the effect of dialysis chains on mortality among patients receiving hemodialysis
yi zhang, dennis j. cotter, and mae thamer . health research and educational trust
...although patients in chain 5 were slightly younger than patients from other facilities, they also had clinical factors that have been shown to be associated with decreased survival, such as lower serum albumin, higher serum creatinine, lower predialysis hct, and the highest charlson index scores. compared with patients in chain 2 who had the highest risk of mortality, patients in chain 5 also had similar preexisting comorbid conditions.
patients from chain 2 had the highest risk of mortality and the difference in the mortality risks between chain 2 and chain 5 (which had the lowest mortality) was found to be 24 percent.
some contend that lower resource use in the delivery of dialysis by fp facilities compromises the health outcomes of dialysis patients. fp facilities use less labor and equipment per treatment, for instance, suggesting a lower average cost per dialysis session (grifﬁths et al. 1994). poor outcomes might also be attributable to lower levels of stafﬁng in fp facilities (held et al. 1990), which notably affects esrd patients who rely on their dialysis center as their primary health care provider (holley and nespor 1993; bender and holley 1996).
given the organizational status of a facility was found to be strongly associated with the use of injectables and use of higher drug doses did not improve patient survival, the current study might have important implications
regarding the wisdom of bundling separately billable items (primarily injectable medications) with other composite rate services into the new dialysis prospective payment system to be implemented in january 2011. our ﬁndings--that lower doses of injectable drugs do not appear to compromise quality of care--supports medicare's implementation of a bundled payment system for injectable drugs.
i've read the article twice now and the only discussion i can come up with is: yikes! 24% !
Dec 10, '10
Thank you for sharing this article. It doesn't surprise me in the least. I worked for one of "those" for-profit clinics, and it was always being hammered into us that we should be doing more with less. In fact, my clinic manager told me that there was an large monitary incentive policy for the higher-ups in the chain of command above her to find ways to cut costs to maximize profits. It was a bare-bones operation, and damned scarey to work there. I prayed in my car every single day I was on my way to work, and prayed a prayer of thanks when I left that everyone was still alive. But I knew - it was only a matter of time. . .I left after 14 months, as I really really felt my license was in jeopardy because of how they operated. I thought I might be interested in going on to travel nursing for dialysis, and one of the recruiters said they (nursing recruiter company) refuses to staff the clinics owned by this dialysis company because of their unethical business practices. They should know that when you are taking someone's blood out of their body at a very rapid pace, at times things are going to go wrong, and there had better be staff available to fix it. I never did go back to dialysis.
Leaving this co was the best nursing decision I've made to date.
Dec 10, '10
I am currently studying to be a Dialysis tech. I have been reading several articles like this recently. It is frightening to me to think that I may be in such a place. After reading these articles, I always come up with the same questions? So WHY are hospitals not providing more of this service???? Why are there only 2-4 chairs available in my area per hospital. Finally a off campus unit was opened by the city hospital with 6 chairs. Still no way near enough. If the Dialysis business is so financially lucrative, why have hospitals not caught on and made delivery of this service more of a focus. This is a life saving service.
My mom spent 4 years on dialysis at one of "those" facilities. At one place, she did so well, at a different place, I could not believe how bad it was. Assemblyline service with a total lack of concern for her welfare. This is what drove me to seek this certification. Still, it is not one of the sexier services, so there is not too much time and money spent by hospitals in the delivery of this service. Very sad.
Dec 10, '10
I don't know about this area, but if it is so lucrative and facilities are trying to do things by volume, that kind of tells me that payments per patient are not very high. This forces the facility to perform an assembly line service, as you described. Like a former vet I used to work for once said, "Get the money and get 'em out".
Dec 10, '10
Sadly, FP Homecare is becoming much like this as well...IMHO
Dec 10, '10
Profitability and quality health care are mutually exclusive.
Dec 11, '10
This month's (December) Atlantic actually has an article about for-profit vs. non-profit dialysis providers and ESRD treatment in general in the US, mainly in the context of how it's the only diagnosis that guarantees lifelong government covered care.
To summarize, yes our for-profit providers suck as a result of cutting corners, but our non-profits also pale in comparison to other countries that focus on early intervention, longer dialysis runs per treatment, limiting the incentive to give drugs unnecessarily to improve profits (Epo), and having only RN's on staff as well as MD's rounding continuously during treatments.
Dec 11, '10
the number of infections and complications that seems to become inpatients at my hospital alarm me, whether for profit or not for profit. i worry that out patient dialysis clinics may not be as strict in adhering to the pricipals of sterile technique and infection control practices. there are so many out patient dialysis clinics in our area and there seem to be certain ones that have more occluded lines and patients admitted positive with mrsa blood stream infections than others. it is frightful to say the least.
we have so many guidelines that we have to follow as a joint commission facility and i do not know if the clinics are held to those same standards or not. there are daily admits for declots and sepsis and i just shudder wondering if the clinics have to abide by the same guidelines and how strict they are with them.
i can easily believe that it is 24% higher, our locals clinics seem to have more than their fair share of complications with their access lines.
Dec 11, '10
This but another symptom of the sickness that affects a for-profit model of health care delivery...IMHO
Dec 16, '10
I know that the 3 areas of any hospital most likely to have Code Blues are ICU, ER and dialysis. We see people all the time that come to us from dialysis because they get hypotensive once they are home or during treatment; one frequent flyer who leaves early because he doesn't "like" dialysis, and then ends up with us in fluid overload like clockwork. Dialysis is no joke, and it's not for the village idiot; I've seen people who had MIs after dialysis because something went sideways during treatment. It's going to take someone going ballistic and shooting up a dialysis clinic before the news "discovers" dialysis and does enough stories that something's done to mandate better training, better resources, and better compensation to keep these folks going back home instead of to ICU.
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