Hubby has been letting me sleep and going to training on his own.
Daily dialysis is agreeing with him, his KT/v (measurement of how well the blood is being cleaned) has bumped up to 2.0
Going with in center care he never got beyond a 1.68 which is the
minimum required to sustain life.
Yes folks, Medicare would rather pay for three times a week in center hemodialysis,
just enough to keep a person alive.. then to change the reimbursement to pay for short daily.
Short daily increases a dialyzing person's life span, less hospitalizations, less medications needed and a HUGE improvement in quality of life. However, a recent study was published that showed the increased cost of short daily was not "cost effective". Why? because it costs more than typical three times a week dialysis.
As of now, many home training centers eat the cost of those two to three extra treatments a week. (If you're care is paid only by Medicare, they can charge private insurance for the extra runs.)
Anyway, I think of E being a pioneer in the home hemo world. As more studies are done (he's participating in one now), more machines get approved for use and people speak out to demand more choices.. the Medicare billing will change.
Home hemo will become the norm instead of the exception.
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Here's something to ponder-- mind you it will make your head hurt.. but it's very interesintg.. and kinda scary considering E's issues.
There are some odd medical ethics brewing out there.. QALY is something to be VERY VERY afraid of.. how valuable is a loved ones life in terms of cost to care for that person? And where do you draw the line and stop treament?
(FYI: Typical Limit is $100,000 QALY , dialysis patient QALY runs about $96,000.)
In the future, QALY could be used to decide:
You cost too much to keep alive.
http://en.wikipedia.org/wiki/QALY
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/07/cost-effectiven.html
http://www.huffingtonpost.com/kathleen-reardon/whatever-you-do-dont-get_b_99944.html