Dialysis from the sharp end of the needle

Dialysis & CKD Blog Report 6/6

By Miriam Lippel Blum

 Here are the CKD related blogs updated since my update on 6/3.   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 Bill reports on the possible expanded role in MedPAC in Medicare cost containment; a blog report.
• Kamal Shah's Blog Kamal is suffering from chronic and severe hemorrhoid pain and wonders if he can take a day off from work; sees a different doctor and finds out his pain is actually from prostatitis and is now on antibiotics for that, makes a strong case for allopathic medicine. (I'm so glad you finally found out what was really wrong and hope that improvement will come soon.)
• Kaply, Inc. Tracy has excruciating shoulder pain; had a dislocated shoulder that is now back in; tells what things one should not do while doped up on pain meds; and she really wants to buy a Kindle.
• poetry on dialysis continued Three new beautiful and moving poems generated from a frustrating and limited life on dialysis. (Your poetry makes me sigh. You capture so well complex emotional realities in your words.)
• Toastiest recalls a doctor and a classmate whose obituaries he happens to see, writes out his Match.com profile.
• Birdman is getting all his tests done to ready for a transplant.
• Hasten down the wire presents Michael Moore's ideas regarding GM Corp; discusses the news business' desire for paywalls around corporate news content.
• Becky Perry wants others to participate in creating lists of things that make one happy.
• Jack's Kidney Adventure Jack's nurse brings distress when she queries him about a skewed lab result that reflects a particular medication level, it all turns out okay but he wonders if he's getting paranoid.
• Life on dialysis ... and now life after my transplant! Holly wrote a letter to her donor family who were moved by it, she struggles with medication changes, and plans to distribute organ donation pamphlets in movie theaters when "My Sister's Keeper" opens.
• On the Road to a Cure a Men and Lupus Webchat will be Wed. 6/10, 3 pm Eastern Time; the Lupus Foundation held a meeting of global lupus experts to address medication needs.
• I Am. Are you? applauds that Conan O'Brian is a registered organ donor.
• Transplant Alliance has a post about Australian researchers using stem cells on contact lenses to treat blindness caused by damaged corneal tissue.
• Life on Dialysis finds meeting with old school friends meaningful.
• Dialysis Postings has a new look for the blog.
• Bud's Ramblings Bud waters his garden from his power chair and has a good hamburger at Krystal's; he dislikes getting up early to go to dialysis but is glad to get it over with so he can live the rest of his day.
• Disability Prejudice And Civil Rights Watch reports that the first H1N1 death in Virginia was in a State Training Center and wants to know what is being done to prevent more deaths of people who have been institutionalized. (Probably not much.)
• Precious Bodily Fluids has a link to an online endocrine textbook.
• Renal Fellow Network shares a video illustrating the principle of branching morphogenesis; a study looks at  the nature versus nurture" question of deceased donor kidney transplants, what is the importance of donor characteristics ("nature") versus transplant center characteristics ("nurture") on deceased-donor kidney transplant outcomes; gives an explanation of the chemistry behind the acidosis caused by excessive Tylenol ingestion.
• Uremic Frost reports on a study showing that early angiography in cardiac patients with CKD reduces the risk for re hospitalization and is associated with reduced risk for death and nonfatal re-infarction.
• Neophron's Senescence spent an exciting day at Safari West, has photos; he needs a break after dealing with a very difficult situation involving end of life comforts being thwarted by an unrealistic family member.
• pkdmom2five got some freebies from her frequent buyer card at CVS pharmacy.
• Lemonade and Kidneys Ruth has a terrible shoulder spasm; rants about gender disparity in medical care, and is conducting  her first blog giveaway - send her a message by June 8 and maybe you can win a terrific marble maze.
• Mushroom's Blog He wakes to sun beams on his face and is grateful for the gift. (Sometimes simple things are the greatest blessings.)
• I need a kidney has a nice new layout for his blog.
• Kidney Community Emergency Response free registration (thru 6/7) for a First Aid/CPR/A online course from the National Safety Council; a report on 10 early lessons learned  from the H1N1 outbreak and 10 core issues that need to be addressed.
• Renal BizBlog updates on California's possible cutting of dialysis benefits for Medi-Cal eligible people.
• Writings along the cave walls - Ashbat's Lair went to the movies, opening scene of Star Trek made her cry.
• The Renal Unit Latest renal tweets, news, and blogs.

Expanded role for MedPAC seen in Medicare cost containment

By Bill Peckham

Ezra Klein reports that MedPAC (or a MedPAC like entity) is set to take a featured role in containing Medicare costs. There are two ways that MedPAC could be used. One being pushed by Senator Rockerfeller and outlined in Tom Daschel's book Critical gives MedPAC authority to set Medicare payment rates, a sort of Federal Health Board modeled after the Federal Reserve Board.

I wrote about this back in January, when I pointed out my question was:

What point of view are you taking? At the MedPAC meeting there was no discussion of the negative SDO Medicare margin as something that needs to be addressed. The bias is to reward financial efficiencies which then promotes consolidation. Is consolidation an objective? Or is it a cost? Should we design the system for the people buying the needles or for the people on the sharp end of the needle?

My concern holds for the provision of dialysis as well as the whole Medicare system. The current MedPAC framework leads it to reward the economic efficiencies that only the large corporate entities can provide.

Ezra reports that the second way MedPAC could play a role in in Medicare cost containment is to:

package MedPAC's yearly recommendation and fast track them through Congress for a simple, up-or-down vote. No filibuster. No changes to the package of recommendations. Health reform, under this scenario, would become a yearly legislative project.

This sounds like a an interesting idea. Trying to get a change to the provision of dialysis is a decade long project right now; this would make change a yearly feature of the program. A little scary but it could work.

I would still worry about the criteria MedPAC would use to evaluate reimbursement but there is a way to make this a truly effective cost saving structure without promoting more and more healthcare  consolidation: allow Medicare, through MedPAC, to negotiate prescription drug reimbursement and make those prices part of the yearly up or down vote.

Instead of rewarding the perscription drug purchasing power of large healthcare providers, MedPAC should be tasked with using Medicare's undilluted drug purchasing power to set reimbursement rates based on fairly negotiated drug prices.

Dialysis & CKD Blog Report 6/3

By Miriam Lippel Blum

I learn a great deal from reading all these blogs.  Sometimes what I read makes me furious. I learned from Renal BizBlog  this week that California Gov. Arnold Schwarzenegger, as part of his budget balancing measures, has called for the discontinuation of dialysis for CKD5 dialyzors who have Medi-Cal only (this constitutes 10% of the dialysis population in CA).  He calls it an "optional benefit."  I am outraged!  Is this not cruel and unusual punishment for those who have  committed no crime?  Is this not murder?  What do you think?  Here are the CKD related blogs updated since my update on 5/31.   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. 
• Kaply, Inc. Tracy spends time in the ER with a sore arm; and tells someone on the second floor to leave her alone (in no uncertain terms).
• Drinking my way through Trader Joe's Wine Anna reminisces fondly about and reviews her first wine - Boone's Farm Tickle Pink. (Mine was Manischewitz Concord Grape!)
•  Toastiest struggles with whether to take off from work when he feels lousy from PKD and isn't ready to start dialysis yet even though he thinks he needs it.
• Hasten down the wire writes about a typography program for the Web.
•  Nitey Nite- a nocturnal dialysis blog links to a humorous and satirical diary in the I Hate Dialysis forum.
• On the Road to a Cure The Lupus Foundation recognizes Men's Health Month (June), because men get lupus, too; and Walk for Lupus Now events in California and Florida on June 6.
• I Am. Are you? announces 2 weeks left to win Kenny Chesney tickets from Donate Life, Illinois; he also discusses Natalie Cole's transplant and dismisses the myth that the rich and famous get priority in transplants.
• Transplant Alliance is exhausted by a visitor.
• Life on Dialysis treks with a friend up Karnala; and takes a a small camping trip to Savna Lake; now is struggling with health issues and feels lonely and despondent, yet he hopes.
• Chronic Chick Talk finds organic gardening therapeutic and the results delicious.
• Bud's Ramblings watched badly dressed kids at the mall, drank too much fluid, and his arm is still purple from a needle infiltration. (Ouch!)
• Precious Bodily Fluids Joel likes his iPod pedometer but recently has noticed some imprecision in its calculation;  a report on a British libel suit that may quash scientific discourse; and links to an important article in The New Yorker about what drives the high cost of US medicine; reports on  another negative trial of renal artery revascularization - stents fail again.
• Renal Fellow Network relays important facts about catheter-related bacterimia and implications for treatment; discusses dialysis in the elderly (over 75) with and without ischemic heart disease.
• Uremic Frost reports on a study that shows that aspirin use is okay in hypertensive CKD patients; a German study shows an increased risk of Sudden Cardiac Death among diabetic dialysis patients with the highest HbA1c levels;  and a new audio download on Acute Kidney Injury is available from NephSAP, link is provided.
  
• Kidney Notes - Exploring the Intersection of Medicine and Technology has a photo entitled "Manhattanhenge 2009"
• Lemonade and Kidneys is dreaming about baking, literally; and provides snapshots from life events that she has not blogged about.
• Chronicals of the PD Warrior writes about the murder of the Wichita doctor who performed abortions.
• DailyHemo - Home Dialysis Advocates New Videos: Two about TeleMedicine in use; an Italian educational video about AV fistulas; Demonstration of RMW removal; Sophia's Dialysis at Hopkin's Children (This brought tears to my eyes); French organization ATEM creates dialysis clinics around the world; Growing AV fistula tissue in the laboratory (This one fascinated me!); A Second Lease on Life at Jahangir Hospital; Andy Williamson, Kidney Dialysis Patient Climbs Skyscrapers (And he plays the tenor sax at the same time, really!); Brazilian Campaign in the Prevention of Kidney Disease.
• Biologically Safe Water Filters has a post on burn unit/wound care water filtration.
• Encompass Network Partners Foot screenings are imperative in diabetic hemodialysis patients to prevent amputations.
• Renal BizBlog California proposes budget cuts that will end dialysis for Medicaid patients in the state, as it's considered an "optional benefit." (This does not bode well for the rest of the country.)
• A Kidney for my Daughter reports on a wearable dialysis machine called AWAK that is being tested (It's a peritoneal dialysis based system.)
• The Renal Unit Current renal tweets, news, and blogs.

Dialysis & CKD Blog Report 5/31

By Miriam Lippel Blum

 Here are the CKD related blogs updated since my update on 5/28.   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 Kamal discusses the question of whether to tell people about his CKD or not. (I've struggled with that, too.); protests delays in the trial of the terrorist that shot up Mumbai.
• Kaply, Inc. Tracy had an ultrasound of her fistula and a problem was seen that required surgery the next day; it went well but she is still impacted by the drugs. (I had a fistula repair done this week, too. My arm looks like it was in a bar fight!)
• Drinking my way through Trader Joe's Wine reviews a red wine she dubs a "Wednesday night" wine, as opposed to a Sunday wine, but since she considers herself a Wednesday night person that is acceptable.
• Toastiest is feeling lousy because of CKD symptoms; posts recipe for his famous Lemon-Ginger Punch (I hope this takes the edge off the day.); may become a Nielsen TV rater and change the content of the commercials, no more Wilford Brimley, for example.
  
• Nitey Nite- a nocturnal dialysis blog Michelle grouses about appointments with social workers, dietitians, and doctors that really accomplish nothing but generate bills. (I'm with ya', Babe.)
• Becky Perry is planning her own homeschooling curriculum for her boys; posts a photo of her handsome boys all dressed up for a graduation ceremony; and starts a list of summer activities to accomplish.
• Life on dialysis ... and now life after my transplant! Holly is recognized while in the supermarket, makes some cool new posters, and while she is encouraged by new data on transplants still sees much more work that must be done.
• PKD & Dialysis ... Where I Tell It Like It Is doctor recommends orthopedic stockings for swollen feet.
• I Am. Are you? recommends an Examiner columnist that writes about notable donor families and volunteers.
• Transplant Alliance Mia awaits x-ray results.
• Life on Dialysis has a low BP blackout at work; wants to make a difference in the lives of people he meets and know who his real friends are.
• Chronic Chick Talk has a mother-daughter chat about leg hair removal.
• Dialyse This clotted on the new machines but is cheered up by Stargate Atlantis.
• Bud's Ramblings bought some antibacterial hand soap that he doesn't like and some Biotene toothpaste that he hasn't tried yet; posts photos of the flowers in his front yard. (Lovely!)
• Precious Bodily Fluids has a spoof ad about the Palm Pre; and presents information from chapter one of The Sugar Fix which implicates fructose as a cause of obesity.
• Renal Fellow Network writes about how to differentiate familial hypocalciuric hypercalcemia versus primary hyperparathroidism.
• Uremic Frost has a video report about a study linking kidney stones and heart disease. 
• Free range fish sticks has a quick but emotionally nurturing trip to family in Florida, at home Sheila's doctors try to figure out her dry weight.
• Chronicals of the PD Warrior links to a humorous cartoon site.
• The Ballad of Billy The Kidney is going to chronicle his participation in a kidney fund-raising event and provides a link  for sponsorship.
• DailyHemo - Home Dialysis Advocates New videos: PD with the Baxter HomeChoice; Excuse the Dialysis Machine?; Baby Julian During Dialysis; She Describes How She Does Home Dialysis.
• Kidney Diet Tips has an article on controlling high potassium in CKD.
• The Renal Unit Renal tweets, news, and blogs.