis & CKD Blog Report 5/19

By Miriam Lippel Blum

Here are the CKD related blogs updated since my update on 5/16.   If you have or know of a blog that should be on the list let Bill know. Comments in parentheses are my reactions or opinions.

• Dialysis from the sharp end of the needle has a blog report.
• Kamal Shah's Blog He continues his story about the "charmed glass of water" cure for renal failure wherein he describes a frightening episode of fluid overload and conflicts with his family; eventually he gets demoralized and disgusted with the "treatment" and gives up on it; in the epilogue he reflects on his experience, expresses frustration with those who offer untested therapies, and wonders why alternative therapies are not regulated more.
• Kaply, Inc. Talks about sundry matters and wishes her Mom a happy birthday; has two bad days but expects her robots and nothing will ruin the day of the robots. (I have no idea what robots she is talking about, but hey, have a blast, Tracy!)
• The Life of a 20-Something With Lupus Her Dad wins an award for his volunteer work with sickle cell anemia fundraising, and she worries about whether she will pass on her illness to her child.
• Becky Perry Interviews her friend Marisa Gary who just wrote a book entitled Remnants: Devotions for When We're Broken; Becky adds another PD exchange during the day and she is feeling much better now.
• The Adventures of Stacy Without An E Stacy briefly chronicles his last five years on dialysis and, as he starts year six,is very despondent.
• Life on dialysis ... and now life after my transplant! Holly has a lovely weekend, receives a beautiful gift, and attends a fundraising 10K run in Manchester.
• On the Road to a Cure reports that investigators at UCLA believe they have discovered an antibody in the blood, MAGE-B2, which may be associated with lupus kidney disease in children.  This may have implications for treatment eventually.
• I Am. Are you? Reports on the Texas hospital that is "twittering" a kidney transplant surgery.
• Transplant Alliance announces a seminar in NY on Hepatitis C and the liver.
• Chronic Chick Talk has a Janet Jackson video posted.
• Bud's Ramblings had a needle infiltration at dialysis and his arm is swollen (Ouch!  Ice should help it.) so he couldn't go to a homeowners meeting, and shares a yummy summer drink recipe called "Lime Freeze."
• Renal Fellow Network notes that you can purchase the full 30 Rock music video for the song "We Need A Kidney" at the I-Tunes web site for only 99-cents, the proceeds of which are being donated to the NKF; next is a report on a genome-wide association study for CKD; and last, a post about the history of bicarbonate in dialysate.
  
• Renal tsar's blog notes the publication of the Specialised Renal Services (Adults) Definition for the UK.
• Free range fish sticks Sheila is still in the hospital and had a nuclear medical imaging test + spinal tap to determine the source of unrelenting headaches.
• pkdmom2five has an H.Pylori infection and has to do some major and unpleasant antibiotics, yet she counts her blessings.
• Mid-life ramblings had a good Sunday, will be learning to put in her own needles tomorrow. (Good for you! You can do it!); managed to do her own needles and didn't even get queasy (Congratulations! That's terrific!)
• My Chronic Kidney Disease shares some information he's learned during his search for a cure for his CKD.
• DailyHemo - Home Dialysis Advocates has videos on hemodialysis, PD, In-center nocturnal and home  dialysis in Portugal, Reverse Osmosis, Dialysis & PKD, Difficult Patients, and the transcript from the Twittered kidney transplant.
• I need a kidney new blog for the blog report - catches 30 Rock
• Encompass Network Partners has information and statistics regarding peripheral arterial disease (PAD); and clinical approaches to PAD.
• Renal BizBlog has a link to the Twitter transcript from Monday's kidney transplant.
• The Renal Unit Latest renal twitters, news, and blogs.