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March 5, 2012

Happy Birthday, Medicare Kidney Amendments!


4 Comments to “Happy Birthday, Medicare Kidney Amendments!”

  1. Bob Gutman said,

    March 21, 2012 @ 1:05 pm

    We are all very grateful to Allen for so ably championing the perception that ACO management by hospitals depends on our collective nephrology wisdom. At the risk of being labeled an ungrateful skeptic, I will predict that nothing much will come of this. The early ACO-like experiments in CKD and ESRD management by nephrologists were disappointing. These are very sick people and their intrinsic needs (or demands) are fundamentally unchangeable; and are not going to go away with fancier machines or options for different schedules. The improvements are very marginal, albeit measurable.
    Allen raised the story of the chain transplant success. This story has implications worth emphasizing. First, renal transplantation is clearly better than dialysis for the patient, the family and for budgets. I was with the early Scribner team. At that time, so long ago, I had hair; transplantation went from nearly unavailable to being largely a failure. But now is really different. It is far better. The second implication is that living kidney donation is a major goal. The third and most critical implication is that with the right rules and infrastructure, we could have a lot more living transplantation and a lot less dialysis. This change could be enough to give DaVita and FMC investors the shakes.
    Note that while the National Organ Transplant Act (NOTA) prohibits the sale of organs, behavior has begun to change under the radar. No money changed hands in this or any chain as far as one can tell, but note that only the first donor is truly altruistic and the last recipient gets a kidney without his family or friends making a “donation.” In fact, all the other donors are not called “altruistic”, but rather “bridge donors.” They are clearly being paid, not in coin of the realm but they are getting something…a kidney for their loved one. It is time to revisit NOTA. It was crafted when there was legitimate concern that rich people would exploit poor people. But now we have a means (the cadaveric kidney system) to accept donations from screened healthy donors who would not have any way of dealing with the recipients. If the government or insurance could pay for donations, there would be enough to clear the backlog in a relatively short time. Those who argue that this is also exploitation ignore the fact that poor people of color dominate the demography of our dialysis population. They are being badly treated by this outdated ethical construct. Duke University Law School and Ethics Institute are presently in the early stages of planning a conference on just this subject. I pray that is will go well and lead to a major paradigm shift to the benefit of renal patients, their families, the people who are willing and able to donate living kidneys and offer a major break in costs to society.

  2. Robert Merrell said,

    March 29, 2012 @ 10:36 am

    Thanks for the reminder of where we have come from in this field.

    When we do our daily activities and plan for the future, it is alway good to remember the past. Not to dwell on it, but to spur us on to continue to build on the successes of others.

  3. Dottie said,

    January 17, 2013 @ 8:57 pm

    My mother is 85 years old. She has to have dialysis three times a week. She has to be in a Skilled Care Facility but we are having problems finding a facility that provides transportation to the dialysis centers. Does anyone have any information that will help. Either in Mobile, Alabama or Fairhope, AL.

  4. kikicol said,

    February 9, 2013 @ 4:15 pm

    I have been on hemo- a year before going on home hemo. I love it so much, I’m sorry about comenting on a birthday, but I have no Idea what you meAN AND THIS MIGHT NOT BE THE RIGHT ON TO GET INFO OR TIPS. i HAVE NOT BEEN DOING HOME HEMO FOR JUST A DEW MONTHS. MY dR . SAID i WOULD START FEELING BETTER MY FIRST WEEK AND HE WAS SO TRUE. i DO IT 2 HOURS A DAY FOR 5 DAYS. I CAN DO ANY DAY i WANT AND TIME. MY SON,STEVE, IS THE MANAGER. MY HUSBAND COULD DO IT BUT HE HAS DEVLOPED PARKINSON’S


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