"Bundling" and the renal community in the US - page 2

by madwife2002 4,286 Views | 15 Comments Senior Moderator

In the renal community life has changed drastically since the 1st January 2011 a new and dreaded word became the norm, the word which strikes fear into the hearts of our community is "Bundling". So what does Bundling mean to... Read More


  1. 1
    Thanks Madwife for this great article.I did Peds Chronic HD, Acute and Chronic HD in the 90s with on call..i enjoyed my experience at that time. I came back recently to do PD/ HD and during my orientation...left pretty much alone with a PD TECH to train a lot of 85 something HD patients to do home PD.....the docs on the unit get $$$$$$$$ if they can recruit one of the chronics to do home PD or home hemodialysis.....i was so sick everyday till i finished my 90 day probation because i was jumping from doing chronic hemodialysis with only two weeks classroom training to shadow the techs ...at the same time help with training of the newly recruited 80 something chronics with co morbidities including dementia and no fixed care giver to do home pd or home dialysis so docs make more $$$$$$$$$$$$$$ after PD training.....Left the company faster than the speed of light and so glad i did to protect my license...
    madwife2002 likes this.
  2. 1
    Something about penny wise and pound foolish comes to mind with medicare's efforts to control costs in the dialysis community. I forsee a competition for the "good" patients you can make a profit on and the abandonment of those you can't. The situation in Ohio with clinics losing money on medicare patients and depending on private insurance patients to bridge the gap is unsustainable. Especially if the insurance companies start applying the same criteria for reimbursement that the government uses. And none of this is centered on what's best for the person at the "sharp end of the needle". The only positive thing in that post was the link to Bill Peckham's blog. Thanks.
    madwife2002 likes this.
  3. 1
    My only thought on "abandonment" of non-compliant patients is this. If they are not willing to be active participants in their care and health, why should the system be forced to take a loss on them? We're not talking about people who are not competent to make their own decisions.
    elkpark likes this.
  4. 2
    When the needs of the system take front seat over the needs of the patient we have arrived at a hellish situation. Non compliance in dialysis patients is evident because being a renal patient places so much demands on your life and you are monitored so closely. If the financial health of the system is to be the highest priority then what is to stop medicare from denying treatment for diabetics whose HgbA1C is high? Denying treatment for cardiac patients whose cholesterol is too high? At this point we still allow patients the freedom to decide what they want even if it is not in their best interests. Unless they are dialysis patients.
    Marisette and madwife2002 like this.
  5. 1
    I have questions about the justification of bundling simply because I don't understand who is determining
    what the quality outcomes should be and how they come to the conclusion that these numbers are benefiting
    patients. Should a patient on dialysis with metastic cancer who does not want to dialize 4-5 hrs still be obligated
    to complete the hours dialized so the dialysis company can be reimbursed? Who sets the anemia management goal, the medication providers or the md based on the needs of the patient? Is it fair that the dialysis company not get reimbursed if a patient gets a HGB level less than 0.1 below or above the CMS goal? Do dialysis patients obtain a good adequacy or kt/v everyday or just on the day tested so that the company can get the CMS number and reimbursement. We just test and test until patients meet the goal for reimbursement. Is this good for the patient, the dialysis company or goverment regulators. I don't believe it's about the patient. It's business and reimbursement that impacts care delivered to patients.
    madwife2002 likes this.
  6. 0
    Marisette you have raised some very valid and relevent points, the answer is simple!
    Only the nurses and techs care-upper management dont care one bit it is all about the $'s
    It comes to something when you report a death, and somebody higher up says
    'I hope they didn't have a fistula'
    I am speechless!


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