Kidney Function

Part B medical insurance helps pay for outpatient maintenance dialysis treatments in any approved dialysis facility, including the costs of laboratory tests, supplies, equipment, and other services associated with treatment. Charges for maintenance dialysis vary from one approved facility to another. Medicare pays the facility based on a per treatment rate that is set in advance. This rate is known as the composite rate. Medicare pays 80% of the composite rate minus any part of the Part B deductible they have yet to meet. You are responsible for any unmet Part B deductible plus the remaining 20% of the composite rate. The facility may never charge more than the unmet Part B deductible plus 20% of its Medicare composite rate.

Physicians’ services also are covered while you are receiving dialysis treatment. Medicare pays for these services via a monthly capitation payment. The amount is paid regardless of whether a patient dialyzes as an outpatient in a dialysis facility, or at home. Under this method, Medicare pays 80% of a physician’s monthly payment less any unmet Part B deductible. A patient pays any unmet Part B deductible plus the remaining 20% of the monthly payment. If a physician accepts assignment, Medicare will pay them directly, and you may not be charged more than the unmet Part B deductible plus 20% of the monthly capitation payment. (Assignment means that a doctor accepts the payment approved by Medicare as the total payment). If a physician does not accept assignment, you receive the payment and there is no limit on the amount that can be charged.

If you’re admitted to a hospital because you medical condition requires the availability of other specialized hospital services on an inpatient basis, the maintenance dialysis treatments would be covered by hospital insurance (Part A), as part of the costs of the covered inpatient hospital stay. While you are hospitalized, a physician may elect to be paid for each individual service that they provide. In such a case, a physician receives a prorated portion of the monthly capitation payment, reduced in proportion to the total number of days that you are hospitalized.

Medicare and Self-Care Dialysis

If people participate in a self-care training program within the first three months after treatment has begun with the intention of doing self-care (aka “home”) dialysis, Medicare benefits will start during the month that the self-care training begins.

Monitors are devices that measure several dialysis functions during treatment. Their purpose is to provide safe dialysis treatment and to respond with a light and a noise to alert the staff when there is something wrong.

When a monitor indicates an alarm, dialysis may be automatically stopped. In most cases, the problem is not immediately dangerous to you and can be quickly corrected by the staff. The combination of the monitors and the supervision of the staff helps to make dialysis treatment comfortable and safe.

The venous pressure monitor and the arterial pressure monitor measure the pressure of the blood as it flows through the dialyzer. If there is a break, kind or any obstruction in the blood lines or in the dialyzer, the pressure changes and the monitors send out an alarm to alert both you and the staff. The temperature monitor indicates an alarm if the dialysate solution is either too hot or too cold. Because the blood normally cools when it leaves the body through the blood lines, it must be rewarmed to the normal body temperature before it is returned to the body. This is accomplished by heating the dialysate solution, which, in turn, rewarms the blood. The negative pressure monitor shows the amount of suction or negative pressure used to remove the excess fluid from the body. An alarm sounds if this pressure changes. Another very important device on the artificial kidney machine is the blood leak monitor, which sets off an alarm if any blood leaks into the dialysate solution through a tear in the dialyzer membrane. The conductivity monitor indicates the concentration of substances in the dialysate solution. The air detector detects any air or foam that might pass through the system. This detector not only indicates an alarm, but also has an automatic device that clamps the blood line returning to the body to prevent air from being pushed into the vein. It may be frightening when an alarm sounds, but rest assured that the monitors are designed to protect you and to make treatment as safe and comfortable as possible.

Peritoneal dialysis is the preferred treatment for many people. You may be a better candidate for peritoneal dialysis than hemodialysis if you have poor hemodialysis access routes or heart instability. You also might prefer peritoneal dialysis instead of hemodialysis because both diet and fluid intake is more liberal, and blood is lost during peritoneal dialysis treatment. Physicians believe that the large fluid gains between hemodialysis treatments place stress on the heart and blood vessels. This is not the case in peritoneal dialysis. In addition, there is a reduced need for some medications, particularly antihypertensives.

There are, however, some disadvantages to peritoneal dialysis. There is a possibility of weight gain (fat) caused by the high amounts of dextrose, or sugar content, of the dialysate. Older people and diabetics require testing of their blood-sugar level as some of the dextrose in the dialysate is absorbed into the bloodstream and can raise the blood sugar to very high levels. Diabetics, however, may add insulin directly to the dialysis solution.

There are some potential catheter-related problems as well. Infections can occur at the catheter site at the external part of the abdomen. In most cases, these infections can easily be treated with antibiotics. The most serious problem that can occur is peritonitis or an infection that develops inside the abdominal cavity. Peritonitis must be treated with antibiotics, although, in the majority of cases, hospitalization is not necessary. When peritonitis is very severe, however, hospitalization is often advised and you may be dialyzed on a machine continuously with antibiotics in the dialysate, and, sometimes, intravenously as well. The risk of peritonitis can be reduced by using the prescribed sterile technique and the close monitoring of your physician.

Which is the best type of peritoneal dialysis?

The type of peritoneal dialysis you choose depends on your medical condition and personal choice. Consult your physician and nurses in the field to help you make an informed decision that will suit your particular needs best.