Chronic HD in the Acute Clinic?

Chisca, RN · Aug 20, 2015

The ER screens them and they have to wait until we have a spot. Lab values determine priority. Medicare covers dialysis therapy but you have to have a social security number. Illegal aliens do not have a SS although they are the most appreciative of what you are doing for them. By not having a clinic they are missing out on iron therapy and tend to be anemic. Then there are those who because of their violent personalities have been kicked out of every clinic in the city. For them the whole world has done them wrong and nothing can make it right. They usually go AMA before their treatment is completed. Yes, a very expensive way to deliver dialysis therapy.

AcuteHD · Aug 20, 2015

Don't forget about the ARF pts that are in limbo until they recover or can be declared ESRD, thanks CMS!

We follow the same anemia protocol as the outpatient clinic and draw labs weekly, so that's pretty well covered.

NurseRies, BSN, RN · Aug 22, 2015

We have an unofficial system that works. We've actually got

So many undocumented regulars at one hospital, that they have created a special fast track admission and discharge area for dialysis patients. They are educated to come

Through the Urgent care (not ER) when they feel sick, if they meet criteria they are fast-tracked to the admission discharge unit and they wait there until we have an open chair. They are monitored by RNs. We have 10 stations and every day we fill up to 20 patients. Only a few of these are inpatient for other reasons. When we are ready to take patients, we walk over to the admission discharge unit, right next door, and bring the patient over for HD. When the patients are done, we usually walk them back to the admission discharge area where they wait for a bed. We usually do 2 back to back treatments, followed by immediate discharge after dialysis. Some people get admitted but have to wait til the next day due to some many hyperkalemias and pulmonary edema in other folks. It's a crazy set up and it functions almost like an acute and chronic unit at once.

AcuteHD · Aug 22, 2015

Thanks, NurseRise, sending through the urgent care sounds good to me, but it's all about reimbursment. I'll suggest it to the director. Thankfully we don't have that many yet.

NurseRies, BSN, RN · Aug 28, 2015

From what I understand, reimbursements for undocumented patients is all about specific hospitals. Some hospitals get no money to take care of them, so you'd be better off transferring them to hospitals that do get paid. If you live in a big city, there is most likely a hospital that does get paid to accept the undocumented patients. Our inner city hospital is mostly paid in federal and state grants to take the patients that other hospitals sometimes turn away. So if you're at the wrong hospital, you can bet that they won't work with you to accommodate these patients. Of course, I'm sure this can vary from state to state, maybe look more into that?

AcuteHD · Aug 28, 2015

There is no other hospital in the area that has an acute dialysis unit. We used to have them come in through admissions for direct admit to the nephrologist for HD and discharge. The hospital didn't get paid, but it didn't cost a whole lot either (nephrologist + HD + weekly routine labs). That system worked well, it seemed. Now they are wanting them to be evaluated by an ER doctor and be admitted / discharged by a hospitalist. And the hospital still doesn't get paid unless the pt is nearly dead and needs emergent care. Super expensive (ER Visit + ER Doc + ER Labs + Hospitalist + Nephrologist + HD), plus there's a 2-4 delay from the ER to dialysis. I don't understand any of this. Just venting now, sorry.

Guttercat, ASN, RN · Sep 2, 2015

Because... 'murica!

CFrancine, BSN, RN · Nov 18, 2015

My hospital used to take those patients but I guess a year ago CMS ripped them a new one for not having the proper protocols and documentation for chronic patients. Along with other things, they nearly shut down the whole unit. So they decided to stop all together. As far as getting paid, I work for an extremely large hospital system that's a not-for-profit. I could be wrong but I always assumed they used it as a write off.