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08/21/2012

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Bill Peckham

One edit:
" a money delivery system ── to carePROVIDERS, their organizations ..."

The organizations that receive money by definition never "give" anything.

I think this nexus of money and influence, put's both money and a stick in the hands of the large dialysis organizations. The patient groups you chose not to name but I will, AAKP, DPC, RSN, NKF, rely on industry funding to accomplish work prescribed by the funders i.e. industry. The thinking goes You can't do the good things we do if you challenge the funders.

If Medicare wants a culture of safety they must bypass the providers and direct incentives at the beneficiaries themselves. If dialyzors were being paid to be monitors of and participants in their own safety, the LDOs would be compelled by their patients to be better actors.

The base problem here is that to work the system really depends on engaged, and aware, beneficiaries. There is not enough money in the Treasury pay corporations to care more about dialyzors than dialyzors care about themselves. However, we could pay dialyzors to manifest concern for their care.

On thing about this Granuflo issue in particular though - why wasn't the elevated bicarb picked up by the MCP physicians in the monthly labs?

Gary Peterson

Thanks, Bill, I made the edit.

I think that it takes years for anyone to become an effective safety monitor. I think that almost all care providers -- and some motivated dialyzors after a year or two of in-center dialysis -- realize that they are most safe and in control at home. Putting patients in the position of judging and/or reporting on the staff that cares for them could create many retaliatory and personality-based problems.

Physicians and nurses are supposed to be advocates for patients. Their licenses require them to report situations when patients are in danger. However, with so few and so powerful employers in the dialysis field, these physicians and nurss essentially end their dialysis/nephrology/publishing careers if they either report problems or write about them... unless they are well-established outside of FMC/DaVita.

Perhaps patient organizations should push the large for-profit providers to establish permanent patient-led focus groups that are dedicated to improving dialysis care.

As for the elevated monthly labs, here are some thoughts. The monthly labs are typically drawn after a three-day weekend, when serum bicarbonate levels are lowest. It is always a less-than-ideal marker of the patient's acid-base status.

Even though most dialysis laboratories specialize in analyzing blood of dialysis patients, their lab result forms have provided reference ranges of normal serum bicarbonate levels for non-dialysis patients (20-29).

In talking to physicians, I have found that even those that were most attuned to the Granuflo/bicarb issue did not see evidence supporting the lowering of dialysate bicarbonate levels en masse until 2009.

Lana Schmidt


The medical director, Dr Mark Greenwell, retaliated against me after I filed a complaint with the Heartland Renal Network.
For 1.5 years I felt that the home hemo nurse had threatened my life in several different ways.

The doctor yelled at me for several days when I was in hospital; called me names; lied about what the Heartland Renal Network said, he said, that they said, I had to be removed from the home hemo program.

Someone/hospital security should have pulled him off me! He was belligerent toward me…
I had just had surgery, general anesthesia, had pneumonia, hemoglobin had bottomed out, etc…

He said that I could no longer be in the home hemo program, only offering me in center which he knew I could not live on.
I told the Heartland Renal Network, they did nothing.
I also reported it to cms and they said they couldnt do anything about it because it was not in my medical records!

There are no policies or procedures in place or punishments for retaliation to patients.
In addition, even though the renal network is suppose to protect patients, they tell me they don’t. All the information on the renal network website implies that patients rights are protected, but they are not.
You're right there is no protection for patients and it is scarey.

Lana Schmidt

How can the kidney world allow Ken Thiry ceo of Davite, the highest paid, make public a statement .."it is not about the patient",
in his presentation at the UCLS Business School.
http://www.youtube.com/watch?v=JowmBdx4nFw&noredirect=1
Go to the 1:09:35 mark of the YouTube video when a student asks a question. No wonder DaVita has such a bad reputation, especially with its own patients and the patients cant do anything about it.

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