Quality dialysis outcomes or $$$

[Marisette, BSN, RN]

Just wondering what the other chronic dialysis RN's think of the qulity goals for dialysis facilities. Goals for anemia, kt/v, phosphorus, albumin and so on. Do you think obtaining the quality goals really improves the quality of patients lives and even their life span.

I think to a certain extent they do, but these quality goals have been changing for years and each year they get more difficult to achieve. The quality goals the anemia drug provider encouraged had to be decreased because the medication was found to have a detrimental effect on cardiac status and some cancers. I believe, this will also be the case for kt/v in the future. I'm not aware of any studies indicating longer life span of dialysis patients with the improvement of these quality goals.

If I were a patient, I would not allow the dialysis providers or the medicare beauraucracy dictate quality goals for me. I think thier motive is $$$ for the dialysis companies and justification for the existance of goverment beauraucracies. Some of these patients are living to dialize instead of dialyzing to live so the dialysis providers can meet their goals $$$$$.

[traumaRUs, MSN, APRN]

I think that we are going to see some bigger changes coming down from CMS:

1. Anemia protocols with an acceptable range of 10 to 11 (very narrow and difficult to achieve)

2. Multiple opinions as to who even gets offered HD. Maybe the 95 y/o with metastatic lung cancer and COPD and an EF of 15% isn't that great a candidate?

3. More onus put back on the pts: if you can't come to HD or reschedule, than you have a co-pay when you do want to come.

4. Medicaid rules are getting tougher.

[madwife2002, BSN, RN]

I am concerned about the changes which have already occurred this year. The guidlines are so narrow and TraumaRus is correct there are many more changes to come.

We changed our anemia management in february this year now we are having to change it again to meet the 10-11 goal.

KT/V really makes me laugh because it only an indication of how good that one dialysis treatment is, half the time it is not accurate because it is the only day we insist that pts run their full treatment.

Vascular Access well! What can I say get to 66% really-the population of renal pts is getting older and older and their vascular access's are poor to nothing.

I have 20 long term catheter pts and there isnt a chance in hell we can get them removed. All their other access's are shot!

[madwife2002, BSN, RN]

I think that we are going to see some bigger changes coming down from CMS:

1. Anemia protocols with an acceptable range of 10 to 11 (very narrow and difficult to achieve)

2. Multiple opinions as to who even gets offered HD. Maybe the 95 y/o with metastatic lung cancer and COPD and an EF of 15% isn't that great a candidate?

3. More onus put back on the pts: if you can't come to HD or reschedule, than you have a co-pay when you do want to come.

4. Medicaid rules are getting tougher.

I like number 3 but realistically can you see them paying!