The Bundle - what are you telling patients???

madwife2002, BSN, RN · Dec 11, 2010

Where to begin-All our patients have been recieving written information which explains some of the simple stuff. We have also given them a web site address plus there was a conference call they could be involved in. Our CEO is Diane Wish who is leading some of the education and information for our state so is heavily involved with information.

The patients really dont understand nor do they care as long as they get their dialysis.

The biggest concern we have is managing the care of the patients during the first six months. Making sure the patients do not suffer from cut backs which is sure to affect their care somewhat.

We have tightened our budget in area's which should not affect the patient care at this time. But as with everything new it is going to take many months before we feel the true pinch!

A lot of the staff are very nervous because it is felt that an already compromised population is being stream lined in the worst possible way and that there will be renal pts out there who will suffer because the budget allowed is not realistic.

Trauma Columnist · Dec 11, 2010

Are you encouraging your pts to have primary care providers? Since we will no longer be drawing hgbA1C, thyroid panels, dilantin, dig levels, it will be greatly important for our pts to have a PCP that will provide these services.

How are you handling antibiotics at the HDU?

Our nephrology practice is still wanting us to do all antibiotics regardless of the reason so that our pts don't have to get a PICC line which I agree is ridiculous to pay to have another line and another potential source of infection.

Doing IV benadryl routinely won't be done either. At least we still will have D50 and NTG or at least that's my understanding.

Heck, pretty soon they'll take the ambu bags and oxygen - said only half in jest.

anurseadvocate · Dec 12, 2010

I think it is important to educate patients on the 'bundling' rule. However, what is disturbing to me is the following: CMS published the 'bundling' rule in the Federal Register. Once a proposed rule is published in the F.R. it is open for 'public comment' meaning anyone can respond. The published rule gives all the details of such. I find it almost shameful, in my opinion, and others, that patients were not given this information at this time. I wonder why the Networks could not provide education at the time of the published rule in order to allow patients/families to respond if they so desired. Many patients, in fact, those who are active in advocacy, did respond with the believe that bundling might affect the delivery of care. It would be wonderful if providers could work with the Networks when a proposed rule comes out that affects patients. Don't patients have a right to be involved if there is any potential of their care, or financial status, being affected? Perhaps, an idea..... when a proposed rule is published in the F.R., the providers give patients/families a one-page handout that gives the highlights of the proposed rule, etc. They also tell the patients that they have a right to submit a comment. This would be idea because many patients, who are not involved in advocacy, might just be interested in that which might potentially affect them, wouldn't you say?

Trauma Columnist · Dec 12, 2010

I have no problem helping pts to understand the bundle but with CMS coming out later and later in the year with rules that go into effect Jan 1st this isn't possible.

I answer all the questions that I get and if I don't know the answer, I do refer my pts to the CMS website (which is cumbersome and difficult to sieve through at best).

As our healthcare system continues to evolve, there will be mre changes and pts should be digging into these things.

ldyjstce · Dec 14, 2010

hi, guys! i am 2 months into my hd rn job and have yet to have anyone give me the lowdown on the portion of the bundling that will hit on 1/1. i have a legal background as well as a teaching background, so reading the super-inflated medicolegalese (nice new word, huh?!) language isn't something that scares me. i just can't get anyone go shoot me to the right spot where i can read about the hd patient bundling and the requirements/guidelines/etc. that will be impacting us. i think i could help some of our staff members out if i could read it, digest it and bring it down to a more understandable level. if someone could shoot me a site, the fr number or something/everything/anything useful, i would be most appreciative!

Trauma Columnist · Dec 14, 2010

Here's a website that makes it easy for us non-legal, non-teaching folks:

Bundled Payments for Dialysis - Renal and Urology News

Here's a one page factoid (unfortunately from July 2010 and there have been changes):

CMS Fact Sheet for the New Dialysis Bundle

And voila, here's the 118 page report (from 2008) on the Report to Congress direct from the CMS website. I have bookmarked that particular website - its the first one because there is a lot more info on this page than just one website:

Centers for Medicare Medicaid Services

Eat your mediocolegalese heart out - lol....

anurseadvocate · Dec 15, 2010

There should be, one would think, a FAQ sheet from the Networks that can be given to patients, or even from CMS. This FAQ sheet would explain to patients what they will not be paying for if they did not pay for prior to bundling, etc. Patients need to be informed about their financial responsibilities prior to the bundling going into effect. I am glad to see that some faciities are educating patients...

Trauma Columnist · Dec 15, 2010

This is how I see it affecting patients (please correct me if I'm wrong):

1. Pts need a primary care provider for things other than dialysis-related issues

2. Especially important because we won't be routinely ordering hgbA1C and lipid panels as well as drug levels

3. The pts might see an increase in co-pays because they are going to have to go see a primary care provider for other things rather than just having the mid-level in the dialysis unit handle things.

Personally, I see a lot more noncompliance due to pts not being able/not wanting to get a primary care provider so other issues may fall by the wayside.

anurseadvocate · Dec 16, 2010

I agree and this is quite concerning. Patients are totally unaware and have not been adequately prepared, in my opinion. In fact, I recently saw that Davita is giving to patients an informational sheet.. it comes from Dialysis Patient Citizens which is Davita's patient group, not sure if these patients in this group are so-called 'hand picked' LOL.. anyway.... it is obvious that CMS did not think about this, nor did the Networks, when it comes to educating and preparing patients.. This bundling might drastically affect many patient's finances to the point of great devastation. I see this as not being the best.