Anyone working for FMC annoyed by this?

Onekidneynurse · Jan 11, 2010

FMC does make a profit from every medicare pt, the last newsletter put out to all employees boasts about the profit margin & the increase that was made on each tx. Every medicare pt in our clinics has a secondary insurance to pick up the 20% not covered. Believe me when I tell you that before any new patients steps foot in the door they better have insurance or our area mgr will not allow us to accept them. I agree with the above posters about needing competion in the dialysis market, FMC has the entire market in my area.

It depends on where you are in the country. It surely costs more in NYC than it does in Asheville NC. Medicare reimburses $125. A cath patient costs more because they need dressing changes as opposed to fistula patients. Those on a 200 dialyzer cost more. It's a bundled payment. And there is no increase for longer times etc.

Here's a good article to explain it. http://jasn.asnjournals.org/cgi/reprint/16/5/1164.pdf.

Onekidneynurse · Jan 11, 2010

I bought a digital television set at Sam's Club for $199.00. Socialized medicine is awful, read the British newspapers online. I would not send my dog to the British National Health Service. Not a fan of the government or insurance companies, cannot stand either one of them. If a dialysis consumer is trained correctly, they will not put in the wrong treatment numbers, it is so easy with the new technology, we are not a bunch of bumbling fools. In fact, more than a few individuals from my home program are engineers. Everyone must work for a profit, the laws of economics will not permit Nurses, physicians, construction workers, or anyone else to consistently lose money and to stay in business. If we look at the American manufacturing sector, despite what you might have heard, is doing quite well. The average American factory worker is producing $234,000 dollars worth of value or goods and services, which is twice the level as in 1990 and three times the level of production of 1980. In other words, they are able to generate more wealth with less workers.
Monitoring dialysis consumers at night, has more to do with legal liability issues than the ability of patients to self monitor their Nocturnal treatments. In fact, Nocturnal patients can be monitored over the Internet, as has been done for years and they can be monitored with web cams, if the patient would so desire.
Laser correction surgery for the eyes has greatly decreased in price, why, very simple, competition. Why do you think that it is when you go to the grocery store that prices have stayed within a reasonable range, competition. I can mention so many consumer products that have decreased in price. The Government decided to stick its nose into the digital television situation, in other words, an unfunded mandate, they do it, morning, noon, and night. So, how has that $13 trillion in social spending been working out in the long term? It is absolute arrogance for a government official to claim that he or she knows more about your health care needs than you do. How can they know about your health care needs when they do not even know you? How does a government official know more about Nursing than you do, they do not. How does Obama, Pelosi, Reid possess the knowledge to make millions upon millions of health care decisions, each and every day??? I worked for President Reagan in 1980 and 1984, I am not a socialist, many of my friends would laugh if they heard you say that to me.
Competition cuts costs, as it has in every sector of the American economy. Profit pushes people to innovate to make our lives much better than they were in the past. Are we still a farm economy as we were in the late 1790's, of course not. In 1790, 90 percent of our labor force was in the farming community. By 1900, only 41 percent of our labor force was in the farming industry and today, only 3 percent of the American labor force is engage in farming as a full-time position. Now, you ask, as that reduction the work force hurt the output of the American farmer? Right now, if necessary, the American farmer could easily feed the entire world. This is how productive and innovative the American farmer has become with the use of advanced farming technology. Now, let us say that I want to build a 5 bedroom house, do you think that the construction workers will build my house for me, because they like me or because they want to make some money? I know they do not give a hoot about me, they want to make some money.
You and I agree that it is worth $100.00 for me to cut your lawn. Yet, the government says, "Mark, you do not have to perform a service for your fellow human being or to serve your fellow human being. "I, the Government will take what your neighbor produces and give it to you, so you can sit on your fanny and watch Oprah in the afternoon." In order to save jobs, would you suggest that we eliminate the use of robots in the factories? Capitalism is the most compassionate economic system on the planet, because it requires you to serve your fellow man or woman. When you are paying an outstanding salary to the physician or nurse, this enables them to perform a higher service or calling, such as taking care of a sick patient in the hospital, or in a dialysis unit, wealth equals compassion. When we create wealth, we give compassion to the sick and the poor, I think that is a great concept. If we cut the physician's salary by 50 percent, this still would not reduce health care costs. The vast majority of the physicians and nursing people that I have encountered, care deeply about the people that come to their office. The main reason that health care costs are out of control is government regulation and mandates. I know that physicians and nurses really hate the business side of medicine. Quite honestly, I do not believe that physicians and nurses are compensated for what they do. I would much rather pay the physician and nurse, than pay for a stupid government regulation. I get tired of the health care industry being sued for every small matter, it is silly. Obama claims to care about the cost of health care, when is he going to rein in the trial lawyers? The answer is never, they contribute millions to his campaign. He wants to talk about special interests............. Talk about favoring the rich???

Again you are preaching to the choir about UHC.

As for monitor nocturnal HD what happens when the patient has a nightmare and doesn't realize he's pulled out his needle? What happens if they have a power failure during the night. I have seem machines turn off without any reason.

Are we both talking about HD or are you talking PD with a cycler?

I agree with laser surgery. It happens to be very comsumer driven but it's an elective procedure. People can live without vision changing surgery by and large. Dental care has not gone down. Why because it's something people need. A tooth ache is a bad thing.

Tort reform would do little to diminish/slow costs. Would you be ok with a surgeon who nicked your bowel during surgery and you got flaming pertonitis? What if they cut off the wrong leg?

Just one further question? What American manufacturing? In 1958 28% of Americans were in manufacturing with 14.6 million people. In 2008 8% were in manufacturing with 12.6 million.

Onekidneynurse · Jan 11, 2010

Whew! I'm an APN who is employed by the nephroloy practice (big one) to do HD visits. I am one of 4 mid-levels that does this.
FMC does indeed make a profit - but agree that it is via machines and equipment. All I ever hear about is the cost per treatment must be less. If I want a stat lab, I must order it on a script so that it is charged to the pt, if I want a bigger dialyzer, I must have all the numbers to back it up, if I want a pt to have a specialty referral, I must make the appt because the FMC employees are only there for dialysis-related issues.
Home hemo I think is better too. In my area, MC does have a small home hemo population but Renal Therapies and Davita do too so there is competition.

Fresenius got rid of Sureseal bandaids because they cost a $1 apiece. I worked with them last year on the way they were aciding the machines. Plugging them back into the wall instead of using the cheap 3 Brothers vinegar. A machine tech figured using vinegar would save 0.17 cents per treatment. It wasn't policy at first but as soon as the AM heard 0.17 cents per treatment it became policy and it's done that way most every where close to me.

Where Fresenius makes money is on EPO at the 20,000 unit strength. Why do you suppose we call it sucking EPO. LOL I heard just recently that we will probably NOT give Zemplar any more. Patients will go back to oral Vitamin D. Medicare doesn't pay enough for IV Zemplar to warrant it's use.

Here's another nice explaination http://www.usatoday.com/news/health/2009-08-23-dialysis_N.htm

Note near the end of the article that there is talk of closing units. Fresenius wouldn't close units if they are making money.

Also read about how other countries handle HD it's interesting. Expecially where many won't put people on it if they are too old.

Americans won't do home hemo like other countries we are too used to being waited on. Sorry to say. Americans really need to step up or step down and get with the program of helping themselves.

Trauma Columnist · Jan 11, 2010

I think with the aging of our population and the number of co-morbidities we have, that we will eventually see folks that we don't put on HD.

Onekidneynurse · Jan 12, 2010

I think with the aging of our population and the number of co-morbidities we have, that we will eventually see folks that we don't put on HD.

I'm hoping patients and families will refuse HD. I've seen too many old ladies cry that they don't want to be there but their families want them to be there. It's sad. I've seen people come from the nursing homes at 0530 in the morning when it's -10 degrees outside. Now that is torture. When I retire I'm not getting up before 10AM. Any one calls me before that will get an earful. LOL

I rembember an 88 year old lady who stopped HD. Her family wasn't happy with her. I went to see her in the hospital. I know I know but she was one of my favs. Her and I compared our knitting projects. LOL She was so happy in the hospital. Said to me, " I had OJ yesterday, it was sooooooooooooooo good and they let me put salt on my food!!!" She died happy.

We really need some education on dying in this country. We are so afraid of it. I'm not afraid of death. I'm afraid of a painful dying process and that's what I see so many times. I think it's sad.

309216505 · Jan 13, 2010

I am very annoyed by that. I work for FMC currently. I'm also upset with the practice of bringing in nurses from abroad who don't have the necessary experience to do hemodialysis and are being used to undercut our pay and hours. Not to mention that they are stealing nurse away from third world countries who NEED nurses even more than we do here in the U.S.

LET'S GET A UNION HERE!!!!!!

Valerie Salva, BSN, RN · Jan 26, 2010

If anyone needs a union, it's FMC nurses.

I worked at an FMC unit where we were required to give protein drinks to pts whose albumins were =/> than 3.4, but less than 3.9. We were not permitted to give the drinks to pts whose albumins were lower than 3.4.

And here is the reason told to me by an FMC mgr:

"If we give the drink to pts whose numbers are at least 3.4, we can bring them up enough in time for their next labs so that our numbers look good. Pts whose albumins are less than 3.4 won't come up in time or enough to make us look good on the next lab results, so they don't get any of the drink."

In other words- "if you are a pt whose albumin is low, screw ya. You can't make FMC look good, so we won't bother with you. If your albumin is borderline, we'll help you out because it will make us look better."

talaxandra · Mar 30, 2011

Socialized medicine is awful, read the British newspapers online. I would not send my dog to the British National Health Service. Not a fan of the government or insurance companies, cannot stand either one of them.

Interesting - the NHHD site you reference is Australian; not only do we have universal health care, the team who set up the trial work in a publically-funded hospital, the pilot was state-funded, and physicians who utilise it increase their Federally-funded incentives. It was based on Canadian literature - another country with universal health care.

I think patient-directed care is brilliant. There's no question that NHHD provides superior patient outcomes is appropriate patients - our NHHD ptients have excellent blood work and a great quality of life.

NDXUFan · Feb 6, 2012

To One Kidney Nurse: I am trained as an Economist in the Milton Friedman School of Economics-Think University of Chicago. I am a free market capitalist, I worked for Ronald Reagan in 1980 and 1984. Mistakes in Dialysis can happen if there is one person there or a thousand people on the site. I never expressed the ridiculous idea that anyone should work for free, nothing on this earth is ever free, ever. I posted the You Tube view of Dr. Jerome Kassirer, who was the Head Editor of the New England Journal of Medicine. Yes, I do read the British Medical Journal, the Lancet, on a regular basis, not some trash off the magazine rack. Yes, the government and taxpayer have a vested interest in keeping the dialysis patient working. Yet, this is almost impossible to do on 12 hours of dialysis or without being able to perform dialysis at night, because most employment is during daytime hours, however, there are exceptions. While you are correct, that healthcare costs will rise, when people do not comparison shop in health care, it is almost impossible to get a cost estimate before receiving health care, as we do have cost estimates in other sectors of the economy. What will bring our health care costs down is a free market medical system that has been freed from excessive and intrusive government regulation, meaning, the U.S. Government pays 45 percent of medical bills in the United States(Wall Street Journal). Modern liberalism has never worked in any part of the world, think Old Soviet Union, Eastern Europe, and socialist economics of Africa and Asia.

I did buy an HD television from Sam's Club for $199.00 and as technology becomes common, it comes down in price, think VCR's, radios, televisions, video cameras, and just about any other product.

Car insurance premiums do not explode like health care premiums because people each and every day compare the cost of premiums with auto insurance. In other words, do you call your auto insurance company for a flat tire, no, because it would not be cost effective. I realize that many in medicine think that people like me are stupid and ignorant. However, I have a college degree and have been to grad school with a 4.0 just like you.

By the way, I used to work for Toyota, so spare me the arrogance of talking down to me. If individuals in the Nursing profession, who I dearly love, would look at us like people and not a disease, I think things would run in a much more efficient fashion.

Yes, it would be nice to always have a partner, but, not everyone is so blessed on this earth. I dare you to walk in our shoes for a week.

Guttercat, ASN, RN · Feb 7, 2012

To One Kidney Nurse: I am trained as an Economist in the Milton Friedman School of Economics-Think University of Chicago. I am a free market capitalist, I worked for Ronald Reagan in 1980 and 1984. about any other product.
.

Friedman, Chicago, and Reagan (still waiting for that trickle) all give me pause.

:)

Marisette, BSN, RN · Feb 10, 2012

I'm not sure where FMC makes it's profit $$$ medicare, private insurance, sale of numerous products (venofer,phoslo,pharmacy servcies, dialysis equipment), but they are obviously profitable. I have not had a 3% raise in a couple years. Employees were informed that they would only get 2% because of the economy and poor medicare reimbursement. Could they possibly be making money from their employees back?

They don't share. They have money for producing anti-union letters and sending out anti union mail. They WILL NOT fire you for union activity, but they will find another reason, if they discover you are engaging in any planning or promotion of union activity. Just the whisper of the word union, will send many FMC employees, across the room to avoid involvement and potential job loss. I can't blame them because this is a tough job economy.

This is not an ethical company. Products are pushed or sold to patients because the company profits from it. Of course, they will tell you, it's done because they provide superior products and services.

NDXUFan · Feb 20, 2012

How true about DaVita.