Anyone been at a clinic taken over by DaVita or FMS?

[wordsmith]

I've been working at a lovely, smallish (okay, we have 150 pts, but they're like family) unit, plus the doctors' office nearby. Because of all the changes down on us by CMS/Medicare, the only way we'll survive, they tell us, is if we get sold, either partially or completely, to one of the Big Cheezes. There were several sets of suits walking around on different days looking at us.

I've worked at hospitals before and have gone through mgmt. changes. Some of the employees here have never worked anywhere else. Has anyone here been at a freestanding unit that was bought by one of the Main Players? What was it like? Did they come in like gangbusters, or was it a slow process? Did they do layoffs and substitute their own people, or did they leave the floor people pretty much alone and just bring in a few managers?

I'm a shift supv. and I keep telling the techs that the new people would be crazy to let us all go because we're the nuts & bolts of the place, but they're totally not believing me.

Thanks for your thoughts :wink2:

[Valerie Salva, BSN, RN]

When FMC buys a clinic, they do require that only FMC dialyzers, lines, and PD supplies be used. even if the former owner/MD prefers other supplies for the pt.

They do also require certain policies, procedures, and staffing. Doesn't matter if the docs don't agree. It's their way or no way.

If staff use more than 2 pieces of gauze, 2 needles or 1 bag of saline for any tx, they require that you write a report explaining why.

A lot of FMC clinics keep all tx supplies in inconvenient places that are hard to get to. They figure that staff will use fewer supplies that way.

Some of the clinics even require that pts buy and bring in their own band-aides. They do not want staff taping off sites with FMC supplies.

They also take nursing duties away from nurses and give them to the unit mgr. Then, they work and treat nurses the same as techs.

There must be a minimum 10% overfill on Epo q day. If there is not, the nurse must recalculate what she has given over and over again, and explain why there is not a 10% overfill. Their computer program keeps track of what nurses give the Epo, and which nurses do not meet their overfill requirement.

I really dislike FMC, and have never seen a good FMC clinic.

[workingmomRN]

Valerie, you are right about the EPO and the supplies. The FMC unit that I still do some prn at has started using pre-made packs with the needles, gauze, and a little tiny roll of tape in it. There are no other spare rolls of tape in the unit, so if someone starts to bleed heavily & you need more gauze or tape, you have to open a new pack to get it. They also have catheter packs as well. If you have a patient that has just started getting a matured access cannulated and they still have a catheter, you have to open a whole new catheter pack just to get the dressing material for the cath dressing change. It seems more wasteful than money-saving.

As for the EPO, what a pain. When they came out & said you couldn't drain vials anymore to prevent pooling medication from mulitple vial in one syringe, & changed the way to draw up the med from the vial, they did not change the amount of overfill that you are still responsible for. Also the same for Zemplar. I always hated having to calculate that overfill & go back & recalculate.

Davita is much better about that area. The med labels are printed out, with the dosage & what Epo vial to use, etc. No handwriting labels, & such.

[Valerie Salva, BSN, RN]

Yes, it's hard to believe with all the technology avaialble, FMC doesn't have any in place so that staff have to hand-write hundreds of labels each week, and calucate epo and zemplar changes by hand.

FMC is a real drag on people who like dialysis and want to continue to work in the field.

[Chayo1989]

I worked at a Davita facility for several months and I really enjoyed it. They were a great company to work for. I'm actually planning to reapply there recently.

[nlovell]

Wow. Seems like there's no straddling the fence on this topic!! My first experience with dialysis was with Davita, as a floor nurse, then Charge Nurse. Their training for me, as an RN w/less than 2 years of experience (and only med/surg) was extensive and helped me fall in love with nephrology nursing. Although I quickly came to love my inner-city clinic, I was just as quick to find out that "the Davita way" wasn't what they preached in orientation. The Facility Administrators (we went through 3 of them in the 2 years I was Charge Nurse) who ran the clinic seemed more concerned with their bottom line and bonuses than good and safe patient care. Because I'm a work-in-progress re: tact when it comes to anyone other than my patients, it wasn't long before the managers deemed me "a problem." Unfortunately, I left Davita a stressed-out MESS, and thought for sure I'd never do dialysis again. I began working in a LTCF but found myself missing my "dialysis babies!" Someone mentioned my name to someone else (small world in dialysis!) and FMC called me in to interview for a Clinical Manager position and I was back home. I noticed right away that the training wasn't as good as Davita's (luckily I knew what I was doing by then) but the support I've received from my management has been amazing.

I've been with FMC now for 3 years and I've moved through 3 clinics. The clinic I currently manage was acquired by FMC about six months ago. No, the transition hasn't been seamless, but I believe that has more to do with the unethical doings of the previous CM and her family, who were running back-door PCT training courses (among other things) instead of focusing on good patient outcomes. Since FMC has taken over, we've re-trained staff, made staff eligible for benefits and organized study groups and quiz review for the upcoming PCT certification. Our patient outcomes have improved dramatically: adequacy has gone from 25% of patients with eKdrt/v of >1.2 to 79% in just 3 months and our catheter rate has decreased 15%.

I've never been a big fan of major corporations, I agree that they tend to lose sight of patient care in favor of budgets and cost. And the new CMS guidelines don't make things easier!! But in the end, people are what make the difference. And at least, in my small corner of dialysis, the FMC team far surpasses Davita's efforts.

*climbing off my soapbox now*

[nlovell]

Yes, it's hard to believe with all the technology avaialble, FMC doesn't have any in place so that staff have to hand-write hundreds of labels each week, and calucate epo and zemplar changes by hand.

FMC is a real drag on people who like dialysis and want to continue to work in the field.

I agree that FMC technology isn't up to Davita's...that was a hard thing to deal with! I'm still going to stick with a company that employs the support staff I work with...I sincerely feel that, technology notwithstanding, we are making a difference in our patients' lives.