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August 23, 2010


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Miriam Lippel Blum


My nephrologist said that he does "face to face" visits with his rural patients via Skype video conferencing. He insists this is acceptable to Medicare. If this is true then why couldn't it apply to all HHD dialyzors? Or is he mistaken?

I wouldn't have a problem with doing a quick appointment with him via Skype instead of shlepping into his office. Do you think the new bundle working regarding doctor visits would preclude this?


Rich Berkowitz

Miriam, the proposed rule stipulates in person face-to-face.

Bill Peckham

Part of the proposed rule that I didn't comment on expands telemedicine to predialysis CKD patients. I think if the rule is finalized as is, docs will be able to provide the 6 CKD4 consults provided for under MIPPA via telehealth.

I didn't suggest any solutions in my comment because I don't really understand the doc reimbursement process in full. I'm not sure I would want telehealth to replace the face to face visit but I do think it can be used to good effect.

Via email it was pointed out that I may have been too quick to accept even the monthly requirement as medical best practice. There have been times over my nine year home career (as of 9/25) when I didn't need to and didn't see my doc for months - while traveling certainly.

I do think with frequent (particularly nocturnal) dialysis a person can reach the point where monthly visits are a waste of time. Leaving the policy as is would be most prudent.

I think current policy would allow skype in the sense it does not now require a face to face for home dialyzors. Thus payment is the same whether you skype or not so in effect the doctor is free to use skype in place of face to face by her judgement, for example for rural patients. That sounds like good care to me and CMS should be willing to reimburse for that.

David L. Rosenbloom

Amen, Bill. I couldn't have said it better. The prime idea behind home dialysis, not unlike a transplant, is to regain control over one's life and live it fully, making accommodations for health, but not letting CKD define one's life entirely. Too often kidney professionals view dialyzors as invalids, who no longer work but live soley from treatment to treatment.

Even today, two years after a successful transplant, I rarely see my nephrologist, who has become my primary physician, more than once every 6-8 weeks. There is no need. I get my blood drawn on the same schedule, review my labs with him, and we make adjustment on meds as needed. No big deal. If something comes up that I feel needs his attention, I email him and hear back from him or his nurse within 48 hours. He is intelligent, diligent and caring, and I trust him. He deserves to be paid no matter how I communicate with him. He is on the job full time.

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