Dialysis and “Medicare Says”

spotlightI know you will appreciate this recent experience I had with “Medicare says…”   That seemed to be the answer to every question I had or suggestion I offered to the staff at my center.  If you read my post, this  experience is similar to  what happened at “The Center from Hell” when I discussed a list of 31 items with the Director of Nursing.  In that case she politely told me why she couldn’t do any of them.  It was a very disappointing moment.

In this recent case, it was at the new center that opened in November 2012.  I figured enough time had passed since the opening and it was time to openly complain about my experience from the patient perspective.  My motivation came from the fact that the lighting was so poor.  To the architect or designer it may have made sense but in practice it was poor.

In addition to large, bright fluorescent lights, they installed decorative lighting (large indirect lights) that are over the aisles with adjustable levels so they can be turned up or down., on or off  Those aren’t as much a problem as the “work” lights they put over the computer workstations that are around the treatment center.  One of them is just over my shoulder and it shines right into my pad and TV.  The reflection really bothers my eyes.  After an hour or so, it’s painful and I still have three more hours to suffer.  I asked the tech to turn off the light.  She thought I meant the decorative light.  I heard, “Turn off number 9!”  and the pretty light that’s not a problem, went out.   Problem not solved.  I explained to her that I meant the bright spotlight over my shoulder.  In the week previous, it was not a problem and they turned it out.  But this time, they didn’t.  She said there was nothing that could be done and explained, “Medicare says we can’t do that.”

So, I had to escalate the matter up to the charge nurse.  See, it’s important to work through the channels… or at least try.  In this case, I trusted the system to work.  There’s no sense calling 9-1-1 about a matter like this (ha,ha) and I didn’t need to call the company HQ or the ESRD Network.  Those steps may come later but I wanted to work through the system for now.

In this new center there’s no way to get the attention of the charge nurse.  She is about 50-60 feet away, behind two rows of patient stations (good physical design, eh?).  I reached for my cell phone and called the dialysis center number.  The charge nurse answered.  I explained the problem to her and she said there’s nothing that can be done.  In  the course of our discussion, she made the point, “Medicare says we can’t do that.”

I got thinking about that… “Medicare says we can’t do that”?  Where and under what circumstances does Medicare get involved in the placement and operation of light switches in a dialysis center?  Is there some government regulation that says that a light over my dialysis station can’t be turned off? Or, are staff members just using that as an excuse to ignore me.  Mercy, no! That couldn’t possibly be.

The next step was to call the company HQ.  They have a Customer Service phone number to call.  I called it.  A nice person answered and took my complaint.  I was pleasant to her because I know there’s little she can do about the bright lights.  But, I also knew that this would mean the person responsible for the facility (the Facility Manager) would get a call and I would get a response.

I let the issue go for the moment but I continued my investigation over the next couple days.  The next day, I was in Houston for a Medicare/CMS session and visited a dialysis center on my way home.  (More about that later).  I spoke with the VP who was intimately involved in the center’s design.  During a tour of the facility, he pointed out the indirect lighting over the patient area and so I asked what “Medicare says” about the design.  He showed me why the center didn’t need bright lights over the computer stations; because they don’t have computer workstations.  The computer is integrated with the dialysis machine and it’s a lighted, touchscreen panel that doesn’t need an overhead light for the keyboard like the one that pestered me in my home center.

I asked him outright if “Medicare says” anything about the design and operation of the lights in the treatment area.  He replied, “no”.  He pointed out that, because they offer nocturnal dialysis in this center, it’s important that the treatment area have low-lighting.  They have rope lighting around the bases of the various counters so they don’t have to light the area while the patients sleep.  Hmmm.  No bright lights because “Medicare says”?

In my next treatment, the facility manager came to speak with me.  It was a good conversation.  I explained I wasn’t being difficult, I just had some issues with the design of the center and the lighting.  The center was new and it needed attention from a patient perspective.  The design, we agreed, lacked any input from staff, patients, or local management.  It was a “Center in a Box”.  And, it needed revision.

We discussed the lighting and that the computer work-lights have no control other than on or off and the entire string of lights (5 or 6) are all on the same switch.  Poor design.  I suggested they rewire the lights so each could be turned on and off individually.  He suggested a lower wattage bulb.  I’m happy with whatever they might do if it solves the problem.  We’ll see. 

CFRIn the meantime, I researched the Medicare requirements and found this CFR (Code of Federal Regulations) 42 that applies to ESRD Providers.  Somewhere in there are the specific requirements for a dialysis facility.  It’s only 114 pages long but I’ll read it and find what I need.  I’ve got little else to do for four hours, three days a week!   Hee,Hee

If anyone should care, the title of the document is:

42 CFR Parts 405, 410, 413 et al.
Medicare and Medicaid Programs;
Conditions for Coverage for End-Stage
Renal Disease Facilities; Final Rule

I provided a link to it (above) in case you want to read it for yourself. I would be interested in what others have to say.

© 2013 DevonTexas

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About DevonTexas

I am a person with ESRD (End Stage Renal Disease) which means my kidneys don't work. Forty or so years ago that would have been a death sentence but today there is Dialysis which means I can be hooked up to a machine that will clean my blood as the kidneys should. Three days a week, I go to a center and have too very large needles stuck in my arm to remove and replace my blood as it passes through a process where it's cleaned and the fluid is removed, a process taking a little over four hours each time. I want to advance knowledge about dialysis so that other patients can learn from my experience and mistakes. We shouldn't have to reinvent the wheel, eh? There is so much to be learned and experienced about our predicament. There are vast resources available to support us and enrich our lives but many patients don't know about them. There are also many issues that we have to deal with whether we want to or not. So I blog about them. All comments are confidential until I approve them. If you don't want your comment public, let me know and I will respect that. So, feel free to leave a comment. Enjoy.
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