Tag Archive | profit

Igre za pacijente, pare za organizatore

Dialiks: novi dokumenti o kriminalnim aktivnostima u oblasti dijalize.

Igre za pacijente, pare za organizatore,

Ili: Zašto mala pčelica kidiše na cvet?

Poštovani čitaoci,

Velika je nesreća biti bolestan, pogotovo biti zavisan od dijalize. Ali, ni tu nije kraj našim mukama i nesrećama.

U skladu sa zapadnim tržišnim vrednostima, koje je ovo društvo mirno prihvatilo, nije sramota zarađivati na tuđoj nesreći. To rade doktori, sestre, cela zvanična i nezvanična medicina. Kriminal je kada se ta nesreća namerno izaziva ili pospešuje, kako bi zarada bila što veća, mada se sam taj poriv za zaradom, u zapadnoj medicini, ne osporava.

Legalno je izigravati i humanitarce. Te organizacije sada možete videti na svakom ćošku.

Mnogi su odjednom osetili potrebu da pomažu obolelima i unesrećenima, da im prikupljaju novčana sredstva za dalje lečenje ili humanitarnu pomoć.

Ono što nikako nismo očekivali, to je da se i sami pacijenti uključe u taj „biznis“.

Famozna Udruženja pacijenata, Savezi, Asocijacije, Lige, Društva, ima ih na stotine i hiljade, niču kao pečurke posle kiše.

Neki pojedinci su već i hapšeni i osuđivani, jer nema nikakve sumnje, da je primarni cilj osnivača tih udruženja – zarada, a osnovni način rada: prevara.

Još uvek (na sreću ili na žalost) ima naivnih i dobronamernih ljudi koji ne shvataju zamku i hoće da pomognu obolelima ili unesrećenima. A onda postaju plen tih i takvih prevaranata.

Smišljen je čak i naziv, koji kao da opravdava sva zla koja nas snalaze. Kažu da je naše društvo: „u tranziciji“. A to valjda znači: „sad se krade i grabi, ko i šta stigne, a posle, kad više ničega ne bude bilo, onda ćemo uvesti zakone i legalizovati postojeće stanje“. To je ta strategija zapadnih gazda, koji su preko domaćih poslušnika i saučesnika, preuzeli rukovođenje našim balkanskim državama.

podmazivanje-korupcije

Zato su i promućurniji pacijenti odlučili da zarade malo, na svojim kolegama, nesretnima i obolelima, jer policija još uvek ne hapsi pacijente – za sada su procesuirani samo zdravi organizatori, neka manekenka, i neki članovi porodice ili udruženja za pomoć obolelima. I to samo neki, vrlo mali broj.

A, po logici statistike, i među pacijentima ima značajan procenat đubradi, kriminalaca i kriminalu sklonih pojedinaca.

Nimalo oni ne zaostaju za sposobnostima i afinitetima onih pravih, zdravih kriminalaca. Često deluju i udruženo. Za njih nema granica u „društvenom“ radu: oni su i vladini, i nevladini, i soroševci, masoni, slobodni zidari, malteški vitezovi, rotarijanci, rotšildovci, rokfelerovci, rođaci, otporaši, animatori, uzbunjivači, – gde god šta može da se drpi, oni su tu.

Možete li zamisliti majku čije je dete dobilo transplantirani organ (ne od nje, naravno), koja onda iskoristi tu činjenicu i ne skida sa sa svih mogućih „skupova“, „seminara“, „obeležavanja“, TV-emisija, javnih rasprava i debata: o transplantaciji.  Javilo joj se.  Da bude u (e)Misiji.  Plavuša a još i prosvetljena.  Deli ženica šarene balone, pristupnice, karte zaveštanja organa, promoviše i sebe i humanizam, ali u osnovi svega je samo lova. Dete joj čuva baba (koja je i dala organ za transplantaciju), a majka ne stiže ni da ga vidi, od silnih „humanitarnih“ obaveza. Osetila žena mogućnost lake zarade. I, kao i oni u „Otporu“, sada putuje i poučava druge kako se to radi.

Zahvaljujući našim insajderima, u prilici smo Vam pokazati i deo njihove elektronske prepiske, kako vrše edukaciju za osnove „humanitarnog“ rada.

Osnova tog „humanitarnog“ rada je: Kako izmamiti sredstva od države ili od privatnih firmi? Kako se žicaju pare? Ima tu cela nauka. Sada ćete videti kako šefica savetuje svoje saradnike o osnovama namicanja „finansijskih sredstava“.

Evo tog teksta:

Uputstva za zicanje

Prosto je neverovatno da još postoje ljudi koji će poverovati u humanizam, društvenu aktivnost, brigu za pacijente, rad na projektima, pravljenje radionica, sastanaka, edukacija, promocija, obeležavanja i sličnih budalaština, organizovanih od strane tipičnih prevaranata. Niko, međutim, ne želi da im se suprotstavi. Da kaže: car je go! – to su lopovi! Kao da svima odgovara da se ta farsa nastavi. Zato i naša najzvaničnija udruženja pacijenata nisu raskrstila sa tim brojnim humanitarcima i njihovim maštovitim imenima tipa: „Donator je heroj“, „Dajte pare za osmeh“, „Brinimo za nezbrinute“, itd, itd. Pogledajte samo kako izgledaju radionice za dijalizne bolesnike… Ko tu koga radi? Da li je moguće da 2-3 besposličarke mogu uzurpirati prostorije udruženja dijaliznih bolesnika i predstavljati svoje glupave seanse kao radionice za dijalizne pacijente? (Budi Bog s nama, kao neki sektaši: spremile sveće i pola kilograma banana, a za dijalizne bolesnike?).  I gde su im tu uopšte bolesnici?  Ne vidimo fistulu ni kod jednog od učesnika? Ili fistule za njih nisu problem?  Važno je praviti baš ovakve Projekte, tražiti pare i redovno prijavljivati multiaktivne Radionice, Sastanke i slične „aktivnosti“.  O, ima li te pravna državo, da li te ove seanse mogu dozvati?

Radionica-za-naivne

Idemo dalje. Znate li ijednog drugog Predsednika, osim predsednika dijaliznih udruženja, da je na tom mestu 20 godina, nesmenjiv i nezamenjiv, privatizovao sve, od pečata do celog udruženja, sve sa fejsbuk stranom. Kao svoje zanimanje počeo je zvanično da navodi, na engleskom (jer mu to kao ostavlja bolji utisak na sagovornike) Medical Office Manager, iako ne zna ništa o medicini, niti zna i reč engleskog. A za zamenika je stavio svog sestrića ili bratanca, koji takođe već stoluje jedno 15-ak godina, jer je nešto kasnije počeo sa dijalizama, ali sluša „šefa“. Sve su to veliki virtuelni humanisti.  Briga o pravima dijaliznih pacijenata, njima je najsvetija dužnost, zanimanje čak.

Ne, nikada nijedno od tih humanista nije prihvatilo nijedan konkretan oblik rada ili pomoći obolelima ili unesrećenima. Da im pomažu pri jelu, pri transportu, pri hodanju, da im prazne guske ili lopate, da im dodaju čašu vode…

Ne, samo pare.

Prikupljanje novčanih sredstava.

Jedini i neprikosnoveni cilj svih tih humanitaraca.

Nekada to prikupljanje i ne bude direktno. Nego se kao organizuju susreti, debate, predavanja, podučavanja, prave se projekti, planiraju „aktivnosti“, a svi naročito vole: „sportske igre“, „edukacije pacijenata“ i štampanje „časopisa“ za pacijente…

Sećate se, već smo se smejali njihovim „obeležavanjima“ svetskog Dana bubrega, kada su nesretne dijalizne pacijente terali da pričaju o sprečavanju „napada bubrega“ – pacijente koje bubreg ne može ni da napadne, ni da zaboli, a tek smejurija kada su dijalizne pacijente nalivali vodom (strašno), jer gde su se baš oni (dijalizni pacijenti) našli da promovišu značaj tečnosti u sprečavanju bubrežnih komplikacija (?!).  Ali, za sve to je neko nekome dao pare, kao što i pretpostavljate.

Smejali smo se kad smo videli da zdravstvene vlasti teraju i medicinske sestre da pišu „naučne radove“, da održavaju „kongrese“, da stiču „reference“, a onda se ta moda prenela i na pacijente. Šta tek sada da se kaže? Pacijenti izlažu radove? Na kongresima pacijenata?

Zamislite situaciju da neki repati dijalizni pacijent organizuje „predavanje“ nefrologa drugim dijaliznim pacijentima? Pacijent plaća doktorima da održe predavanje pacijentima? I niko da se zapita: Odakle tom pacijentu pare da on plaća doktore? Zašto to doktori ne rade kroz svoj osnovni posao, u dijaliznim centrima, gde su im i pacijenti? Zašto potpuno usko-specijalizovana i pacijentima nerazumljiva stručna predavanja održana na kongresu nefrologa drže ponovo, ali pacijentima, zar da bi uzeli još neki dinar?

Obelezavanja1

        Predavanja za pacijente         medalje-ce-smiriti-strasti

zamajavanje pacijenata2    zamajavanje pacijenata4

Da li je normalno, pacijentima u Srbiji, gde zbog preopterećenosti sestre i ne dezinfikuju dijalizne aparate (!!!) pričati o pomodnim svetskim novitetima kao što su HRONO-dijalize. Elem, pokondireni srpski nefrolozi se našli da pričaju o Temi: „Kratke svakodnevne i noćne hemodijalize: modaliteti za bolje preživljavanje“? Zar to nije čisto sprdanje i sa strukom i sa pacijentima?!?!  Da li je ijedan doktor u Srbiji ikada video, a kamoli uradio, noćnu hemodijalizu, osim ako nije vanredna zbog viška vode ili kalijuma, koje nisu redovnom dijalizom izvukli. Pa oni ne postižu ni ove standardne dijalize da nam urade kako treba, ali ih to nije sprečilo (niti se stide) da nadmeno laprdaju o belosvetskim eksperimentima i egzibicijama.

Ko je normalan mogao za pacijente, laike, odabrati ovakav naslov Teme: „Racionalna primena antikoagulantne terapije kod bolesnika na hemodijalizi: nefrakcionisani heparin vs LMW heparin“? Da li ijedan pacijent u Srbiji uopšte zna šta je to LMW heparin, (lomljiv?), i šta mu znači ono „vs“, a nije „viša sprema“, ni „viša sila“, a ni „viša sestra“?

Zamislite pamet organizatora koji poziva „pacijente zainteresovane za svoju budućnost“ da dođu na „predavanje o ranoj smrti“ !!!  Da, to je bila tema za pacijente: „Rana smrt nakon započinjanja lečenja hemodijalizama?“  Da li više volite RANU smrt, odmah nakon započinjanja ili pak, ovu KASNU smrt, posle započinjanja? Ej, organizatoru, genije si, i ti i tvoji predavači.

Srećom pa na ovakva predavanja ne ode ni 5-6 pacijenata od 5000 koliko ih u Srbiji zvanično ima. Ali, nije tu nikome problem što pacijenti bojkotuju ovakve gluposti, važno je da se uzmu pare. Pare je neko izdvojio i one se preko ovakvih manifestacija „legalno“ podele: malo učesnicima, a više organizatorima.

Posećenost, ciljevi, rezultati, – idi begaj, ko te pita za to?

A tek igre za pacijente. Ono kao pikado na vratima nečije garaže, ili stoni tenis i boćanje, pa podela nekih smešnih plastičnih peharčića.  I diploma.  Svi vole pehare i diplome.  A tek Zahvalnice.  Ima li ijednog važnijeg stručnjaka ili funkcionera, kome nisu uvalili neku Zahvalnicu? Uokvirenu.  Sa pečatom Udruženja.  To kod budala ostavlja baš onako, jak utisak. Ali, stvarno.

Pacijenti se malo izpikadiraju, a organizatori bogme i zarade. Niko nikada tu ništa nije čačkao. Igre će biti ponovo, najverovatnije u Banji Koviljači, tamo imamo sve uslove, a znam i ljude koji će nam pomoći. Puno znači to kad imaš svoje ljude, na pravom mestu. A pare za organizaciju? A, lako ćemo za to. To je sve odobreni Projekat, zvanično. I u Fondu i u Ministarstvu. Ima da bude 200 učesnika, u svakom slučaju, ispod 100 neće biti, pa kad se sve sabere, igre su prava stvar.

Kradu na sve strane

Da li ste se ikada zapitali otkuda pojedinim dijaliznim pacijentima ili udruženjima pare za „časopise“ za pacijente? Pazite, skupocena štampa, kolor masni papir, tridesetak stranica, sa masom fotografija unutra. To ne može biti ispod par hiljada evra, cena. Ko to plaća? I zašto to plaća? Čemu to uopšte služi? Za dobrobit pacijenata? Ili za dobrobit onoga koji time maskira neke svoje prihode? Ne treba biti mnogo pametan, da bi se zaključilo o čemu se tu radi.

Nažalost, mnogi pacijenti (čitaoci i članovi) ni toliko (malo) pameti nemaju da bi to shvatili. Ko stoji iza štampanja tih časopisa, koje firme, fondovi, udruženja i pojedinci? Otkuda silne reklame dijaliznih firmi, njihovih proizvoda, njihovih doktora i sestara, u tim „časopisima“? Zašto su časopisi puni fotografija glavnog urednika (u stotinama poza), njegovog mikrofonskog obraćanja „urbi et orbi“ i beskrajnih tlapnji uvek o jednom te istom, ali nikada o suštinskim (konkretnim) problemima dijaliznih pacijenata.

Da li su „urednici“ ikada pomislili da te pare koje obrću oko štampanja jednog jedinog broja uplate nekom nesretniku, pacijentu, za lekove, za hranu, za socijalnu pomoć, da konkretno pomognu bilo kome, bilo kada? Ovaj naš sajt je pokrenuo i ispratio akciju kojom je porodici siromašne bubrežne bolesnice KUPLJENA KUĆA, (kuća, hej!) za cenu od nekoliko brojeva tih časopisa, čiji je sadržaj, u većini slučajeva: obično reklamersko smeće.

Da li urednik, redakcija ili organizatori, zaista sve te poslove oko pripreme časopisa mukotrpno rade dobrovoljno, provodeći dane i sate, bez ikakve nadoknade? Rukovođeni samo svojom sujetom, da se prikažu kao humanitarci, ili i oni tu imaju konkretan finansijski dobitak? Kako se taj dobitak ostvaruje i da li se, i kome, prikazuje?

Pogledajte samo fotografije prisustvujušćeg članstva, dijaliznih pacijenata i druge publike na tim „skupovima“ i „edukacijama“. Pogledajte samo ta turobna lica nesretnika koji ni pred objektivima fotoaparata ne mogu namestiti (makar lažno) oduševljenje temom i predavačem.  Tranzicija, naših para u tuđe džepove, se oseća u vazduhu.

Odusevljenje publike temom i predavacem

Zamislite drskosti organizatora koji eksploatišu psihičke tegobe dijaliznih pacijenata i organizuju im kontinuirane svakonedeljne „radionice“, „seanse“ sa familijarnim (porodičnim) psihoterapeutom, a sve navodno „besplatno“. Zaista, samo psihički i mentalno nenormalni pacijenti mogu poverovati da je sve to čisto dobrovoljni i humanitarni rad i da iza toga nema nikakvih finansijskih tokova. Inače, organizatora i funkcionera Udruženja bolesnika nikada nema među slušaocima ili polaznicima tih radionica i seansi. Njima psihoterapeut ne treba! Oni tih tegoba nemaju!

Ko ovde ne poludi taj nije ni bio normalan

A kradu na sve strane. Gde i od koga stignu. Već pre godinu dana dobismo dojavu da se sa našeg sajta skidaju kompletne tabele namirnica i dijetnih preporuka i doštampavaju kao prilozi uz „časopise“ za pacijente. Naravno, nigde nisu naveli odakle ili od koga je to ukradeno, tj. prepisano, iskopirano. Uvažena mlada doktorka iz Novog Sada, „upošljenik“ (zna se) Frezenijusa, ladno uzela slajdove iz našeg posta o gvožđu, objavila to u „Nefro“ časopisu i potpisala kao svoj rad. Sliku svoje glave stavila na početak, naravno.

U najnovijem broju istog „časopisa“ ukradoše nam 4 stranice našeg teksta o gvožđu, prvi deo. I ne potpisaše nas. Ajde što ukradoše, ako je to učinjeno „za dobro pacijenata“ (a da li je?), pa i da oprostimo, neka ih, neka objavljuju, ali bar su mogli tačno navesti izvor, sajt odakle kradu.

Sestra Dušica Branković, iz Bora, neka lepuškasta sestrica, sudeći prema priloženoj joj sličici, poskidala sama (ili joj je neko poskidao) cele pasuse iz našeg posta Rad medicinske sestre u hemodijalizi, kao i sa postova o punkciji krvnih pristupa – i to potpisala kao svoj tekst!

Tako mlada, a već krade (Što reče jedan nefrolog, saradnik našeg sajta: „Tako mlada, a već Nada“). Ajde da pola od onoga što je pokrala i objavila zna da primeni, pa da i njoj oprostimo, ali imamo dojavu i iz Bora da ni tamo ne dezinfikuju uvek aparate između dve hemodijalize! Pa ti sad dušice, proučavaj prepisano i potpisano, u odnosu na realno, pa smanjuj razliku.

Jedan drugi „časopis“ za pacijente, u kojeg smo polagali puno nade i promovisali ga i na ovom sajtu, časopis koji je trebao biti naš saradnik i saveznik u razbijanju kriminala i korupcije u oblasti dijalize, takođe pokazuje sve značajnija „zastranjivanja“. S jedne strane govori o stvarnim problemima u oblasti dijalize, a onda unutra vidimo pune stranice fotografija onih koji su najodgovorniji za to stanje, i u dijalizi i u transplantaciji. Sa stranica najnovijeg broja „našeg“ časopisa sad nam se osmehuju upravo oni likovi koji su doneli kriminalne Pravilnike (kojima su 50% pacijenata bili stavili na niskopropusne dijalizatore, a do dana današnjeg ne dozvoljavaju više od 20% hemodijafiltracija, kojima bi se smrtnost dijaliznih pacijenata već smanjila za trećinu! Zamislite, ironije i cinizma, da se takvi nama smeškaju sa stranica „našeg“ „časopisa“. Oni koji mesečno primaju kažu, 12 000 evra za svoj krvavi učinak, na nama. Plus zarada od sopstvene poliklinike koja beleži 3000 pregleda mesečno, plus stara (smb) penzija od 600 evra, koja mu dođe onako, samo za cigarete. Eto, to su nam „istorijski“ likovi, „najzaslužniji“ za razvoj naše dijalize i transplantacije, dovedenih u stanje u kojem su i sada, a pazite, rekli smo: stanje.

Zaista, može li postojati ikakvo opravdanje za takav potez redakcije, uredništva „časopisa“, osim ako nije u pitanju totalni gubitak osećaja za meru i pijetet prema žrtvama pomenutih likova. Zamislite da je nekome palo na pamet dovođenje Ajhmana u turistički obilazak Aušvica, i slušanje njegovog predavanja o tome kakve su oni sve probleme imali u „realizaciji“ svojih, po njima, nesumnjivo legalnih zadataka. „Oni su samo radili svoj posao, drugi su odlučivali“. To je ta priča.

Da, zaista je zaprepašćujuće videti fotografiju mladog i nevino nasmejanog doktora, dok u tekstu mirno pominje „prilagođeni rizik od umiranja“ dijaliznih bolesnika (?!). Da li je on normalan?  A za visokopropusne membrane i hemodijafiltraciju reče da one „hipotetički“ povećavaju uklanjanje uremijskih otrova, ali samo „hipotetički“. Zar mu je bilo teško da skokne do laboratorije i odnese uzorak krvi pre i posle hemodijafiltracije i obične hemodijalize, i da proveri beta-2-mikroglobulin u tim uzorcima. Da prekine i patetiku i hipotetiku? E, to mu već šefica (verovatno) ne bi dozvolila. Moglo bi se ispostaviti da dijalizatori koje ona decenijama nabavlja (zna se od koga) uopšte nisu ni najefikasniji, ni najmanje toksični. Ali, o čemu mi pričamo? Pa u tom centru još imaju miševe i guštere (!) u prostorijama gde se dijaliziraju pacijenti (opet dojava). A na šta im liči hrana za pacijente da se i ne govori (isto dojava). Ali, sve to nije sprečilo lekarskog junošu da se sav ozaren nacrta na pola strane i predstavi nam svoju kompilaciju naprevođenih „stručnih“ budalaština kojima su ga nakljukale dijalizne kompanije sponzori „najuglednijih“ svetskih stručnih časopisa. Ni reči nije rekao naravno o argumentima koje je (na našem sajtu) izneo Carl Kjellstrand, jedan od najvećih poštenih nefrologa koje je svet ikada imao. A za domaći, jedinstveni slučaj,  Pravilnika o dijalizi  kojeg je donela i potpisala njegova šefica, znamo zašto ne sme ni da ga pomene, a kamoli da ga komentariše. I pored svega toga usudio se da „svoj“ uradak predstavi kao savete pacijentima koja je vrsta hemodijalize za njih najbolja (?!). Evropski vodič za dijalizu je međutim, to definisao još 2007 godine:

evropski-vodic-za-dijalizu

Pošto je toliko očigledno, da su svi u dijaliznim „časopisima“ zauzeli pozu: „ni luk jeli, ni luk mirisali“, nikoga nije začudilo da su oba domaća dijalizna časopisa doneli cela poglavlja baš o luku.

Da je živ, Frojd bi rekao da je iz njih progovorilo „kolektivno nesvesno“ (ponašanje), obrazac kojeg su odlično naučili i prenose ga generacijama sledećih dijaliznih „upošljenika“. Niko se od njih uopšte ne oseća nimalo odgovornim, nizašta. E, zato nam i poturaju i beli luk u sred dijaliznog časopisa, valjda da potisnu „zadah belih odaja“, o kojem je legendarni Bane Vukašinović jedini progovorio, doduše pred svoju smrt.

Prava-tema-za-dijalizu

Šta će tekstovi o belom luku i kantarionu u „časopisu“ za dijalizne pacijente? Pacijente koji nemaju obaveznu dezinfekciju dijaliznih aparata posle prethodne smene, za pacijente koji se dijaliziraju noću u nedoba i dolaze sa dijalize kući iza ponoći, koji se dijaliziraju na starim i davno dotrajalim aparatima, u prenatrpanim prostorijama bez osnovnih higijenskih uslova, sa reverznim osmozama koje niti ko kontroliše, niti ko održava, sa doktorima koji ne ulaze u sale za dijalizu, sa sestrama koje pola radnog vremena provedu u ha-ha-ha-ha, a drugu polovinu u hi-hi-hi-hi razgovorima, sa dijalizatorima koji su toksični, puni bisfenola, sa apotekom koja nikada nema dovoljno rukavica, sterilnih tupfera i nealergijskih flastera. Za te pacijente još uvek nema nikakve fizikalne rehabilitacije, ni u jednoj banji u Srbiji, niko neće da instalira ni jedan jedini aparat za dijalizu, o odlasku na more ne mogu ni da sanjaju, a o programu radne rehabilitacije ili povratku radne sposobnosti, niko i ne govori. Zašto imamo tako ogroman broj plasiranih katetera za hemodijalizu, zašto ne postoji hitna vaskularna hirurgija, zašto ne postoje multispecijalistički stručni timovi za dijalizne pacijente? Zašto niko od načelnika dijaliznih centara nije hteo da pošalje uzorke vode na besplatno pravilno testiranje? Zašto jedna firma i dalje drži 70% prodaje celokupnog dijaliznog materijala, a sama šalje dopise da njihovi dijalizatori mogu da izazovu sve moguće tegobe uključujući i smrt pacijenta?

A onda se svi kao čude, zašto su u javnosti tako negativne predstave o hemodijalizi? Zato gospodo, što se tamo niko ne oseća odgovornim ni za šta! Ljudi umiru kao snoplje, ali pošto uglavnom umiru od srca, od šloga, od krvarenja ili od sepse, onda se nefrolozi ne osećaju odgovornim, nego krivicu prevaljuju na druge specijaliste, na kardiologe, na neurologe, hirurge ili infektologe, koji se bave tim oboljenjima kod nedijaliznih pacijenata. I na kraju, na svu tu muku, u dijalizne centre nam neko dostavi najluksuznije opremljene „časopise“ za pacijente, sa sve tekstovima o značaju naših istaknutih medicinara i belog luka, zajedno.

Možda tako i treba.

Pre par meseci nas je jedan čitalac pitao:

Da li smo mi kao redakcija već dostigli onaj stepen poštenja koji se graniči sa glupošću?

Verovatno, jesmo.

Zato na kraju, umesto muzičke podloge, daćemo Vam još jedan odgovor.

Odgovor na pitanje iz podnaslova ovog teksta.

– Zašto vredna pčelica kidiše na cvet?

– Zato što je cvet medom obojet.

Uživajte u čitanju.

Zzzzzzzz…

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https://www.youtube.com/watch?v=wZnHGfnbmQo

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A kada vam se pojave opisani humanitarci, da zatraže sponzorstvo, donaciju, podršku, materijal, usluge, predavanje, ishranu, krečenje, snabdevanje, bilo kakav prilog, za dijalizu, za teške pacijente, za njihovo Udruženje, Savez, Ligu, Podružnicu, i sličnu Organizaciju, mi vam preporučujemo da dobro razmislite, pa ako ustanovite da su vam se obratili ili su vas posetili baš ovi ovde opisani – vaš odgovor mora biti kristalno jasan i jednostavan:

https://www.youtube.com/watch?v=6mFVG0imqJM

DiaBloG – 2016

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Još sličnih tekstova:

Popravljalo Pravilnik, Ponovo

Neodržani govor povodom Svetskog dana bubrega

Hleba i Igara, a za dijalizu šta nam daju

Otkrivamo: ko su novinari, mediji, doktori i bolesnici koji zastupaju interese dijaliznog privatnika?

Zašto udruženja dijaliznih bolesnika u Srbiji ne smeju nikada nijednu reč da kažu protiv firme Fresenijus?

Šamar državnom zdravstvu na koji nije odgovoreno

Ko koga i kako pljačka u dijalizi?

.

Istine radi

dužni smo reći da smo dobili i izvinjenje redakcije Dijaliza časopisa, a kažu da su i na svom sajtu objavili isto izvinjenje i da su priznali da su od nas uzimali cele pasuse ili tekstove.

OK. Nije problem, prihvatamo sve. Naš stav je vrlo jednostavan. Ako neko od medicinara u praksi radi sve kako piše na našem sajtu, može slobodno i da se potpiše ispod tih tekstova kao da i jesu njegovi. Mi nismo sujetni. Važno nam je samo da se stvari u dijalizi počnu poboljšavati.

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Došla Fikretova tetka po gramofon, ili: Država počela da istražuje Rajkov Fresenius

K O N A Č N O.

Poštovani čitaoci,

prošlo je svega (?) nekoliko godina od kada smo vam (proročanski) najavili da će doći vreme kada će se o dijaliznim mahinacijama (o kojima za sada jedino ovde možete čitati), govoriti i na II Dnevniku državne televizije.

Najavili smo (priželjkivali i navijali) da će doći vreme kada će policija zakucati na vrata korumpiranih činovnika, korumpiranih profesora, korumpiranih doktora i korumpiranih Predsednika udruženja pacijenata, i kad će se ceo taj sistem pljačkanja državnog zdravstva i države Srbije, srušiti kao kula od karata.

U to doba – niko nam nije verovao!

Govorili su: niste normalni. To je Fresenius – najveća i najmoćnija dijalizna korporacija u istoriji dijalize. Njena godišnja zarada višestruko premašuje srpski bruto društveni proizvod. Završićete u jarku – a ništa nećete postići. Iza FMCa stoji nemačka država, američki kapital, zapadna beskrupuloznost, a vi: šaka zviždača, lupača u šerpe, čiji je čak i sajt na američkim serverima, dakle njima dostupan. Nemački ambasador ne izbija iz Premijerove kancelarije, zajedno lopataju po srpskoj zemlji, otvaraju po šesti put iste proizvodne kapacitete, koje država Srbija subvencioniše, čitaj: mi svi to plaćamo.

Ukazivali su nam na alternativne mogućnosti: da ćutimo, da preusmeravamo kritiku i da još i zaradimo. Umesto da kritikujemo zapadne beskrupulozne profitere, treba da kritikujemo nesposobnu državu Srbiju, njene poharane bolnice, nestašice – treba zapravo da pripremamo teren za privatizaciju. I (zapadni) Bog će da nas vidi.

Dobili bi sredstva, došle bi pare za sve vrste aktivnosti, imali bi svoje novine, svoj sopstveni sajt, ne bi silazili sa TV B52, štampali bi knjige, knjige o dijalizi bi nam pisali naši pismeniji pacijenti, a lekari bi nam nastupali na predavanjima i mi bismo njima za to davali honorare.

Pogledajte samo uspešne (dugogodišnje) primere Zvonka, Miška i sličnih, za koje je zapadni Donor heroj, a državno zdravstvo najcrnje zlo, koje treba probiti glogovim kolcem, da se više nikada ne povrati taj odvratni sistem u kome će svi imati hemodijafiltraciju. Ovako, lepo se zna: hemodijafiltracija je samo za FMC bolnice i samo za Uticajna udruženja, kao što je ono Zvonkovo, gde HDF nema samo onaj ko je nije ni tražio, a takvih je malo. Svi drugi, oko 90% Zvonkovih imaju HDF. A za državne centre kažu da im je i 20% previše. Oni se bore svim silama da se državni dijalizni centri unište, da se privatizuju, da dođe stranac i da im donese obećano zdravlje, čistoću, urednost, rad, red, sigurnost, itd. itd.

Da, oni žele da naš život uređuje onaj isti stranac koji nas je tako lepo gasom uspavljivao na tom istom Novom Beogradu, koji nas je vešao po Terazijama i streljao po Banjicama, Jajincima, Šumaricama, po evropskim standardima, u koje se mi nismo nikada uklapali, iz prostog razloga što mi nismo ONI.

Ali, neki naši Predsednici udruženja pacijenata, ne odustaju. Žele da oni budu ti koji će nas postrojavati za uspavljivanje i streljanje (jer stranci uvek nađu nekoga da im pomaže u tim prljavim poslovima), a zauzvrat za sebe traže povlašteni položaj i sitne privilegije. Žele da oni budu ti „lojalni“ Srbi koji će na Terazijama piti kafu dok se iznad njihovih glava njišu oni obešeni Srbi, ti „obešenjaci“ jedni, lude glave koje su se drznule da zajebavaju veliki evropski rajh, NATO, protestantsku etiku, Milosrdnog anđela i druge zapadne vrednosti, našu budućnost i prevashodnost.

I tako dalje, i tako dalje, no da se vratimo neposrednom povodu za ovaj Uvodnik.

(Čim spomenemo Zvonalisa i Miškolca, naša mala redakcija proključa od emocija i onda evo Zapisničar ima pune ruke problema da ih vrati na osnovnu temu, zbog koje smo se danas i okupili, a to je: ISTRAGA).

Pokrece se postupak..

za detalje, kliknuti na:

http://www.kzk.gov.rs/kzk/2015/07/Zakljucak-o-pokretanju-postupka-Fresenius-Medical-Care-Medicon.pdf

Dakle, najavili smo da će doći vreme kada će se o mahinacijama o kojima samo ovaj sajt piše, govoriti i na II Dnevniku državne televizije. I to se konačno desilo. Doduše, nije baš na II dnevniku, ali se progovorilo u Službenom glasniku Republike Srbije.

A kud ćeš zvaničniji državni organ od Službenog glasnika Republike Srbije ili recimo, sajta državne Komisije za zaštitu konkurencije (prenosimo originalni tekst):

Саопштење за јавност о покретању поступка испитивања повреде конкуренције против привредних друштава Fresenius Medical Care Србија д.о.о и Medicon д.о.о.

22.07.2015

Комисија за заштиту конкуренције је покренула поступак испитивања повреде конкуренције по службеној дужности, против привредних друштава Fresenius Medical Care Србија д.о.о и Medicon д.о.о. и њихових специјализованих болница за хемодијализу, ради испитивања постојања рестриктивног споразума из члана 10. Закона о заштити конкуренције, којим се ограничава конкуренција на тржишту пружања услуге хемодијализе у Републици Србији.

Fresenius Medical Care Србија д.о.о и Medicon д.о.о. и њихове специјализоване болнице за хемодијализу су, према доступним информацијама, једини приватни здравствени центри који могу да понуде пружање услуге хемодијализе у Републици Србији за осигурана лица Републичког Фонда за здравствено осигурање, за која не постоје капацитети за лечење у здравственим установама из Плана мреже РФЗО. Наведена привредна друштва су у једном периоду су подносила заједничке понуде у поступцима јавних набавки за пружање услуге хемодијализе, чиме је у потпуности искључена конкуренција између ових учесника на тржишту. Након престанка заједничког учешћа, ова друштва су подносила одвојене понуде, али одређене чињенице и околности указују да су наставили да координишу своје учешће у поступцима јавних набавки, што, уколико се потврди у испитном поступку, представља ограничавање конкуренције на релевантном тржишту. На основу претходно наведеног, Комисија је основано претпоставила постојање повреде конкуренције забрањеним договорима о учешћу у поступцима јавних набавки, које спроводи Републички Фонд за здравствено осигурање за пружање услуге хемодијализе осигураним лицима РФЗО.

Комисија ће у испитном поступку предузети доказне радње у циљу утврђивања одлучних чињеница, које су од значаја за оцену постојања повреде конкуренције.

Комисија и овом приликом истиче да откривање и санкционисање картела, а нарочито намештених понуда у поступцима јавних набавки, представља приоритет у раду Комисије из разлога што ова врста рестриктивних споразума представља најтежу повреду конкуренције, којом се искључују све користи од конкурентског надметања на тржишту, повећава потрошња буџетских средстава институција које спроводе јавне набавке и ограничава могућност избора производа/услуга.

Комисија користи прилику да свим учесницима на тржишту још једном скрене пажњу на законску могућност да буду ослобођени плаћања мере заштите конкуренције (која износи до 10% укупног прихода), односно да им иста буде умањена, уколико Комисији пријаве постојање споразума и/или доставе доказе који ће омогућити доношење решења о повреди конкуренције из члана 10. Закона. Програм „имунитета“ је уређен чланом 69. Закона о заштити конкуренције и релевантним подзаконским актима (Уредбом и Смерницама Комисије) који су објављени на интернет страници Комисије http://www.kzk.gov.rs.

Eto, toliko od zvaničnih državnih organa Srbije.

Prekardašilo, dakle, i po njima.

Podsetićemo čitaoce, sve je počelo od žutih, od Šunatovca, pa kao nekih Slovaka (kojima je FMC ustupio, pazi FMC nekome da ustupi nešto, 13 mašina za hemodijalizu, u Ustaničkoj 63, Vukajlovićevka to aminuje u ime Fonda, i onda tako krene privatni dijalizni biznis u Srbiji. Zamenik Načelnika VMA, protiv kojega je njegov šef general Jeftić već bio sakupio dosta krivičnog materijala, odjednom daje otkaz, Šunatovac i Ponos mu srede da ipak dobije penziju, ali odmah prelazi i sada otvoreno radi za Fresenius, odvodeći sa sobom još 2 stručnjaka sa VMA, dva uzima sa Zvezdare, plus ostala deca funkcionera i direktora koja su već radila u Freseniusu, i tako pare krenuše iz RFZO, u privatne i stranačke džepove. Za direktora bolnica postavljaju lice iz polukriminalnog miljea, čoveka koji se otvoreno hvalio da je „radio tekstil“ iz Italije, sa Arkanom, zatim „vodio“ turističku agenciju, pa ga je to preporučilo i da rukovodi sa 5 dijaliznih Fresenius bolnica u Srbiji. Kada mu je prvi doktor odbio da radi protiv medicinske etike i da zbog beznačajne „uštede“ ne želi da ubija pacijente, taj direktorski mafijaš mu je ladno rekao: „Pa šta ti misliš, zašto si dobio platu od 3 000 evra? Zar zaista misliš da tvoje ZNANJE nama vredi toliko? Ovde se bato, od tebe očekuje da ZARAĐUJEŠ firmi, pa ako to traži i neke lične rizike, onda si zato i plaćen: da lakše podneseš taj rizik i da nam namičeš pare! Ako nećeš, onda knjižicu u šake i put pod noge!“

„Ali, nismo se tako dogovorili, kad smo pregovarali oko moga prelaska…“ – zavapio je Medicinski direktor Fresenius bolnica u Srbiji.

„Tačno je, nismo – odgovori mu Hrvatčević, i dodade: dobro došao u kapitalizam!“

Dakle, po njima, kapitalizam je sistem u kome su prevare legalna stvar. Potrebno je samo „pravnički“ to uobličiti, tako da uništeni ne može firmi ništa. To se npr. može uraditi tzv. Aneksima ugovora. Ko god ti se ne sviđa, a ti njemu aneks … Na kraju će primati manje nego u onoj državnoj bolnici iz koje su ga dovukli u Fresenius. To je kapitalizam.

I, eto, sve biva, jedno vreme …

Pa posle, ne biva.

Ali, taj osećaj …

Kad su shvatili da dolazi ISTRAGA…

T-a-j    o-s-e-ć-a-j,

j-e    n-e-o-p-i-s-i-v.

Samo zbog njega vredelo je svih ovih godina, boriti se i čekati…

Taj osećaj je kao zvuk trube u vestern filmovima, Dan D, iskrcavanje saveznika u Normandiji, i ulazak Ždanova sa Crvenom Armijom u Beograd …

Zato, scene koje ćete videti u dole priloženom antologijskom filmskom ostvarenju, treba tumačiti u skladu sa aktuelnim povodom.

Islednik je došao, i kaže:

– Ah, da, zaboravih da vas pitam.

Odakle vam ovoliki profit u Srbiji?

– Dala mi tetka da spavam na njenom kauču. Mi posle otvorimo kauč i vidimo: pun para. Tako smo stekli profit u Srbiji.

– E, pa došla tetka po svoj kauč. Ali, traži i pare nazad.

Šta je Rajko, ti bi da se biješ … Ajde, ajde …

https://www.youtube.com/watch?v=3rEtnNa_wbo

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DiaBloG – 2015

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još tekstova na ovu temu:

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Šta mislite: koji organ nikada neće imati svoj Svetski dan?

I bi dan:  Svetski  dan  bubrega.

Poštovani čitaoci,

Šta mislite: koji organ nikada neće imati svoj Svetski dan?

Ako ste pomislili na onaj organ, predmet ginekološkog ili urološkog izučavanja, varate se. Nije to.

Mozak, tačan odgovor je: mozak.

Mozak nikada neće imati svoj svetski dan.

Onima koji prave i određuju te svetske dane, ne odgovara da ljudi uključe mozak i da počnu da ga koriste. To bi moglo biti opasno za njihov naum, to bi moglo da im ugrozi biznis. Jer, i iza Svetskog dana bubrega stoji zarada belosvetskog ološa.

Pare, gospodo, pare.

Iza svake takve kampanje je najobičnija preraspodela ili otimanje para.

U početku smo mislili da je to najobičnija pokondirenost, kaćiperstvo. Ono kao: „videla žaba da se konji kuju, pa i ona …“ Slepo imitiranje ili prihvatanje svega što nam nameću sa Zapada, a što sa nama ili našim tradicijama nema nikakve veze. Imate hiljade sličnih primera okolo, a najnoviji je odluka o proslavi Dana svetog Patrika u Beogradu (mi kad se uvlačimo, ne ostavljamo ni cipele napolju). Tako i za taj nesretni dan bubrega, do pre neku godinu niko od nas nije ni znao ni čuo.

Pored toliko značajnih datuma iz naše nefrologije, pored toliko velikih nefroloških ličnosti (kakav je npr. bio Dr Vasilije Jovanović), mi smo potrčali da preuzmemo neutemeljeni, klizni datum, svake godine drugi četvrtak u martu. Tako nam odredilo!

Da li smo bili zastupljeni, da li smo učestvovali u radu tog tela koje nam je tako odredilo? Nismo.

Da li su druge države ili nacije učestvovale u određivanju datuma i ciljeva te kampanje. Nisu.

Ali smo izbombardovani i ubijeni u pojam, među prvima potrčali da „uzmemo učešća“, jer to je baš ono – svetski.

Svetski, a naše. (To nam je kažu najbolja marketinška rečenica, eto dokle smo došli).

Dakle, mislili smo da su srpske bolesničke Feme izmilele ponovo iz Sterijinih komendija, da su naši Jovani poželeli da budu Johani, da su i bolesnici i medicinari hteli da sakriju praziluk koji im iz dupeta viri, pa navukoše na sebe kartonske ploče sa belosvetskim natpisima o bubrezima. Znate ono, kad balkanske praznoglave starletutke nazdravljaju za mir u svetu …    A kojekakva medicinska spadala, kao onaj Dr Filguz, iskoriste priliku da se slikavaju …

Mislili smo, ali osećamo da nije samo to.

Pa smo pomislili: glup i naivan, priprost taj naš narod. Iz najbolje namere se uključio u nešto, zanesenjaci, idealisti jedni. Ono kao, socijalisti-utopisti. (Socijalisti koji su svoju brigu za narodna prava utapali u viskiju). Ovo podneblje je oduvek bilo pogodno za izrastanje svakojakih prosvetitelja, usrećitelja, ljudi sa misijom, sa vizijom, sa propagandama najgore vrste.

Pa tako privukoše i nas, na priču o značaju prevencije, na potrebu skretanja pažnje, na razmišljanje o problemu, takozvano: podizanje svesti ili preumljenje.

Da se Vlasi ne dosete.

U zemlji u kojoj se ništa ne podiže: ne podiže se porodica, ne podižu se fabrike, ne podiže se proizvodnja, promet, školstvo, nauka, ništa … ne podiže se buna, ne podiže se ni jedna jedina stvar, oni bi da podižu svest.

O značaju bubrega.

Jedan. Jedan jedini dan, u godini, će da razmišljaju o bubregu. Ili o oba bubrega.

I posle ništa.

Trista šezdeset četiri dana nerazmišljanja. Ni o čemu, a pogotovo ne o bubregu.

Pa već to je bilo dovoljno da razumnima pobudi sumnju, u dobronamernost „akcije“.

Kome drugi određuju kad i šta treba da misli, njemu mozak i ne treba. Treba samo da se pridruži armiji podražavalaca, imitatora, sledbenika Novog Svetskog Poretka. A njima je Veliki brat odredio šta svakog dana treba da promišljaju i izričito je zabranio da imaju ikoga drugoga božanstva sem njega jedinoga.

Zvuči Vam poznato, zar ne.

Tako dođosmo do pravog uzroka toj inicijativi.

Dakle: pare, gospodo, pare.

Iza svake takve aktivnosti vrti se neki novac među organizatorima, izvođačima, učesnicima, sponzorima, propagatorima i inim statistima. Pa se u to kolo obavezno uključe i kojekakvi masonci, drotarijanci, centri za demokratiju, slobodne izbore, žene u sivom (50 nijansi), itd., itd…

Da li ste ikada bili na sajtovima ili Fejsbuk grupama, takozvanih Udruženja za ovo ili ono.

Sve te takozvane nevladine organizacije. One koje isisavaju novac od naše vlade, a rade za druge vlade. Nažalost, mnoga Udruženja bolesnika su se pretvorila baš u to. Društva za namicanje para nekolicini ljudi, obično Predsedniku i njemu bliskima. Da samo vidite kako se uzbude pred deljenje para iz različitih Fondova i ministarstava. Da samo vidite tu smejuriju, kad polupismeni Predsednici krenu da prave „Projekte“ za koje traže „Podršku“. Tako se zove prelivanje para, naših para, para svih nas, u privatne džepove. Džepove domišljatih pojedinaca, koji su od svoje bolesti napravili biznis.

Iz naziva se već vidi da su se polupismeni Predsednici „udruženja“ najviše pomučili smišljajući nazive tih svojih Organizacija. Na primer: „Sve za osmeh, pare ni za šta“, „Inicijativa za normalnu diurezu“, „Sivo tržište bubrezima – pedest nijansi“, „Donor-heroj, a primalac-tajkun“, „Forum za unapređenje mežububrežne razmene“, „Dole dijaliza, gore profit!“, itd. itd.

Znate već onoga u Vojvodini, koji je formirao svoje privatno udruženje, štampa ilustrovani časopis šurujući sa farmakomafijom, pa u svakom broju objavi 50 svojih slika, sve sa velikim mikrofonom pred ustima, kao on drži predavanja, edukuje pastvu, a sa medicinom ima veze toliko što je dvaput ležao u bolnici i pročitao uputstva za dijalizne bolesnike iz Večernjih novosti. Ali, on celo članstvo voda na sportske igre i zajedničke ručkove („druženja“), sve sa muzičkim orkestrom i prigodnom muzikicom za bolesničke uši. Naravno, u pitanju je orkestar njegove kćerke pa pare uvek ostaju u porodici, a bolesnici ionako ništa ne kapiraju.

E za takve je Svetski dan bubrega – kao Bogojavljenje.

Tad ili nikad.

Pa oni se mesecima spremaju za „obeležavanje“ istog. Prijavili su Projekat, odobrena su im sredstva, iskukali su još nešto od opštine, od Sponzora, od apoteka, od privatnika, od humanitarnih organizacija, pa su našli nekoliko praznoglavih „volontera“, dobrovoljaca, naivnih i obmanutih „aktivista“ koji će deliti letke, štampati plakate, meriti pritiske ili šećere, nije ni bitno. Bitno je da se od tog „obeležavanja“ zadrži pooveliki deo „sredstava“, za sebe.

Eto zašta služi Svetski dan bubrega. U manipulacije sa boleštinama, sada su se pored medicinara, farmaceuta, političara i raznih drugih profesija, uključili i sami bolesnici. Pare su čudo. Ljudi su spremni obogaljiti sopstveno dete da bi prikupljali novac „za njegovo lečenje“.

Kad pogledate držanje tih „dvostrukih“ bolesnika, vidite da oni tu ne vide nikakav problem. Oni ne osećaju krivnju. Zaboga, oni rade isto što i medicinari, farmakomafija, političari i svi ostali koji žive od boleština. Pravih ili stvorenih.

Da zadržimo za sada, u fokusu, samo Dan bubrega, kao takav.

I da razjasnimo, ono što vas najviše interesuje: šta ćemo mi, dijalizni bolesnici u svemu tome?

Jer, iz dosadašnjih „obeležavanja“ videsmo da su dijalizni bolesnici bili ključni, ako ne i jedini učesnici tih morbidnih poklada.

To je ono što vređa zdrav razum.

Šta će dijalizni pacijenti na promociji sprečavanja bolesti bubrega?

Da izigravaju strašilo, da uplaše prolaznike dokazujući šta će im se desiti ako ne piju dovoljno tečnosti?

Da li ima išta otužnije na kugli zemaljskoj nego gledati kako dijalizni bolesnik priča u kameru kako treba unositi dovoljno tečnosti u organizam. To priča on koji je povazdan žedan, kojemu su odricanje od vode nametnuli kao glavnu terapiju. Tragedija, šta drugo reći.

Šta će dijaliznim pacijentima (ciljano za njih planirano) predavanje u Kolarcu: Kako sačuvati bubrege?

Zaista, kako da sačuvaju bubrege ljudi kojima su bubrezi već propali? Oni koji idu na dijalizu, doći će na predavanje da čuju kako da sačuvaju bubrege? Da nije malo kasno?

Da imamo svog domaćeg Riplija, da ovo beleži i prevodi svetskim agencijama, verujemo da bi nas ismejavali od Kejptauna do Vladivostoka. A i šire.

Ajde, da je tema kako da sačuvaju krvni pristup – to bi imalo smisla, itekako.  Ili: kako poboljšati kvalitet lečenja dijaliznih bolesnika. Ali, tih tema nema, i neće ih ni biti. Nije cilj nešto popraviti ili iskoreniti, rešiti problem. Ne. Cilj je zarađivati. Vrtiti priču i uzimati pare. Nisu bitni rezultati, nego marketinška predstava koju prodamo narodu. Jer, ako ostvarimo rezultate, prihodi će jednoga dana prestati. Da li stvarno mislite da je to na pameti onih koji godinama žive od tuđe ili svoje bolesti. Ne.

Pogledajte prethodne kampanje za prethodne Svetske dane bubrega. Nikakve rezultate nisu dale. Ono što se pričalo pre 5 ili deset godina i danas se može ponovo pustiti, opet bi bilo aktuelno.

Pare se daju za širenje straha. Ili kako režiseri ovih predstava kažu: Za podizanje svesti.

(Na primer, jedna kampanja je bila: Zaustavite napade bubrega. Naši srpski nesretnici, sveže izbombardovani, delili su na ulici letke sa bukvalnim prevodom engleskih parola, pa je na tim lecima pisalo Zaustavite napade bubrega. Niko u našoj medicini nije znao šta su to napadi bubrega, jer je bubreg jedan miran, povučen organ, i ne napada nikoga. Ako su mislili na bolove koje bubregu pravi kamenac, onda je to bol zbog kretanja bubrežnog kamenca, a bubreg je tu žrtva, a ne agresor. Takvih budalaština sa prevođenjem nametnutih im parola, ima svake godine).  Što bi rekao pokojni Predsednik, ne napada bubreg njih, nego oni napadaju bubreg, zbog para.

Ove godine im je naredilo da kampanju nazovu: Zdrav bubreg svima.

Jeste, zdrav bubreg svima, a osiromašeni uranijum samo nekima.

Milosrdni anđeli. Oni koji su zarobljenim Srbima naživo vadili organe verovatno su i tada nudili zdrav bubreg svima, ili bar onima koji imaju pare, da plate.

Zamislite budalu kojoj je palo na pamet da natera dijaliznog pacijenta da se slika kako pije vodu i zatim pruža čašu vode drugoj osobi, pa tu sliku onda treba da „tvituje“ uz užasno blentavu, takoreći ogavnu, mantru, ceo praznoverni ritual: „Danas ja proslavljam  #worldkidneyday. Ja pijem i pružam #glassofwater zato što #isupportwkd”. Neophodno je napraviti sliku kako pijemo i pružamo čašu vode drugoj osobi, a zatim se slika  tvituje na @worldkidneyday.

Da povratiš. Čim pročitaš.

Ovi ludaci na RTS otišli su u Centar za dijalizu u Leskovac da anketiraju ženu u sred dijaliznog tretmana, pa su još naglasili da je ta žena iz mesta (neobičnog naziva) Donje Brijanje, a onda im je ona ispričala sve najpohvalnije o svom lečenju. Prosto da budeš srećan što si dijalizni bolesnik. Sa čašom vode svako jutro, obavezno.

Ne znaju da: Za svaku čašu vode zdrav bubreg ti kaže hvala,

a dijalizni bubreg: neka hvala, ne smem.

Eto, šta nam donese Delivery Unit.

Na srpskom se Delivery unit prevodi kao junica koja se porađa.

Problem je samo što je sve to na državnim jaslama.

Tragedija.

Sve navedeno može nas samo učvrstiti u uverenju,

da za dijalizne pacijente, koji još koriste mozak,

Svetski Dan bubrega može biti samo

Dan žalosti.

 

DiaBloG – 2015

 

 

 

 

Literatura:

Partneri i sponzori


 

WKD na RTS-1http://www.rts.rs/page/stories/ci/story/56/%D0%A1%D1%80%D0%B1%D0%B8%D1%98%D0%B0+%D0%B4%D0%B0%D0%BD%D0%B0%D1%81/1856825/%D0%A1%D0%B2%D0%B5%D1%82%D1%81%D0%BA%D0%B8+%D0%B4%D0%B0%D0%BD+%D0%B1%D1%83%D0%B1%D1%80%D0%B5%D0%B3%D0%B0+.html

ili:

http://www.nshronika.rs/intervju-dana/budi-donor-postani-heroj-obelezen-svetski-dan-bubrega/

ili:

http://www.blic.rs/tag/12177/Svetski-dan-bubrega

ili:

Povodom Svetskog dana bubrega, juče je ispred restorana Ruski car u Knez Mihajlovoj ulici organizovana promotivna akcija gde su zainteresovani građani mogli da dobiju odgovore od stručnjaka o svim dilemama u vezi sa bolestima bubrega, transplantacijom organa i donorstvom. Organizatori akcije su udruženja bubrežnih bolesnika i invalida na kućnoj dijalizi Renalis, Nefrološka sekcija Srpskog lekarskog društva i Centar za demokratiju. – See more at:

(http://www.danas.rs/danasrs/drustvo/novi_bubreg_na_odlozeno.55.html?news_id=185663&action=print)

Partneri i sponzori1



 

 

Sergej Lazarev: medicina u kojoj su pare važnije od morala, mora propasti!

Svetom vladaju farmaceutske kompanije, banke i osiguravajuća društva.

Ako neki lekar ili naučnik stvori novu metodu lečenja bolesti, jednostavnu, koju može koristiti bilo koji čovek, jeftinu, tada će tog lekara ili da ubiju, ili će da ga optuže i oduzmu mu diplomu. Sve se to odradi relativno lako kad je novac u centru sistema vrednosti i kad je jedini cilj ostvarivati profit.

Kada u osnovi neke funkcije ne leži ljubav i moral već novac, funkcija umire. Isto kao što sada umire današnja civilizacija. Ako je ranije glavni impuls bila ljubav, vera, religija i moral, sada je glavni impuls novac. U skladu s tim vidimo degradaciju. Medicina se degradira i umire zato što njen cilj nije da pomogne čoveku, već da zaradi novac.

Poštovani čitaoci,

u susret predstojećem prazniku Oslobođenja Beograda i planiranoj paradi tim povodom i DiaBloG je našao načina da bude aktuelan i rekli bismo: u trendu.

I mi imamo specijalnog gosta iz Rusije.

Samo za Vas,  Sergej Nikolajevič Lazarev, veliki ruski filozof, psiholog i pedagog, govori o onome što nas sve interesuje: istinu o današnjoj medicini i šta je ono što bi trebalo da nas najviše brine.

Sergej Lazarev

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Sergej Nikolajevič Lazarev je rođen 4. septembra 1952.godine. Školovao se u Moskvi i u Sankt Petersburgu, a najviše se bavio proučavanjem veze između fizičkog i duševnog stanja čoveka, te povezanosti između zdravstvenog i moralnog stanja čoveka i perspektive njegovog opstanka u savremenom svetu. Do sada je objavio 7 knjiga iz serije „Čovek budućnosti“. Deo tih knjiga je preveden na nemački, poljski, engleski, češki i bugarski jezik.

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Sergej Lazarev je veliki protivnik današnje medicine jer kako kaže, život čoveka nije u rukama lekara danas, već bankara i novca. Nedavno je održao predavanje u Sankt Petersburgu gde je ljudima objasnio kako medicina funkcioniše danas. Tamo navodi kako je lekarima potpuno zabranjeno da leče, što je potpuni apsurd, a ko se tom šablonu usprotivi uskoro umire, zatvoren ili degradiran.

Naravno, sve što Lazarev govori može se videti i u primerima kod nas. Ako doktor javno govori protiv svoje struke, uskoro biva ismejan i proglašen šarlatanom. Cilj svega ovoga je smanjenje ljudi na planeti.

Danas lekarima nije u interesu osloboditi čoveka od bolesti

Ako, na primer,  postoje neke pojave koje izgledaju potpuno nepovezano, kako shvatiti šta se događa? Da bi to razumeli, potrebno je 3 – 4 sitnice povezati u zajedničku tačku, u jedinstven logaritam. Tako nastaje ono što mi danas nazivamo razumevanje, spoznaja.

Da bi shvatili šta je bolest, treba povezati zajedno uzroke pojave bolesti, njenu funkciju i posledice. Kada posmatramo kako se pojavljuje bolest, šta je uzrok i kako se razvija, kako završava, tada možemo shvatiti šta je bolest u suštini. Šta vidimo danas?

Postoji više od 70.000 bolesti. Medicina se očajnički bori s bolestima, a njih je sve više. A uspesi medicine sve su lošiji i lošiji. U primenjenom aspektu postoje neka briljantna dostignuća, a broj teških bolesti na planeti sve više raste. Može se kao uzrok navoditi ekologija, može se govoriti o stresu, lošoj ishrani i smirivati populaciju, ali je li to baš zaista tako?

Postoji jedan ozbiljan razlog zašto se medicina danas ne može nositi s bolestima. Znate li koji? Medicini nije potrebno izlečenje bolesti. Medicina se bolesti ne želi osloboditi. Ranije je lekar pokušavao sve da izleči čoveka, a sada lekar pruža čoveku lek i račun za plaćanje usluge. I što duže čovek boluje, tim je više računa, više naplaćivanja, istom čoveku. Zato broj lekara raste, mogućnosti površnog i dugotrajnog lečenja rastu, a činjenični rezultati su sve gori i gori.

To jest, ako bi se posmatrale glavne bolesti, ako bi se pokušalo uvideti šta im je zajedničko, naći glavni uzrok, tada lekari ne bi bili potrebni, ostalo bi ih nekoliko, kao i nekoliko metoda za sve bolesti. To znači gubitak novca i radnih mesta.

Za savremeno tržište jedna od najvažnijih ideja, ideologija slobodnog tržišta su slobodna radna mesta. Što je više radnih mesta, više je novca, više je kupovine i prodaje što znači da država cveta. Isto kao što je BDP jedan od glavnih stubova države. Što se više pruža usluga stanovništvu, BDP raste. Ako se pola države razboli, biće im pružene usluge lečenja i BDP će dvostruko porasti. Prelep pokazatelj.

Sergej Lazarev5  Sergej Lazarev4  Sergej Lazarev1  Sergej Lazarev9

Medicina je i sama bolesna, ona ne može lečiti, dok se sama ne izleči

Dakle, medicina pruža platne usluge, iznutra. Podsvesno nju ne zanima izlečenje čoveka, lekar je nezainteresovan podsvesno, nije zainteresovan za izlečenje čoveka, lekar nije zainteresovan za izlečenje.

Stoga pružanje usluga raste, raznolikost raste, cene rastu, pojavljuju se novi lekovi, a bolesti su sve teže. Ako čovek ne želi nešto, to neće uzeti i neće to koristiti. Zato se danas ljudi sve više obraćaju alternativnim putevima lečenja.

Nedavno sam razgovarao s jednom ženom, ona je razgovarala s lekarom u Nemačkoj, veoma zanimljive stvari mi je rekla. Medicina je bolesna. Zbog toga je njoj teško lečiti čoveka. Medicina ne zna šta je čovek, ne zna šta je bolest. Medicina ne razume uzroke razbolevanja. Površno – da. Stvarno – ne.

Medicina nije samo bolesna. Šta se obično događa kada čovek boluje? On umire. Medicina u nekim aspektima realno počinje umirati. Kako se to odražava? Verovatno ste primetili da su u poslednje vreme, posebno u inostranstvu, lekari prestali da leče. Idete kod lekara jer imate problem, na primer u Španiji, Nemačkoj… U Izraelu sam otišao u apoteku da kupim antibiotik. Došao sam u apoteku i pitao:

– Mogu li se kupiti antibiotici?

– Ne mogu, samo na recept.

Prijem kod lekara koji će propisati te iste antibiotike je oko 100 dolara. U evropskim zemljama čoveku koji dolazi kod doktora ne propisuju lek nego konjske doze antibiotika. Površinski efekat je dobar, a šta se događa dalje, to je već drugo pitanje.

Sergej Lazarev7Doktor gleda u računar ako imate neke znakove bolesti i u tom računaru on nalazi šemu lečenja. Ako odstupi od te šeme, imaće problema. Zato lekar ne leči već je lekar dodatak računara. On propisuje ono za šta ga neće optužiti.

U Rusiji sada ta tendencija ide relativno brzo, vi to znate. Mogućnosti lekara su sve suženije, s jedne strane. S druge strane, 10 – 15% lekara dobija za propisane lekove, novac od farmaceutske kompanije. Zbog toga se propisuju skupi lekovi koji nisu uvek efikasni.

Šema je vrlo jednostavna: Tržište upravlja svetom. Tako lekari prestaju lečiti. Oni su instrument, dodatak računara. U suštini, oni su manekeni farmaceutskih kompanija koje prodaju svoju proizvodnju.

U Nemačkoj se pojavilo udruženje lekara koji su pokušali promeniti tu tendenciju. Treba odati priznanje Evropljanima, oni imaju sistemsko mišIjenje i imaju hrabrosti tražiti promene.

Dakle, Nemci koji relativno sistematično misle, šta su učinili? Njihovi lekari su počeli shvatati situaciju: Zašto je lekarima zabranjeno lečiti? Zašto moraju obavezno raditi po šemi koja je izložena u računaru?

Ispostavilo se da se doktor boji sprovesti lično lečenje, zato što će ga optužiti. Ko će ga optužiti? Osiguravajuće društvo. Zašto će ga optužiti osiguravajuće društvo iz bilo kojeg razloga, zbog bilo kojeg odstupanja od striktnog šablona? Zato što osiguravajuće društvo radi u paru s farmaceutskom kompanijom. Osiguravajuće društvo se dogovara s farmaceutima koje lekove treba prodavati. To se unosi u pravni registar i zatim lekar ne može ništa učiniti.

To nemačko udruženje lekara tužilo je farmaceutske kompanije i osiguravajuća društva. Dobilo je na sudu. Sada je dozvoljeno, samo predstavnicima tog udruženja lekara, da stvarno leče. To jest, osiguravajuća društva i farmaceuti su u određenom stepenu izgubili vlast nad njima. Jedino se tako može početi prava medicina.

Šta možemo zaključiti? Kada u osnovi neke funkcije ne leži ljubav i moral već novac, funkcija umire. Isto kao što sada umire današnja civilizacija. Ako je ranije glavni impuls bila ljubav, vera, religija i moral, sada je glavni impuls novac. U skladu s tim vidimo degradaciju. Medicina se degradira i umire zato što njen cilj nije da pomogne čoveku, već da zaradi novac. Ako želimo pomoći čoveku moramo razumeti šta je čovek u suštini.

http://www.youtube.com/watch?v=xVOUliuGbxs

http://www.youtube.com/watch?v=xVOUliuGbxs&list=UUq7fmiqaTtysGtyMJfKnunw

Čovek je pre svega božanska iskra, to je večna duša, a potom svest i telo. Znači da bi se izlečio, čovek pre svega treba pomoći svojoj duši. Kada se medicina zamisli o postojanju duše i njenoj pomoći, tada će oživeti i neće umirati. Za sada vidimo suprotnu tendenciju.

Ko se usprotivi, biće ubijen

Šta se sada događa? U celom svetu vlast drže farmaceutske kompanije, osiguravajuća društva i banke. Osiguravajuća društva su tesno povezana s bankama. Ide zajednički biznis. Kao rezultat toga, ono što je korisno osiguravajućim društvima i farmaceutskim kompanijama dospeva na tržište.

Ako neki doktor stvori novu metodu lečenja bolesti, jednostavnu, koji može koristiti bilo koji čovek, jeftinu, tada doktora ili ubiju, ili ga optuže i oduzmu mu diplomu. Sve se to odradi relativno lako kad postoji mnogo novca. Mogu ga smestiti i u zatvor ili se na njega usmere potkupljeni svetski naučnici, njihovi predstavnici, kojima je zadatak oklevetati ga i proglasiti šarlatanom. Ili od njega kupuju njegov pronalazak pod uslovom da zaboravi na njega. U praksi je to dosta rasprostranjeno.

To jest, efikasne metode lečenja obustavljaju se u stadijumu istraživanja ili primene. Farmaceutske kompanije striktno stoje na straži ne dozvoljavajući mogućnost izlečenja čoveka.

Interesi farmaceutskih kompanije se poklapaju ne samo s interesima osiguravajućih društava nego i banaka. S obzirom na to da bankari sada vladaju svetom, moraju populaciju na zemlji smanjiti najviše do dve milijarde. Zato efikasno lečenje ljudi nije korisno malignom tumoru koji se zove Međunarodni Monetarni Fond.

Zato se  ljudi pokušavaju sve više sami lečiti bolesti, koriste narodno lečenje, alternativnu medicinu i razne duhovnjake, što ih često odvodi na pogrešan put.

(Dnevno.hr)

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 DiaBloG – 2014

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farmakomafija

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Koliko HD aparata se ukrade

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Galenika

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Nemci i Hrvati

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hemoterapija

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novac-dinari

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Picture1b

 

Preko 5000 sudskih postupaka protiv Freseniusa – pacijenti pokrenuli

Ili: kako nešto korisno naučiti iz tuđeg iskustva, a ne završiti u loncu.

Samo u jednoj od 50 američkih država sada se vodi 5000 sudskih postupaka protiv Freseniusa (nemamo podatke za celu zemlju), a u Srbiji i Republici Srpskoj – nijedan.

Poštovani čitaoci,

U utorak 17.jula 2014. godine američke novine, Bostonherald donele su i za nas jednu zanimljivu vest: Preko 5500 tužbi protiv dijalizne firme Fresenius.

Samo u jednoj američkoj državi (Masačusetsu) trenutno se vodi 5500 sudskih sporova protiv firme Fresenius. U gradu Bostonu je pokrenuto 1800 sudskih postupaka, a pred Višim sudom u Masačusetsu je još 3694 tužbi.

Ne smiruje se gnev pacijenata i njihovih porodica protiv dijalizne firme Fresenius. Svi su podneli tužbe zbog lečenja Freseniusovim dijaliznim koncentratima kojima su bili izloženi riziku od ozbiljnih zdravstvenih posledica, uključujući i srčane aritmije i /ili naglu srčanu smrt.

Masovna sudjenja Freseniusu

(za detalje kliknuti na: http://bostonherald.com/business/healthcare/2014/07/suits_target_waltham_maker_of_dialysis_solutions)

Sve je počelo 2011. godine, kada je anonimni insajder doturio u javnost interni Freseniusov dokument u kojem su Frezenijusovci sami priznali do čega sve može doći kada se primenjuju njihovi dijalizni koncentrati (metabolička alkaloza i nagla srčana smrt). Interni Frezenijusovi podaci su govorili da je za najmanje 950 njihovih pacijenata godišnje (samo te 2010-e) korištenje tih koncentrata bilo fatalno: oni su umrli usled naglog srčanog zastoja na hemodijalizi.

Tužioci su našli da je najveća krivica Freseniusa i njegovih „stručnjaka“, što su sve ovo znali (i napisali u dokumentu), a nisu ništa učinili da obaveste ostale mnogobrojne korisnike tih istih koncentrata. Štaviše, do dana današnjeg nisu povukli iz prodaje te koncentrate. Nisu otklonili opasnost.

Slično se događa i u američkoj državi Luizijani:

Louisiana also sues Fresenius

(za detalje kliknuti na: http://www.nephrologynews.com/articles/110304-louisiana-sues-fresenius-to-reclaim-payment-over-granuflo-use)

I tako dolazimo do paralele sa situacijom u našim državama gde je Fresenius takođe monopolista na dijaliznom tržištu. Ne samo da je decenijama 90%-ni snabdevač svih državnih dijaliznih centara, nego mu je od vladavine „žutih“ dozvoljeno da otvori i svoje „bolnice“ i da u njima o trošku republičkog Fonda zdravstva (po duplo većim cenama) sam primenjuje sve te svoje proizvode na našim građanima (pacijentima), po istom američkom obrascu: „mi smo najveći, neprikosnoveni, mi imamo sve svoje, protokole, smernice, proizvode, profesore, doktore, sestre, udruženja pacijenata, – i ko će nas da kontroliše kad je sve što je vezano za dijalizu – naše!“

Zamislite da neka druga farmaceutska kuća kod nas otvori svoju bolnicu i u toj bolnici naše pacijente leči samo onim što ona sama proizvodi (i po ceni koju oni sami odrede). Priznaćete: deluje suludo. Ali, Freseniusu je upravo to dozvoljeno.

Žalosna je istina da kod nas nema ni žalbi na to. Niko nezavisan (nezavisan od njihovih donacija i sponzorstava) – njih ne kontroliše. Posle iskustva iz SAD-a 2011. (kada ih je insajder raskrinkao) sada su svojim zaposlenim nametnuli režim kontrole kao da ne rade u zdravstvu, nego u Pentagonu ili NSA. Mogućnost da se u našim siromašnim zemljama, sa korumpiranom birokratijom i vlastodršcima, pojavi neki uzbunjivač unutar Freseniusa, je nezamisliva. Oni to dobro znaju i namerno održavaju i podstiču taj imidž spoljne snage i unutrašnjeg straha.

Nijednom rečju u Srbiji nisu ni pomenute tragedije u Freseniusovim dijaliznim centrima nastale usled korištenja Freseniusovih koncentrata. Niko iz njihove firme u Srbiji nije nigde ni reč progovorio o tome. A redovno daju takozvane „intervjue“ u novinama gde se besramno reklamiraju i traže još para, još nabavki, još pacijenata, samo još i još, i samo njima (link). Po već utvrđenom scenariju u tim intervjuima odmah nastupaju i Predsednici takozvanih udruženja pacijenata, koji duvaju u istu tikvu i uvek podržavaju tu firmu. Ne postoji nijedan od tih „večitih“ i „nesmenjivih“ predsednika koji je bilo kada i bilo gde rekao nešto protiv interesa firme Fresenius, imao neke primedbe na njihove aparate, filtere, linije, igle, a kamoli koncentrate. Čak i kada smo na ovom sajtu objavili (link) nedvosmislene (Freseniusove) dokaze o neispravnosti njihovih proizvoda i aparata (što naravno nikome nisu prijavili), niko od tih brižnih predsednika udruženja pacijenata nije progovorio ni jednu jedinu reč o tome. Muk.

Kada smo objavili da je Fresenius u svojim dijaliznim centrima, na našim pacijentima, ispitivao svoje lekove: PA-21 i Osvaren, opet ništa. Muk. „Etički“ komitet te „bolnice“ dao saglasnost. A svi članovi tog „Etičkog“ odbora su primali finansijske „nadoknade“ od Freseniusa. Treba li da kažemo ko i koliko?

Freseniusov lek, Freseniusove bolnice, Freseniusovi doktori-ispitivači, ako to nije sukob interesa, onda ne znamo šta jeste. Kada smo objavili na ovom sajtu da je u Fresenijusovim dijaliznim centrima u Srbiji i u Republici Srpskoj vršeno tajno ispitivanje (niko nije znao, ni osoblje ni pacijenti) u kome su pratili kako će i kada naši pacijenti umirati – opet muk. Niko ništa nije imao protiv.

Pa je li to medicinska ili koja već etika: postaviš hipotezu da će brže umirati oni koji imaju niže albumine i čekaš da vidiš da li je hipoteza tačna?! I na kraju utvrdiš da jeste tačna. Znači, znali su. Ni na pamet im nije palo da su bili dužni preduzeti nešto za te ljude, ako su već znali ili posumnjali da će prvi početi umirati. Ništa niko nije učinio. Freseniusovi menadžeri su dali pacijentima na ulasku, odmah, da potpišu blanko saglasnost da se rezultati njihovih analiza krvi mogu unositi u internetsku bazu podataka, a radi praćenja njihovog lečenja. Nigde se nijednom rečju ne spominju studije ili neka ispitivanja (znači: prevara). O samom uslovljavanju pacijenata ovim dokumentom uputioci pacijenta (iz srpskog Fonda zdravstva) nisu se ni interesovali, niti su smeli dići svoj glas zbog ovih uslovljavanja. Jer, znalo se ko u vlasti stoji iza kampanje da se dijalizni pacijenti daju privatnicima.

A naš Zakon jasno kaže: pacijent mora biti „dovoljno obavešten o smislu, cilju, postupcima, očekivanim rezultatima, mogućim rizicima i neprijatnim okolnostima“ svakog pojedinog medicinskog ispitivanja, pre nego što da svoj pismeni pristanak.  „Dovoljno obavešten“, a ne NEOBAVEŠTEN, prevaren i žrtva njihovih eksperimenata!

Stav 4. člana 25 je posebno nepovoljan za ove Freseniusove muljavine, jer se u njemu kaže: „Pacijent mora biti posebno upozoren da je slobodan da učeće u istraživanju odbije i da pristanak koji je dao, u svako vreme opozove, u pismenom obliku.“ Da li je iko od tih nesretnika bio „posebno upozoren“?! Zašto ta studija nije bila javna, zašto nije imala odobrenja nadležnih državnih institucija (osim ako ih sada naknadno ne ištancaju i antedatiraju)?

Pa kako da ima odobrenje kada pomenuti Zakon o pravima pacijenata, član 25. stav 12. jasno kaže: „Zabranjeno je vršenje medicinskog ispitivanja u privatnoj praksi“. Možda će pravnici Freseniusa ustvrditi da oni i nisu privatna praksa, nego državni projekat. Za pare sve može, kod njih, a izgleda i kod nas.

Uglavnom, pacijenti u srpskim Fresenius „bolnicama“ su umirali, bez da se iko i nakašljao zbog toga. Potvrđivali su hipotezu, za koju je Fresenius pretpostavljao da je tačna. I bila je tačna: umrli su. Da su bilo koga od tih nesretnika uputili na lečenje u državnu bolnicu, možda se za njega i moglo nešto učiniti. Ali, ako bi Fresenius iz svog dijaliznog centra vratio nekoga nazad na lečenje u državnu bolnicu, onda će Fresenius imati manje prihode. A Freseniusovi menadžeri sve mogu dozvoliti, ali i pomisao da im se smanje prihodi, to sebi nikada neće dozvoliti. Zato je državno zdravstvo, kakvo je takvo je, sa svim njegovim manama i nedostacima, još uvek neka garancija da nad ljudima i njihovim životima neće odlučivati zarada nego medicina, ako je još išta od te medicine i medicinske etike i preostalo u uslovima divljeg kapitalizma.

Već smo objavili da sve svetske studije pokazuju da je mnogo veća smrtnost tamo gde Fresenius ima najveći broj klinika i najveći broj pacijenata. Najmanje 20% je veća smrtnost u Fresenius centrima, nego u neprofitnim dijaliznim bolnicama. Ovde u Srbiji Freseniusovci još ne posežu za tolikim „uštedama“ jer nisu preuzeli većinu pacijenata, ali štede na antibioticima i svim drugim lekovima. Lepo su sami Freseniusovci napisali u jednom od meilova koje smo objavili: „moramo ovako dok ne zauzmemo tržište.“

Ništa od ovih problema nije zabrinulo ni domaće predstavnike pacijenata ni nadležne zdravstvene stručnjake. Znamo ili pretpostavljamo i zašto. Sponzorstva. Donacije. Kongresi. Putovanja. Plaćena predavanja. Učestvovanje u izradi Vodiča, Protokola, Smernica, Standarda, itd. itd. – sve je to finansirano od strane farmakomafije. Šta čekaju nadležni organi? Da li hoće da im dostavimo imena, mesta i fotografije vodećih lekara koji su godinama „gosti“ Freseniusa na plaćenim putovanjima u inostranstvo? Istih onih koji godinama organizuju dijalizni sistem u našoj državi. Ako treba, dostavićemo im i to.

Ali, nismo sigurni da će i posle toga iko išta učiniti.

A već postajemo sujeverni.

Sujeverni u smislu da bi moglo nešto da nam se desi. Na primer, da nam uđe vazduh u venu tokom dijalize, ili da nam se desi neka neobjašnjiva automobilska nesreća, da nam padne saksija na glavu dok prolazimo ulicom, ili da nas neko uhapsi zbog pronevera ili neke druge izmišljene krivice …

Nas ili naše saradnike.

Teško je biti prvi petao, a ne završiti u loncu.

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DiaBloG – 2014

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Nama je najvaznije da popunimo nase centre

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Još sličnih tekstova:

Privatne bolnice za hemodijalizu    Smrtnost kod privatnika    Tajna ispitivanja na Srbima u privatnim HD centrima  Serviser sprečio skandal i zatvaranje bolnice za hemodijalizu   Republički Zavod za zdravstveno osiguranje čuva monopol firmi „Fresenijus MC“   Doktorka otpuštena iz FMC-a jer je brinula o pacijentima    Dosije XXXXXXXL – nastavak internet natpisa o mahinacijama firme FMC    Nevoljni učesnici u FMC ispitivanju smrti uživo – obelodanjen projekat MONDO.    Ključni dokaz o tome da FMC upravlja postupcima Udruženja pacijenata   Ispitati političku pozadinu cene dijalize    Kako izgleda briga o pacijentima u Fresenius dijaliznim centrima u Srbiji, I deo.    Afera “Dialiks” – otkriveni delovi prepiske iz Freseniusove internet mreže u Srbiji, II deo.    Afera “Dialiks” – otkriveni delovi prepiske iz Freseniusove internet mreže u Srbiji, III deo.    600 000 dinara mesečno je malo mnogo, ali naći ćemo način …- Dialiks IV   Prilika da se zaradi još malo para …- Dialiks V    O Freseniusovim aparatima, dijalizatorima, koncentratima, jonometrima i ostaloj opremi, ali iskreno, iznutra, od njih samih-Dialiks VI    Dialeaks dokumenti: Stenogram sastanka lekara i direktora FMC Beograd    Pljačka države po tipu mašine    Strategija dijalizno-farmaceutskog biznisa u Srbiji: manipulacije i prevare sirotinje raje   Thanksgiving Day   Mučenik iz Banjaluke    Ponovo problemi sa Frezenijusovim aparatima i dijalizatorima     Afera plus: Kako Fresenius namiče profit u Republici Srpskoj?    Kako nam se nabavljaju dijalizatori?       Otkrivamo: ko su novinari, mediji i bolesnici koji zastupaju interese dijaliznog privatnika?    Rasprava između Fonda zdravstva i Freseniusa, te odluka Državne komisije o nabavci dijalizatora      Protestno pismo japanske dijalizne firme Nipro srpskom Fondu zdravstva    I Narodna Republika Kina pokrenula istragu protiv Freseniusa    Skandal: pare namenjene poplavljenima dali Frezeniusu!!!      Afera plus: kako Fresenius namiče profit u Republici Srbiji     Šamar državnom zdravstvu na koji nije odgovoreno     Pismo o Freseniusu koje nijedan medij nije smeo da objavi     Da li će opet sve ostati Među nama?

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Afera plus: Kako Fresenius namiče profit u Republici Srpskoj?

Ili: ako ne može da se povećava cijena, može zarada, ali na mala vrata.

Poštovani čitaoci, u nastavku na prethodni opis mahinacija one iste multinacionalne globalističke dijalizne aždaje u Republici Srpskoj (vidjeti prethodni post: Šta radi Fresenius u Republici Srpskoj), dobili smo nove podatke o još nekim malverzacijama, koje zaista prevazilaze sve do sada viđeno.

Vidjeli smo naime, da Frezenijus uzima velike pare (110 evra) za tretman koji je u državnim bolnicama koštao mnogo manje (35 evra), link. Vidjeli smo i kako su ušli u zdravstveni sistem Republike Srpske, kako su maltretirali pacijente, vidjeli smo i koga su sve doveli da rukovodi nefrolozima RS, vidjeli smo i kako izbjegavaju bilo kakve troškove u RS, kako izbjegavaju plaćanje carina i poreza u Republici Srpskoj, ali …

Da li ste znali kako se može povećati profit, iako vam je cijena usluge fiksna?

E, za to treba biti menadžer.

Dakle, ako znamo da se svaki dijalizni pacijent dijalizira 3 puta nedjeljno, po fiksnoj cijeni (110 evra), to vam može izgledati kao redovna, dobra i zagarantovana, zarada.

Ali, i to se može povećati.

Jednostavno, povećate broj tretmana! Produktivnost.

Na istim aparatima, sa istim zdravstvenim radnicima i na istim pacijentima.

Može li išta biti lakše.

Fresenijusovi doktori će objasniti neophodnost dodatnih tretmana, blagajnik će ispostavljati veće fakture, Fond će sve plaćati – jer, šta mu drugo preostaje?

Da li je to po propisu?  Da li se to sme?

Pa, ne baš.

Evo kakvi su propisi u tenderskoj dokumentaciji za dijalizne tendere u Republici Srpskoj.  Imamo i to, u originalu:

Tenderski uslov1

Kao što vidite, zakonski i pravnički je sve jasno: tri dijalize sedmično.

Može neko, naravno, da ima i dvije hemodijalize sedmično, dok ne pređe na 3, kao što i neko sa redovne 3 hemodijalize može ponekad imati i jednu vanrednu hemodijalizu. Na primjer: dođe čovjek u hitnu pomoć, dan pred svoju redovnu dijalizu, guši se, ima visok kalijum ili visok pritisak, svejedno, onda će mu se obezbijediti VANREDNA hemodijaliza i biće mu lakše. U redu, bilo 14 hemodijaliza tog mjeseca.

Ali da neko redovno ima 5-6 hemodijaliza nedjeljno, to sigurno niste čuli.

Pa, evo Vam samo jedan od brojnih takvih primjera:

Ispunjavanje tenderskog uslova1

Naravno, mislite možda je čovjek bio u pogoršanju, ležao u bolnici, pa su mu bolnički doktori indikovali česte hemodijalize, ne znajući šta drugo da mu rade.

Nije to.

Ti ljudi uopšte nisu ležali u bolnici. Dolazili su od kuće na redovne hemodijalize 4-6 puta nedjeljno!

Štaviše, i za one koji su imali najbolju moguću hemodijalizu, a to je hemodijafiltracija, fakturisani su prekobrojni tretmani:

Ispunjavanje tenderskih uslova1

Kažemo fakturisani, jer ima priča da mnogi od tih spornih tretmana nisu ni izvršeni. Ima priča da su fakturisani tretmani i za umrle pacijente, a za neke žive su naplaćivani dva puta.

Pošto za taj deo optužbi nemamo dokaze, ne želimo ni da vjerujemo da su odgovorni u Frezenijusu išli toliko daleko.

Ali, da su slali fakture, ne sa 13-14, pa hajde i 15 tretmana, nego sa 16, 17, 18, 19, 20 i 21, – e, za to već imamo dokaze.

Na primjer, evo kopija faktura o redovnom vanrednom dijaliziranju pacijenata u jednom centru. Preskočili smo (namjerno) i izbacili one koji su imali manje od 14, pa i 15 tretmana, prikazujemo vam samo ove sa 16 i više tretmana:

Mjesecna faktura

Ovo su naravno podaci iz samo jednog mjeseca i iz samo jednog centra. A koliko je toga bilo ukupno? Ihaj-haj, možete misliti.

Pitate se naravno, da li su to stalno isti pacijenti? Nažalost, vrlo često jesu, ali nije pravilo. Ima među njima i mladih i starih, i manje i više bolesnih, ima čak i stranih osiguranika, koji dođu kod nas, u zavičaj, a FMC im fakturiše 18 tretmana za jedan mjesec.

Naravno, sve te tretmane Frezenijusu plaća srpski Fond, pa on nema nikakva strahovanja da bi mu neko mogao osporiti ovaj način povećavanja profita.

A da je pravde, sada bi sve te prekobrojne tretmane trebalo prebaciti na teret firme Frezenijus. Pošto je ta firma preuzela sve hemodijalizne pacijente iz skoro svih dijaliznih centara u Republici Srpskoj, red bi bio i da odgovara za kvalitet tog liječenja. To znači, da svaka prekobrojna hemodijaliza bude plaćena od strane firme Frezenijus, ako taj pacijent nije došao na prekobrojnu dijalizu iz državne bolnice ili iz hitne pomoći. Ako državni organ ili doktor nije tražio dodatne tretmane, zašto bi to država morala plaćati? Sami davali, ali da drugi plati.

Menađeri.

Hvale se velikim kvalitetom tretmana, a onda priznaju da su nekim pacijentima morali davati i 6 tretmana nedjeljno, kao zbog lošijeg kvaliteta tretmana.

Ko je ovdje lud?

I gdje to uostalom ima?

Pa za 2 dana bolovanja, ili za skener, čovjek mora na neke Komisije, na odobravanje i tamte-vamte ko zna kakve sve procedure. A za ove hd – ništa. Osam (8) vanrednih hemodijafiltracija, puta 130 evra, preko hiljadu evra više mesečno, po pacijentu, a bez ikakvih komisija, odobravanja ili natezanja sa Fondom. Ima li to iđe? Dobro neko reče, da je dijaliza u RS ispala zlatni rudnik za privatni biznis. Da li je igdje moguće ovako lako zarađivati i povećavati profit?

Da li su odgovorni u Fondu zdravstva Republike Srpske ikada razgovarali sa svojim kolegama iz Fondova u Srbiji, Hrvatskoj, Crnoj Gori, ili sa kolegama iz Federacije? Koji rade obračune hemodijaliza, plaćanje faktura? Niko nikada nije vidio toliki broj hemodijaliza po jednom pacijentu mjesečno. I da je samo jedan mjesec. Nego je godinama tako. Dok su ti isti centri bili u državnom vlasništvu nisu imali ni jednu vanrednu dijalizu po 3-4 mjeseca. Ili, po 3-4 godine, kako koji.

I šta sad.

Pošto niko ni do sada nije reagovao na ove pojave,

najbolje je da i Vi, poštovani čitaoče, zaboravite sve ovo.

Ipak, niste Vi nizašta krivi.

Vi će te to samo zaboraviti.

A ovi koji su nadležni,

oni će zataškati.

To ipak nije isto.

Zato, zaboravite sve.

Nije do Vas.

Hrkljuš.

.

DiaBloG – 2014

(redakcija sajta se zahvaljuje  gospodinu M. Biliću na ustupljenim dokumentima i komentarima)

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Priznanje

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Još sličnih tekstova:

Privatne bolnice za hemodijalizu    Smrtnost kod privatnika    Tajna ispitivanja na Srbima u privatnim HD centrima  Serviser sprečio skandal i zatvaranje bolnice za hemodijalizu   Republički Zavod za zdravstveno osiguranje čuva monopol firmi „Fresenijus MC“   Doktorka otpuštena iz FMC-a jer je brinula o pacijentima    Dosije XXXXXXXL – nastavak internet natpisa o mahinacijama firme FMC    Nevoljni učesnici u FMC ispitivanju smrti uživo – obelodanjen projekat MONDO.    Ključni dokaz o tome da FMC upravlja postupcima Udruženja pacijenata   Ispitati političku pozadinu cene dijalize    Kako izgleda briga o pacijentima u Fresenius dijaliznim centrima u Srbiji, I deo.    Afera “Dialiks” – otkriveni delovi prepiske iz Freseniusove internet mreže u Srbiji, II deo.    Afera “Dialiks” – otkriveni delovi prepiske iz Freseniusove internet mreže u Srbiji, III deo.    600 000 dinara mesečno je malo mnogo, ali naći ćemo način …- Dialiks IV   Prilika da se zaradi još malo para …- Dialiks V    O Freseniusovim aparatima, dijalizatorima, koncentratima, jonometrima i ostaloj opremi, ali iskreno, iznutra, od njih samih-Dialiks VI    Dialeaks dokumenti: Stenogram sastanka lekara i direktora FMC Beograd    Pljačka države po tipu mašine    Strategija dijalizno-farmaceutskog biznisa u Srbiji: manipulacije i prevare sirotinje raje   Thanksgiving Day   Mučenik iz Banjaluke    Ponovo problemi sa Frezenijusovim aparatima i dijalizatorima      Kako nam se nabavljaju dijalizatori?     Preko 5000 sudskih postupaka protiv Freseniusa – pacijenti pokrenuli     Otkrivamo: ko su novinari, mediji i bolesnici koji zastupaju interese dijaliznog privatnika?    Rasprava između Fonda zdravstva i Freseniusa, te odluka Državne komisije o nabavci dijalizatora      Protestno pismo japanske dijalizne firme Nipro srpskom Fondu zdravstva    I Narodna Republika Kina pokrenula istragu protiv Freseniusa    Skandal: pare namenjene poplavljenima dali Frezeniusu!!!      Afera plus: kako Fresenius namiče profit u Republici Srbiji     Šamar državnom zdravstvu na koji nije odgovoreno     Pismo o Freseniusu koje nijedan medij nije smeo da objavi     Da li će opet sve ostati Među nama?

 Bitte hilfe gur gur

(Ko se naš’o da zajebava veliku nemačku firmu)

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Picture1b.     .     .

Q U O T A T I O N S

What Gary Peterson said:

2017.07.05:

What people want most during emergencies is information. The Kidney Community Emergency Response (KCER) Program offers no centralized information to patients during emergencies, often leaving patients at the mercy of for-profit providers that hoard both information and patients. (Preparing for Emergencies: a Guide for People on Dialysis — June 2017 Update)

2017.06.30:

This is typical of how dialysis patient advocacy groups operate in the US. (Don’t bite the hands that feeds you, despite the fact that they are harming the patients for whom you are „advocates“.) There is no (for-profit) industry money for those groups that attack the junk-credit-rating business model which, compared to the non-profit business model, continues to cause the deaths of thousands of dialysis patients unnecessarily.

2017.06.29:

A few ago on a conference call, I heard Doug Johnson, the chief medical officer of non-profit DCI, state that his organization was not greatly motivated by the financial incentives of the QIP program. On the same call, a top nephrologist for one of the top for-profit dialysis providers said his organization was ‘jumping through all sorts of hoops’ for these financial incentives.
It seems these financial incentives make little difference to those already doing the right things for patients. These financial incentives also seem to motivate the for-profit companies to manipulate or massage QIP data, or even report fraudulent QIP data, resulting in a lack of congruence between USRDS mortality/hospitalization results and the CMS star rating system results.
This could explain why DaVita fought the implementation of the CMS star rating system, but then embraced it when the initial star ratings surprisingly showed that DaVita had the best results (while DCI has had the best mortality/hospitalization data for 14 consecutive years). This throws into question the integrity of all U.S. dialysis data collection systems.

2017.06.21:

53-minute YouTube video from September 2016 KidneyWorks meeting.  Dr. Doug Johnson, chief medical officer (CMO) of DCI, speaks between 24:10 and 35:40.
Speaking on dialysis patient employment, he states:

„Honestly, we have not done a good job to make it more likely for you to be employed.“

Can you imagine the CMO of Fresenius or DaVita making such a statement? DCI has also had the best mortality and hospitalization data compared to Fresenius and DaVita for the last 14 years. DCI does the right things for patients because they do not have perverse financial incentives. The only way to make major changes in Fresenius’ and DaVita’s operations is to change their financial incentives.

2017.06.21:

How much longer will U.S. nephrologists continue to debilitate dialysis patients with short, brutish, minimal treatments, as well as ignore the iatrogenic effect that these treatments have on the social needs of their patients?

2017.06.16:

For me, the most symbolic moment in John Oliver’s exposé of what is wrong is U.S. dialysis care occurs around the 7:40 mark. DaVita’s Kent Thiry is leading a cheer and among those responding is the nephrologist who is the honorary historian for the American Association of Kidney Patients (AAKP). In a 2017 press release AAKP President Paul T. Conway stated, „Dr. (redacted) is a prolific and respected writer, and we are honored to have him tell the compelling history of how kidney patients have worked through the past several decades to impact treatment and chart the course for strategic patient engagement for themselves and all who suffer from a chronic disease.“
I believe the biggest point that John Oliver missed is how complicit U.S. nephrologists have been with junk-credit-rating companies in providing embarrassingly poor dialysis care. Hundreds of now prominent U.S. nephrologists have become multimillionaires from these business practices. Thousands of younger nephrologists are now financially dependent on this business model. Their incomes, their medical school loan payments, their children’s college funds, and their own retirement plans depend upon continuing these medically- and morally-poor business practices.
John Oliver could have also made these points:

  • Virtually all nephrologists would choose a different dialysis treatment modality for themselves than the one that the vast majority of their patients utilize

  • The largest non-profit dialysis provider has had better survival and hospitalization rates than the largest for-profit providers for 14 consecutive years

  • This field of medicine has abysmal employment and rehabilitation rates

Will U.S. nephrology continue ever be capable of any kind of effective self-examination? Will they listen to financially independent patient groups that don’t fawn over them for their supposed patient-centered care?
They say history is written by the winners. U.S. dialysis patients have not been the winners.

2017.05.16:

Both DaVita and Fresenius Medical Care have risen to the top in the U.S. through junk-bond-financed acquisitions of dialysis centers. This has put hundreds of millions of dollars into the pockets of leading U.S. nephrologists who, as partners and/or employees of these corporations, no longer effectively advocate for patients. In junk-bond corporations, physicians focus on numbers and metrics, not patients.
This story (link) is as much about the moral failure of corporate leadership as it is about the moral failure of many U.S. nephrologists and the enabling and facilitating positions of their professional organizations. They continue to shepherd over 85% of their patients into dialysis treatment regimens they would never accept for themselves or their own family members.
The U.S. dialysis care industry doesn’t need far better medical leadership, it needs far better moral leadership.

If this (link) isn’t a wake-up call for the American Society of Nephrology and the Renal Physicians Association to change, then they should forever be seen as organizations that foster physician and corporate greed. It shouldn’t be the case that John Oliver is a better patient advocate than the ASN and RPA.
President Donald Trump announced on May 4 that he will nominate a former DaVita executive as Assistant Secretary of Health and Human Services for Legislation. Matthew Bassett worked for DaVita from 2006 to 2011, and left the company as Vice President of State Public Policy.

2017.05.12:

Fresenius Medical Care’s credit rating has fluctuated between investment grade and junk grade over the last decade, depending on the rating agency (see 2015 article). DaVita’s credit rating has always been junk grade.
The large for-profit dialysis corporations have borrowed heavily to purchase thousands of dialysis clinics from U.S. nephrologists, making hundreds of leading U.S. nephrologists multi-millionaires. The chief medical officers of FMC and DaVita then have to practice medical with the pressure of billions of dollars of high-interest-rate, low-grade corporate debt on their shoulders. Servicing this debt and maintaining their stock price appears to lead to decisions that do not serve the patients’ best interests. For 14 years consecutive years, DCI, a non-profit, has had the best mortality and hospitalization rates in the industry.
Is there any better example of how poorly designed financial incentives in for-profit medicine can harm patients — than U.S. dialysis care?

2017.05.03:

If U.S. dialysis care is ever going to be „great again,“ it doesn’t need far better medical leadership, it needs far better moral leadership.
U.S. dialysis care should be the poster child of „conflicts of interest“ in U.S. medical care. The combination of physician ownership of dialysis facilities and corporate junk-bond financing of dialysis facility acquisitions has led to a decades-long failure of patient advocacy responsibilities by U.S. nephrology. The result has been ‘junk-bond nephrology.’ Most leading practitioners have greatly rewarded themselves financially while this field of medicine has lagged far behind others in improving patient outcomes and technology. “Dialysis is a promise unfulfilled,” said Jonathan Himmelfarb, director of the Kidney Research Institute.

2017.04.05:

Gary Peterson: Are there any better descriptions of the realities of for-profit U.S. dialysis care than the two below quotations?

(KevinMD blog): „Pay-for-performance takes medical quality metrics to the next level by using them economically. In our health care system, they are not working to improve care — why? Because the metric does not incentivize doctors to be more human. Instead, it rewards treating patients as commodities and lifeless objects. Doctors resent this incentive because commodification is dehumanizing. As incentives push doctors into becoming more mechanistic, we then invent new metrics such as “satisfaction surveys” to desperately attempt to pull them back towards a humanistic ideal. Satisfaction itself is now a commodity and subject to the rules of the market — massive, absurd inflation everywhere!“

„The art of medicine, whatever that might mean, is not measurable, and teeters on the verge of extinction.  Increased control over the body ended up bringing about domination over bodies: paternalism, futile end-of-life care, polypharmacy … and pay-for-performance. Pay-for-performance promises the quantification of the entire patient-physician relationship and then its optimization as providers become rational profit-maximizers.  Rather than the comforting hand of the healer, the invisible hand of the market will guide improved patient care.  So goes progress.“

2017.03.27:

This is (yet) another wake-up message for patients and their advocates. U.S. nephrologists have little or no interest in disrupting their economic/treatment system with a well-patient model of care.  With today’s financial incentives, most of U.S. nephrologists aim no higher than „not dead“ and „not in the hospital.“ This current system of care is likely a major factor in the widespread depression seen in dialysis patients. (Can you even raise this issue at an ASN or RPA meeting, let alone a FMC or DaVita meeting?)
Until we provide significant financial incentives to motivate nephrologists to deliver well, high-functioning patients, Kt/V (URR) and stagnant technology will remain the standards of excellence in U.S. dialysis care.

2017.03.24:

Why isn’t effective health coaching a standard of U.S. dialysis care? Blame the power of poorly-designed financial incentives, especially the perverse incentives that have made CEOs and many U.S. nephrologists multi-millionaires.
For the for-profit dialysis centers and nephrologists, their financial goals and incentives lead them to perform as little uncompensated care as possible for their patients. Most patients are steered into minimal, in-center dialysis regimens that virtually no dialysis professionals would choose for themselves.
The largest non-profit dialysis company, DCI, not only has the best mortality and hospitalizations data, but they also steer as many patients as possible to transplantation before they need dialysis.
It would seem that many dialysis patients could benefit from this „coaching at their fingertips,“ as long as it is not provided by for-profit companies under today’s perverse financial incentives.

2017.03.17:

„Employment and education status were inversely associated with mortality in patients on maintenance HD in Japan. Employment but not education was also inversely associated with hospitalizations. After adjustment for comorbidities, the associations with clinical outcomes tended to be stronger for employment than education status.“
There is no better example of excellence in dialysis care than an employed dialysis patient. It has been a tragedy that the leaders of the dialysis patient organizations have not made employment and rehabilitation leading priorities, as these goals can drive so many improvements in care processes, technology, and patient engagement. Instead, patients have endured decades of stagnancy and being ignored. Enduring awful treatment regimens, which U.S. nephrologists would never accept for themselves, has become the „job“ for too many patients.

2016.05.04:

U.S. dialysis care, which is effectively controlled by junk-bond-financed, for-profit corporations, is unnecessarily harming and killing thousands of dialysis patients each year. U.S. nephrologists would never accept for themselves the treatment regimens that the vast majority of their patients receive. Until U.S. nephrologists, the American Society of Nephrology, and the Renal Physicians Association break free from the financial ties and medical practice controls of these corporations, U.S. dialysis care will continue to be the prime example of medical materialism gone wrong… and the shame of U.S. medicine. Physicians cannot serve two masters.

2016.04.29:

How many more millions of dollars and precious time must we waste trying to create a quality measurement system that uses biochemical markers that do not matter to patients — or uses measures that can be „manufactured“ through manipulation and/or cheating?
The best example of excellence in dialysis care is a long-time employed ESRD patient. Unfortunately, CMS, U.S. nephrologists, and the large for-profit dialysis providers have ignored this outcome for decades. They have instead focused on biochemical markers, which has led to few improvements in the patients’ quality of life or technological innovations over the last 40 years.
While DaVita and Fresenius have recently announced programs to support employment, there is little to them beyond „turfing“ patients to government agencies that have no dialysis expertise. It seems to be a new version of the intern’s way to avoid addressing patients’ needs. Remember „buff and turf“ from The House of God?
What if Fresenius and DaVita employed dialysis patients and also paid their health insurance premiums? Extending the Medicare Secondary Payer (MSP) period for employed patients would then drive tremendous changes in this field of for-profit medicine.

2016.04.26:

It is time to admit that U.S. dialysis care has failed patients and instead functions primarily to serve the financial interests of for-profit corporations and the many prominent U.S. nephrologists who find no fault with the current economic incentives.

2016.04.20:

The Hippocratic Oath vs. medical materialism. The U.S. experiment in balancing medical decisions and profit motives does have its most spectacular failures.
It appears that our society’s most vulnerable patients (in nursing homes and dialysis clinics) are also the most susceptible to medical decisions that favor corporate owners over patient well-being. The weakest get used.
In U.S. dialysis care, the Peer Group and the American Society of Nephrology continue to be blind to the impact of financial incentives/structures on U.S. dialysis care. Has any other field of medicine made so little progress in the last 40 years? Does any other field of medicine have so many physicians admitting that they would choose better treatment regimens for themselves than they provide for vast majority of their patients?
Why has the largest non-profit dialysis provider (DCI) delivered better mortality and hospitalization outcomes than the largest for-profit, junk-bond-financed, dialysis providers for 13 years?  Most U.S. nephrologists advocate for whom?
Our system is out of balance and, in many ways, self-defeating. Denial of the harmful effects of profit motives — and the legal implications of acknowledging the thousands of avoidable patient deaths — prevents any meaningful changes from occurring. As a result, most dialysis patients will continue to be shepherded into more harmful, for-profit, treatment regimens.

2016.04.14:

Other than „assisting“ a patient in choosing a dialysis modality (which may or may not be available locally), there seems to be little being done for patients regarding employment and rehabilitation.
Until these for-profit corporations have a financial incentive — rather than disincentives — to increase patient employment and rehabilitation, these „thrive“ programs will consist of little more than throwing information and hyperlinks at patients and saying, „Go for it.“
For working-age patients, this remains largely self-defeating and far from holistic dialysis care. Due to decades of paternalistic care and ineffective patient advocacy, the large for-profit corporations have neither the infrastructure, the technology, the professional expertise, nor the needed patient feedback mechanisms to drive significant improvements in employment and rehabilitation rates. Ratios of patients-to-social workers (and nurses) are far too high for any meaningful change to occur. As Dr. Scribner said, „If the treatment of chronic uremia cannot fully rehabilitate the patient, the treatment is inadequate.“
Without financial incentives for these corporations, only the patients with a strong will to overcome enormous obstacles — essentially on their own — will thrive. Almost all other patients will default to short-time, in-center, daytime treatments, and enslavement to a life called dialysis.
This situation will only truly change when these profit-focused companies can tell working-age patients, „It is financially advantageous for our company that you remain employed and/or get rehabilitated.“ Physicians and patients must fight for the holistic care that was the norm in dialysis care 45 years ago.
Fresenius and DaVita should employ dialysis patients. Then they would gain the expertise needed to truly help working-age patients.

2016.04.11:

More evidence suggesting that CMS and U.S. nephrologists have been harming dialysis patients for the last 40 years by failing to incorporate the patients’ employment and rehabilitation goals into the system of care.

2016.04.11:

This awful piece continues to overlook the failures and shortcomings of the stagnant and harmful model of U.S. dialysis care. This model functions primarily to maximize the benefits for junk-bond financed dialysis corporations which, in turn, fill the political campaign coffers of U.S. congresspeople.

2016.03.30:

Nearly all U.S. nephrologists have failed to target – or deliver – thriving dialysis patients for the last forty years. Considering the enormous, continuous, and rapid advancements in renal transplantation, it is time for the U.S. government to abandon dialysis care as a long-term treatment for most kidney failure patients.
U.S. dialysis care is effectively controlled by junk-bond-financed corporations which have little interest in greatly improving either their technology or the quality of their patients’ lives. While this junk-bond approach to medicine has richly rewarded many prominent U.S. nephrologists, it is hopelessly stagnant, is blind to the effects of its perverse financial incentives, and has failed patients and taxpayers for decades. All avenues that increase kidney transplantation rates – including payments to donors – need to be explored.

2016.03.25:

Only financial incentives and for-profit-corporation control of government policymaking explains why the US trails other first-world in countries in dialysis care.
US nephrologists continue to believe (and deny) that they can serve two masters without causing patient harm. Leading nephrologists in junk-bond-financed corporations ARE the biggest problem in US dialysis care.
In addition, it seems nearly all nephrologists – even the author of this blog posting – discount the importance of psychosocial needs in renal replacement therapies. They still do not ask, „What, besides medical needs, is important to the patient?“

2016.03.24:

Considering the recent breakthroughs in transplantation and the long-term stagnation seen in for-profit US dialysis care, I now believe the time for paying kidney donors has come.
It is time to rehabilitate and return as many of kidney disease patients as possible to living as normal lives as possible.  US dialysis care nephrologists and CMS have failed to carry out the mission they were given by Congress over 40 years ago.
Long-term dialysis care has failed over 90% of patients. Continuing to keep patients on dialysis unnecessarily is uneconomical, is awful medicine, and continues to limit the meaning and purpose of far too many patients’ lives to being revenue streams for paying off junk bonds.

2016.03.23:

The Peer group appears to continue to be blind to the impact of financial incentives/structures on U.S. dialysis care. Can they not see the differences in mortality/hospitalization rates that have existed for over 15 years between the non-profit DCI and the for-profit, junk-bond-financed DaVita/FMC?
Unfortunately, all consensus statements by the Peer group must have the buy-ins of the chief medical officers of the two biggest for-profit, junk-bond-financed corporations. When will U.S. nephrology acknowledge the obvious conflicts of interest and finally cut these ties?
The Peer group also continues to fail to embrace the more holistic approach to dialysis care which was the norm fifty years ago. At that time, patients were part of the „team“ and the model of care included the psychosocial, technological, infrastructure, employment, rehabilitation, and quality-of-life needs of the patients.

2016.03.18:

The chief medical officer of Fresenius Medical Care again fails to mention dialysis patient employment or rehabilitation as a goal of overall care. He does advocate for:
„…tailoring dialysis prescriptions and schedules to current physiologic needs;“ (but apparently not for psychosocial needs).
These junk-bond-financed medical corporations need to extract maximum profits from existing infrastructure and capital investments. Their corporate officers have little interest in major breakthroughs that would destroy their business model. These corporate officers continue to fail chronic kidney disease patients and the U.S. taxpayers by failing to target patient rehabilitation and employment. Only a small percentage of patients being treated by these junk-bond corporations are able to avoid enslavement to a life called dialysis. On top of all this, according to more than a decade of USRDS data, these junk-bond corporations provide worse outcomes for their patients than the largest non-profit dialysis care corporation.

Until U.S. nephrologists and the American Society of Nephrology extricate themselves from the profit schemes of junk-bond medical corporations and instead become true patient advocates, U.S. dialysis patient care will continue to trail other first-world countries not only in mortality, but also in patients’ quality of life.
Dialysis patients need to wake up to the fact that junk-bond medical corporations have failed them… and will continue to fail them.

2016.03.17:

If CMS and U.S. nephrologists had targeted improving dialysis patient employment rates from the beginning, the ESCO concept would have been integrated into the system of care for decades.

Providing financial incentives to increase employment rates would:

  • improve patients’ medical care

  • drive technological advancements

  • improve care coordination

  • improve psychosocial support services

  • improve patients’ quality of life

  • create a more diverse dialysis infrastructure

  • drive more individualized, patient-centered care

What other target/incentive does this?

2016.02.11:

It’s not just about getting everyone to home dialysis therapies.
I believe we need to differentiate between non-profit dialysis centers and the for-profit, junk-credit-rating-corporation dialysis centers. In most for-profit centers, patients must fit the corporation’s system which targets „numbers“ that must be acheived — regardless of patients’ needs. Isn’t it a question of the values, morals and ethics of the nephrologist?
Why has DCI (large non-profit dialysis provider) had better outcomes than Fresenius or DaVita (junk-credit-rating for-profit providers) for more than 15 years?

2016.03.09:

„Conclusions: Although trials in hemodialysis have typically focused on outcomes such as death, adverse events, and biological markers, patients tend to prioritize outcomes that are more relevant to their daily living and well-being. Researchers need to consider interventions that are likely to improve these outcomes and measure and report patient-relevant outcomes in trials, and clinicians may become more patient-orientated by using these outcomes in their clinical encounters.“

2016.03.04:

In junk-credit-rating corporations, business executives routinely manipulate financial reports to report optimal results. Failing to ‘hit the numbers’ often results in an even worse credit-rating, increased costs of attaining capital, and a possible stock price collapse.
In order for a junk-credit-rating corporation to succeed in healthcare, its financial successes cannot be seen as the result of providing lower quality care or worse patient outcomes. Unfortunately, the mentality of junk-credit-rating business executives has seeped into patient-related data reporting. In recent years, widespread cheating has been reported in the dialysis industry. This insidious need to report optimal results ultimately leads to a breakdown in the purpose and sanctity of physician-patient relationships.

In junk-credit-rating healthcare corporations, decisions regarding patient care routinely default to the selection that is best for the corporation’s finances. These selections can only be overturned by defiant personal stances or irrefutable scientific evidence. Unfortunately, these instances rarely occur. Junk-credit-rating corporations richly reward executives at the top and — to a less degree — the nephrologists, managers, and employees who are willing to put corporate financial needs first. As a result, far too many patients end up in a junk-bond dialysis hell which no nephrology professional would ever choose for themselves or their family members.
Those who choose not to profit from kidney patients’ illnesses provide better care. This junk-bond-healthcare reality has been staring us in the face for over a decade. DCI, the largest non-profit dialysis provider, has long had the best mortality and hospitalization data in the industry. While DaVita may claim a new rating system shows it provides the best care, the most recent USRDS data shows that DaVita provides the worst outcomes for its patients (see Tables 10.2 and 10.4 in Chapter 10 of the 2015 USRDS report).
DaVita would do much better by its patients to turn its DaVita Patient-Focused Quality Pyramid upside down and instead began its patient interactions by defining the values and activities which are most important to each individual patient.
(In 2015, DaVita led the list of all U.S. companies settling fraud allegations with the government.)

2016.02.19:

Fresenius Medical Care (FMC) was able to push back to show that GranuFlo® itself did not cause cardiac arrests. What they could not dispute, however, is that GranuFlo product use led to significant buffer (bicarbonate/acetate) dosing errors.

These were largely due to problems with GranuFlo/Acetate  display/design errors on the Fresenius Model 2008 dialysis machines.  Since close to 90% of dialysis machines in the U.S. were Model 2008 machines, this required FMC to fix over 130,000 dialysis machines over several years.
These problems were finally addressed in these May 2015 FDA recalls for GranuFlo®/Acetate display errors on Model 2008 machines.

(I suggested this recall back in September 2013. It is amazing how long this problem continued despite FMC’s knowledge of it — over 15 years!  See this August 2012 posting.)

It was poor product stewardship on FMC’s part from day one.  With GranuFlo, there were a multitude of ways that acetate and bicarb levels could be confused on machines, computer data entry systems, Dr.’s order sheets, treatment forms, etc.   When GranuFlo first came out, no effort was made to educate dialysis care providers and clinicians on all the nuances for the correct use of GranuFlo. Today, far more policies and procedures are in place throughout the industry regarding GranuFlo’s use.
When problems were first noticed, most nephrologists did not understand the basics, let alone the complexities, of the acetate/bicarb/GranuFlo issues. This allowed FMC to legally blame nephrologists and clinicians for the dosing problem, but from a long-term sales and business perspective, it was a self-defeating approach. Rather than winning more Pyrrhic victories in court, it was better to settle.
I believe this case shows, along with ESA usage, that the medical professionals who are promoted to the top spots in for-profit dialysis corporations are individuals who tend to put corporate interests before patients’ interests. I also believe this case helps demonstrate that the junk-bond financing of for-profit dialysis care in the U.S. (all medical staff must hit their numbers!) has rotted our system of care to its core.
Why has DCI, a non-profit, had the best mortality and hospitalization data for over a decade?

2016.02.17:

Patients in thirteen clinics will move from non-profit dialysis care to junk-credit-rating, for-profit-corporation dialysis care.
Which large dialysis provider has the best mortality and hospitalization data? See Tables 10.2 and 10.4 in Chapter 10 of the 2015 USRDS report.
Why would anyone choose worse mortality and hospitalization outcomes for their patients?

2012.05.25:

A “Renal Debilitation” Program That Is Failing Patients and Taxpayers

1972-2012: Forty Years of Federally-funded Dialysis

In order to continually improve outcomes and technology that are important to patients and taxpayers, renal replacement therapy must be synonymous with long-term patient employment and re/habilitation.”

4/3/2012

  • Abstract

  • Biggest problems

  • After 40 years – How dialysis care should be (or “Today’s Goals”)

  • Follow the money –a history

  • The dysfunctional system and its players

  • What went wrong

  • Other problems

  • Topics needing media and/or congressional investigation

  • Overall long-term goals

  • Possible solutions

  • Requests to Congress: What should be done to begin improving dialysis care

  • Questions to ask

Presentation by:

Rich Berkowitz, Home Dialyzors United

Denise Eilers

Gary Peterson, RenalWEB

ABSTRACT / SUMMARY

In 1972, Congress added a provision to Medicare (1) to pay for life-saving dialysis treatments for any U.S. citizen of any age who was suffering from kidney failure. Forty year later, dialysis has become a $20 billion a year industry that will treat over 400,000 Americans this year. Over 5700 dialysis centers across the country now routinely offer treatments that have prolonged the lives of a small percentage of patients for decades.

Today, very few realize that kidney failure patients enter a government / corporate system of care that has become highly dysfunctional. Most patients endure a very low quality of life that would be unacceptable to the industry’s medical professionals and corporate leaders. Despite having regulatory and medical professionals overseeing patient care, extensive medical databases, quality improvement programs built into the system, and corporate leaders that are highly regarded, this system of care has been failing patients and taxpayers ── spectacularly:

  • Unlike every other field of medicine, dialysis patients have seen little improvement in their mortality rates over the last 25 years.

  • Standard dialysis care has become minimal, debilitating, and offers little psychosocial support to vulnerable and overwhelmed patients.

  • Virtually no renal medical professional (2) or corporate officer involved in dialysis care today would accept the treatment modality that more than 90% of their patients receive

  • Few advances in technology have been developed that improves patients’ quality-of-life and allows them to lead normal lives.

  • A far smaller percentage of patients dialyze at home today than in the 1960s.

  • A far smaller percentage of working-age patients are employed today than in the early 1970s. It is estimated only 10% of working-age patients remain employed after three years on dialysis.

  • Two dominating corporations, which care for over 70% of U.S. dialysis patients, have no programs for patient employment or rehabilitation. “Renal debilitation” has become the norm because of low expectations.

  • Patients are increasingly viewed as short-term corporate revenue streams that only provide profits during their first three years on dialysis. The median survival time for U.S. dialysis patients is 36-38 months, not much longer than when the Medicare Secondary Payer period expires.

  • Taxpayers pay for additional federal and state social services that must be provided due to the unnecessary debilitation of hundreds of thousands of U.S citizens.

  • Almost no data has been collected on patient experiences, positive or negative, during the last 40 years.

  • To deflect criticism, patients are routinely characterized as unmotivated, non-compliant, medically disabled, unemployable, and elderly.

  • Patients seldom complain and those who do may find themselves dialyzing in hospital emergency departments on a non-routine basis which places their lives at much greater risk.

This system, best described as a medical-industrial complex, is made up of an intertwining web of entities and influences from the corporate, financial, government, medical, political, and academic worlds. Unfortunately, this system no longer serves patients’ best interests and insufficient motivations exist for significant change to occur. Realizing the futility of trying to change this system from within, patient advocates and activists are now working with the media to educate the taxpaying public and Congress about the failures of this federally-funded program.

Despite decades of directionless and non-improving care, a common sense solution exists to greatly improve dialysis care. There is no better public example of excellence in dialysis care than an employed patient. Towards this end, the entire medical-industrial complex can be set on a corrective course with a simple, common-sense philosophy:

In order to continually improve outcomes and technology that are important to patients and taxpayers, renal replacement therapy must be synonymous with long-term patient employment and re/habilitation.

This basic philosophy of care will improve multiple quality-of-life outcomes for patients, drive the development of smaller and easier-to-use technology, promote home and self-care dialysis, greatly increase patient participation in the system, and change the financial incentives for corporations. Publicizing patient employment data would provide patients with a tremendous tool in identifying dialysis providers that provide the best overall dialysis care.

Considering the hundreds of billions of taxpayer dollars that will be spent on dialysis care this decade, we strongly urge Congress to hold hearings to correct this federal program’s failures, problems, purpose, and direction. We believe Congress should insist on a coordinated, five-year effort from corporations, medical professionals, and government agencies to greatly increase patient employment. After forty years of ever-worsening missteps, this federal program must return to serving patients and taxpayers and a truly patient-centered model of care.

BIGGEST PROBLEMS

  • Dysfunctional government / corporate system of care with no effective sense of direction or purpose.

  • The vast majority of patients endure a very low quality of life standard that is non-improving.

  • Little or no patient feedback built into system of care.

  • Little improvement in mortality in the last 25 years. By focusing on biochemical markers and statistics, nephrology is “stuck” and cannot adopt the therapies that physicians/professionals would choose for themselves.

  • The original intent of our national taxpayer-funded dialysis program, to support working patients, has been forgotten and ignored. Employment rates among working-age patients are now lower than 40 years ago. Fastest growing segment of incoming dialysis patients are now working-age patients.

  • Despite having tens of millions of dollars of databases on dialysis patients, patient-specific employment data is not tracked anywhere: USRDS, DOPPS, CMS, Forum of ESRD Networks, LDOs.

  • US taxpayers now pay over $20 billion a year for a major-organ replacement industry that has no holistic model of care, no well-patient model, no rehabilitation, few psychosocial services, and no incentives to keep patients working. This system of care also adds tens of thousands of people to welfare rolls yearly.

  • If the treatment of chronic uremia cannot fully rehabilitate the patient, the treatment is inadequate.“ – Dr. Belding Scribner, pioneer of dialysis therapy.

  • Programs to sustain or increase patient employment and/or rehabilitation DO NOT EXIST.

  • Few facilities offer shifts starting after 5 pm. The system of care is shaped to serve corporations’ needs and for the convenience and ease of nephrologists and dialysis staff, not working patients.

  • Original social contract was not for taxpayers to pay for dialysis treatments AND disability payments.

  • Depression is common and widespread. When patients self-report depression, they have a 48% higher risk of death. Disability and debilitation have been reported, but are not widely acknowledged in the renal community as causes of depression.

  • Virtually no medical professionals or corporate officers would accept the treatment modality that 90% of their patients receive. In order to stay healthy, they know they must dialyze at home. Standard, in-center hemodialysis treatments do not provide enough therapy.

  • Government funded ESRD Networks, which are supposed to direct quality improvement, are not effectively addressing the issues of employment, rehabilitation or quality-of-life (QOL) nationwide.

  • Dialysis care is dominated by two corporations that have no professional expertise in patient employment and rehabilitation. Free market “choices” do not exist for most dialysis patients.

  • Patients are easily intimidated and threatened. Due to lack of choice, patients must often dialyze in the same corporation’s facilities that they criticize.

  • Little technological advancement has occurred in the last 20 years.

  • Poor patient fluid management has led to cardiovascular disease, the leading cause of death in dialysis patients. The traditional hemodialysis schedule is a major source of problem (3-times a week with 2-day weekends off dialysis).

  • Numerous financial disincentives exist that discourage long-term survival and patient well-being (MSP, Part A/B separation, “acute dialysis” contracts, medical director salaries, low utilization of home therapies and reliance on high-cost brick and mortar facilities)

AFTER 40 YEARS, HOW DIALYSIS CARE SHOULD BE (OR “TODAY’S GOALS”)

• Greatly improving mortality rates — like every other field of medicine

• Should offer survival outcomes similar to transplants for many patients —more frequent dialysis does

• Employment and re/habilitation seen as integral components of overall patient health and successful renal replacement therapy (or any major organ replacement therapy)

• Hundreds of thousands of employed patients on renal replacement therapy who remain working and paying taxes after their diagnosis. Many patients are integrated into the system of care and employed by large dialysis providers and renal organizations. Large dialysis provider corporations leading the movement for dialysis patient employment.

• A system that considers all societal costs of renal replacement. Incentivizes long-term patient employment and rehabilitation.

• High health-related quality of life for patients, near normal diets, highly individualized approaches to care, minimal dialysis recovery times. Patient choose optimal dialysis schedule to fit and maximize their lives. System of care shaped to meet the individualized needs of patients.

• New medical specialty (renal replacement therapy specialist or renal rehabilitation counselor) created that focuses on optimizing employment/rehabilitation with major organ replacement. This field has unique expertise in educating and motivating patients.

• Small, portable, convenient, easy-to-use dialysis machines are the norm. There is a wide diversity of equipment choices.

• Many people are able to combine hemodialysis with restorative sleep. Nocturnal hemodialysis is a widely used treatment modality.

• Dialysis schedules and technology effectively address patient fluid management (no 2-day weekend gap with every-other-day dialysis). Excellent left ventricle health and few hospitalizations for fluid overload/heart failure.

• Diversity of whole-patient and well-patient approaches to renal replacement therapy FOR ALL AGES.

• High quality patient feedback integrated into the formation of federal legislation, systems of care, and technology design. Government-funded Network 19 (not dependent on corporations) provides independent patient perspective.

• Far more home dialysis and self-care dialysis

• Minimal renal-related medication use

FOLLOW THE MONEY — HISTORY (Reimbursement history: http://www.atlanticdialysis.com/Downloads/1%20-%20Dr.%20J.G.%20Bhat.pdf)

1960s

In 1962, Northwest Kidney Centers in Seattle founded. Throughout the decade, most patients were employed and many dialyzed at home.

1970s

In 1972, federal government begins reimbursement for dialysis treatments through Medicare. Hospitals and clinics submit bills for treatment expenses. Nephrologists receive fee, monthly capitated payment (MCP), for overseeing patients’ care. Government initially estimates treatment costs at $140. For next 30 years, many large, medium, and small dialysis providers come into existence, most of which are for-profit. Many physicians also build and own their own dialysis facilities. Gradually over the next four decades, all U.S. dialysis providers replace most RNs with technicians and increase patient/staff ratios.

1980s

Dialysis treatments: OBRA 81 established a Medicare cost savings mechanism called the Medicare Secondary Payer (MSP) period. Originally it was a 12-month period when Medicare coverage would be secondary to a patient or spouse’s employer group insurance for any ESRD patient who qualified for Medicare due to ESRD only. Simply put, commercial insurance paid for the first 12-months of dialysis treatments for many patients.

In 1983, the prospective payment system (PPS – also sometimes called the “composite rate” or the “first bundle”) is instituted by Medicare to control costs. It sets a limit on reimbursement for treatment costs of $128 (Medicare pays 80% of it), which is a bundled payment for treatment labor/supplies and routine labs, but excludes injectable EPO, iron, vitamin D, antibiotics and non-routine labs).

For next thirty years, Medicare reimbursement essentially stagnates and dialysis providers begin charging commercial insurance plans higher rates than Medicare during the 18-month MSP period to compensate.

In the 1980s and 1990s, the “dialysis adequacy” formula was developed and “quality” dialysis care usually meant reducing the amount of time patients spent connected to the dialysis machines. This approach was embraced by for-profit dialysis providers, as shortening dialysis treatment times reduced their operating costs. Providers were paid the same whether they provided a 2.5-hour treatment or a 6-hour treatment. This practice resulted in higher patient mortality and has been reversing in the last few years.

For next thirty years, physicians and small providers sell their dialysis facilities to large and medium-sized dialysis provider corporations at enormous profits. Some physicians and small dialysis corporations sell their operations at a price tag of $40,000-$75,000 or more per patient (per head).

EPO/Meds: In 1989, EPO (erythropoietin or later known as an “ESA”) introduced to treat anemia and reduce blood transfusions. EPO reimbursed at $40/treatment for doses under 10,000 units and $70/treatment for over 10,000 units.

1990s

Dialysis treatments: Stagnant Medicare reimbursement, but Medicare patients can be profitable with EPO/IV drug revenues. In 1990, OBRA 90 extended the Medicare Secondary Payer period to 18 months (and expanded those affected to patients dually entitled to Medicare due to age or disability as well as ESRD). In 1997, BBA 1997 extended the MSP period to 30 months. MSP-period patients are now routinely used to subsidize Medicare patients. Dialysis providers begin charging commercial insurers an even higher rate than previously charged to those payers, significantly higher than Medicare. Fresenius Medical Care becomes vertically integrated, owning facilities and manufacturing equipment and supplies. Large dialysis-providers begin use junk bonds to finance acquisitions.

EPO/Meds: In Dec. 1990, EPO reimbursed at $11 per 1000 units, and then reduced to $10 in 1994. EPO and separately billable drugs becomes profit centers and their use increases throughout decade.

2000s

Dialysis treatments: Stagnant Medicare reimbursement rates. MSP-period patients increasingly subsidize Medicare patients. Dialysis providers charge commercial insurers 2-10 times Medicare rate. Physician-owned and small dialysis providers increasingly unable to make significant profits and are purchased by medium and large-sized dialysis providers. Large providers now own private laboratories to capture more reimbursement.

EPO/Meds: Greater use of EPO and IV drugs in for-profit centers. In 2006, EPO use peaks in U.S. at mean of 7,507 units per treatment, as Medicare costs for EPO exceed $2 billion. In 2006/2007, CHOIR, CREATE, and TREAT studies are published, which result in FDA Alerts. Some dialysis providers establish pharmacies and buy pharmaceutical companies. Chronic kidney disease patients become highly sought after commodities as large dialysis organizations establish brief education programs to market their brand to them.

2010s

Dialysis treatments: Medicare reimbursement no longer profitable. All providers must rely on MSP-period patients, charging private insurance 5-20 times Medicare rate, to subsidize Medicare patients. In 2011, Medicare creates second “bundle” as EPO, IV iron and vitamin D and dialysis-specific labs are bundled into per treatment reimbursement of approximately $230. Largest dialysis providers are thriving (with economies of scale). Large dialysis-providers use billions in junk bonds to finance more acquisitions. The only high-margin/profit “products” remaining are MSP-period patient treatments (first 33 months of Medicare eligibility) and some acute in-hospital treatment contracts.

EPO/Meds: Second Medicare bundle is instituted to control EPO, IV drugs and lab costs. No longer are sources of profits, IV drugs and most lab tests for Medicare patients now cost-centers to be controlled and limited. EPO and IV drug dosages decline significantly. Transfusions increase placing patients at higher risk of blood borne infections and jeopardizing potential transplants, making patients longer-term captives of dialysis providers.

THE DYSFUNCTIONAL SYSTEM AND ITS MAJOR PLAYERS

• Corporations – Fresenius Medical Care, DaVita, DCI (large dialysis organizations (LDOs))

• Nephrologists – Renal Physicians Association (RPA) and American Society of Nephrology (ASN)

• Centers for Medicare & Medicaid Services (CMS)

• Congress

• Lobbying Groups: Kidney Care Partners, Kidney Care Council

• Amgen/Pharma

• Individual Patients

• Patient Groups

• Academic medical institutions

A well-constructed system of care that continually improves outcomes that are important to patients must balance corporate, government, medical, and patient concerns. The current system’s most obviously dysfunction is that the collective patient experiences have been lost and no effective patient advocacy system exists. The system has failed patients and continues to fail patients. At this time, this system of care best serves the interests of corporations and nephrologists at the risk to patients. The system must begin collecting patient experiences (good and bad), valuing patient input and feedback, as well as aid the development of effective, independent patient voices, both individual and collective.

• Corporations – Two for-profit corporations, Fresenius Medical Care and DaVita, now dominate dialysis care with their sheer size, market share, financial power, political power, purchasing power, economies-of-scale, and clinical/medical influence. They capture as many dollars associated with dialysis patient care with dialysis facilities, pharmacies, large laboratory businesses (blood analyses), and acute dialysis hospital contracts. Fresenius is vertically integrated, manufacturing equipment, supplies, and pharmaceuticals as well as owning dialysis facilities. Both are growing internationally and Warren Buffet (Berkshire) recently invested in DaVita.

Dialysis providers have two high profit margin services: MPS-period dialysis treatments and some acute, in-hospital dialysis treatments. The large profits earned on these services allow Fresenius and DaVita to exist as Fortune 500-level companies. Fresenius and DaVita currently have business strategies that now function to increase their market shares under the new “Medicare” bundle.

They can operate at lower costs than independents and are purchasing competitors, increasing their power and influence. If they have the “acute dialysis” contract at the local hospital, they make more profit when patients are hospitalized, giving little incentive to improve care in their centers. They employ nephrologists as medical directors of dialysis clinics, creating a conflict of interest in terms of patient advocacy. Many top nephrologists also have financial ties and arrangements with them, including clinic ownership, research, consulting, and corporate stock ownership/options.

Fresenius and DaVita not only employ most nephrologists and nephrology nurses, but also provide much of the funding for the physicians’ and nurses’ professional organizations and most patient organizations. Fresenius and DaVita have succeeded by cutting operating and supply costs and psychosocial services to a minimum. They have won the “race to the bottom” in terms of providing minimal patient support/convenience/education/training, yet still “technically” comply with federal/state regulations for rehabilitation on paper, and thus maximize profits. Patients are simply given packets of information. Although social workers and dietitians are required to provide care, their case loads are now often over 125 patients. Social workers spend nearly all their time on insurance and transportation issues and few have time to attempt any kind of patient employment/rehabilitation advocacy.

These corporations spend heavily on lobbying, political influence, and campaign contributions.

Fresenius and DaVita have no patient focus groups to improve care. The typical, new, in-center patient quickly discovers that that they are expected to conform to the existing system of care, regardless of their employment or life activities. The existing culture is one that routinely “infantilizes” patients, with little support or expectation of patient employment or rehabilitation. Considering this environment, behavioral scientists would likely find frequent displays of patient non-compliance not unexpected.

DaVita emphasizes the experience of the employees, not the patients.

• The next largest provider is DCI, a non-profit, which has had better outcomes (mortality and morbidity) since the United States Renal Data System (USRDS) began comparing the large dialysis organizations (LDOs) several years ago. No one asks why. This may be because DCI offers more psychosocial services and patient support than the for-profits.

• Nephrologists, RPA, ASN – In general, nephrologists see dialysis care as managing medical problems, not as a part of a chronic illness that should be managed to provide the patients with the highest possible quality of life.

Comprehensive, holistic approaches to patient care are almost unknown and are not presented at their professional conferences. Over the last four decades, the field of nephrology has shown little interest in patients’ health-related quality of life, employment, or rehabilitation.

Nephrology, as a medical specialty, appears ill-suited for overseeing the quality of chronic disease patients’ lives. Nephrologists receive no training in patient employment or rehabilitation or home dialysis therapies. They see rehabilitation as the responsibility of the dialysis providers or other professionals. Forty years after the start of the federal ESRD program, there should be medical journals dedicated to CKD5 patient employment, rehabilitation, and health-related quality of life. There are none.

Simply put, instead of asking “What’s the matter?” nephrologists need to ask “What matters to you?” For the 1980s and 1990s, nephrologists focused on how short dialysis treatment times could possibly be.

In the 2000s to the present, they have been debating on whether patient mortality can be reduced by increasing dialysis frequency or treatment times.

Nephrology has become stuck in an endless argument over what data, studies, statistics, and databases are correct. Nephrologists keep insisting on sufficiently-powered, randomized controlled trials with statistically significant results to change patient care policies.

As medical scientists, they are unable to recommend the therapy to their patients that they would choose for themselves.

Nephrologists would never accept the treatment regimen that over 90% of their patients receive.

They know that in order to stay healthy, they would almost always have to dialyze at home in order to get the amount of therapy they felt they needed.

Thousands of nephrologists are facility medical directors for corporations. Few independent voices remain. Numerous financial conflicts of interest exist. The system of care has become shaped to maximize the ease, convenience, and profits of the nephrologists and corporations.

Many nephrologists see transplants as both rehabilitation and a “cure” for dialysis. Even if a nephrologist wanted to emphasize patient employment and rehabilitation for dialysis patients, the LDOs have no tools for them use. Nephrologists (Brent Miller Talk at ADC) have a financial disincentive to have home patients. According to Dr. Miller, he can see three times as many in-center patients as home patients for the same amount of money.

To rise in power and influence within this system, up and coming nephrologists must “go along” to “get along”.

  • AMGEN – In the 1990s-2010’s, received 20-30% of all federal reimbursement for dialysis care. Original 1989 patent extended through 2013. Amgen provided a “magic pill” for anemia correction. The term “quality of life” in dialysis care became attached to anemia correction for decades. Fatal/dangerous side effects of Amgen’s products and high dosages were denied for years. With its 90% margins, profits, hiring, grants, and sales incentives, few questioned Amgen’s motives and a slow, insidious corruption of many professionals in this medical field occurred.

  • DaVita administered more IV drugs than other providers. DaVita justified this by saying nephrologists signed the orders. Often, nephrologists were medical directors and stockholders in DaVita. DaVita and Fresenius recently signed contracts with Amgen that effectively locks out other anemia drug makers of the ESA/EPO market, discouraging competition and patient choices.

  • CMS – Policies are out-of-touch with patient needs. Receives little feedback and information from patients. Never collected patient experiences, positive or negative. Does not promote patient employment or rehabilitation. Existing “quality” programs (QIP) are ineffective. CMS has created an extremely convoluted reimbursement/quality improvement system that has nothing to do with patient life outcomes. ESRD Networks ineffective in improving care.

  • CMS has spent millions of dollars implementing the CROWNWeb system to track enormous amounts of treatment and lab data that are entered by facility personnel and, although values are validated within a range of expected, there is no way to verify the accuracy of the data entered. With the potential to lose money under the current the QIP, there is an incentive for facilities to game the CROWNWeb system. It can be argued that far better patient outcomes could be achieved by simply tracking and publicizing patient employment data.

  • Only 14% of current morbidity and mortality can be accounted for by assessing the CMS mandated clinical performance measures that dialysis facilities report (albumin, Ca, P, Kt/V, PTH, hemoglobin, etc). The system of care must instead address the issues that make the greatest difference in outcomes, not continue outmoded measurements that do not reflect quality of care (Boston 2009 conference).

  • Congress – Receives a great deal of lobbying from the two largest corporations through many influences. Receives little valid feedback and information from patients.

  • Congress has enacted legislation that directs CMS to set the wrong financial incentives for improving dialysis care. Congress should set financial incentives that improve outcomes important to patients and taxpayers. Congress has an extremely power tool to improve dialysis care, in that it can control the MSP period length and the conditions for which it applies.

  • Kidney Care Partners – Lobbying group that, in theory, represents all stakeholders, but it controlled by corporate interests. It includes one seat for patient groups that rotates, so there is no continuity in the patient voice. Dues are charged to pay lobbyists and admission of nonprofits is intended to establish credibility of this organization with legislators.

  • Individual patients – extremely vulnerable, lives are highly medicalized, often feel overwhelmed. Most are provided very limited psychosocial services.

Patient who do want to remain employed and/or maintain a high quality of life quickly are often shocked to find that there is no system of care to advocate for them. These patients either quickly or eventually figure out that they must do it on their own.

More often than not, most patients resign themselves to a much lower health-related quality of life. They accept their place in a system of care that “infantilizes” them and shows little interest in trying to improve the situation.

Once patients stop working, it is nearly impossible to have them return to the workforce for a variety of reasons. Many feel they are unemployable if they require dialysis and their doctors and other dialysis staff do little to change this perception.

Some patients will choose not to pursue any sort of rehabilitation. Renal rehabilitation requires a high degree of compliance with prescribed medical care and is not for everyone. Some patients will always choose the minimal treatment possible. In those cases, dialysis providers and caregivers must be non-judgmental, evaluate each patient’s reasons, and provide education to separate myth from fact about work expectations, benefits loss, and work incentive programs.

  • Patient groups – Never developed a collective patient voice. Most are dependent on corporate funding. Some accept corporate money to develop and provide minimal psychosocial services for patients, something the providers should do themselves. In doing so, many patient groups have become de facto divisions of the major corporations. Some offer programs that funnel prospective patients to the corporations.

American Association of Kidney Patients routinely gives awards to the medical directors of the largest for-profit corporations.

American Kidney Fund (AKF) describes itself as a “patient“organization. However, it acts as an incredible profit-generating instrument for the large dialysis providers. As it is illegal for Fresenius and DaVita to pay the private insurance premiums of their patients, they and other dialysis providers instead donate money to the AKF3. AKF pays the premiums which results in returns of 10-60 times their “donations.”4

  • Academic medical centers – Harvard and other leading academic centers have had nephrologists and medical staff with financial ties to Amgen, Fresenius Medical Care, and DaVita.

WHAT WENT WRONG

  • Patient employment HAS NEVER BEEN A TARGET of treatment or care. • General, long-term belief that as technology improved, dialysis treatments could be done quickly and infrequently.

  • Kt/V (and its derivative urea reduction ratio (URR)) – Medical measurement of dialysis treatment adequacy that became standard of care starting in the 1980s. Uses urea removal as a marker for dialysis adequacy. Focused only on two outcomes: hospitalization and death. Value is only a point-in-time result and is essentially meaningless.

  • 1983 bundle (composite rate) not balanced with patient-centered outcomes. To hold down growing costs, Medicare decided to pay a fixed rate of $128/treatment… regardless of the patients’ employment status.

  • Separate reimbursement for Medicare Part A and B for dialysis patients. Little incentive for dialysis providers (Part B) to provide preventative care and keep patients healthy and out of hospital (Part A). Today, if the dialysis provider (or physician group) also has the “acute dialysis” contract at the local hospital, the provider (or physician group) can make more money when the patient is hospitalized.

  • Stagnant CMS reimbursement rates were offset with increased MSP charges to commercial insurance. Patients are only profitable for providers when their commercial insurance is paying. Since the MSP period is 30 months, there is a disincentive for long-term survival. Today, the ideal patient is one that either dies, transfers, gets a transplant, or is discharged shortly after their MSP period expires.

  • No separate care goals for working-age patients. The medical field never has seen the importance of being gainfully employed in overall patient health, well-being, and survival. All patients have been treated as disabled and/or retired by Medicare.

  • Lack of quality patient feedback, lack of data collection of patient experiences, no effective collective voice, patient intimidation inherent in system. No one, not CMS, providers, or patient groups has accumulated patient feedback and their experiences

  • Financial disincentives for nephrologists to improve patient outcomes. Being on corporate payrolls, adding services means they reduce their own pay and corporate standing.

  • No incentives to create better dialysis machines, equipment, services, and supplies that improve quality of patients’ lives.

  • Replaced too many RNs with minimally educated and trained technical staff.

  • Stopped feeding patients on dialysis. Many are malnourished.

OTHER PROBLEMS

  • Mortality rate in US is worse than in Europe, much worse than in Japan

  • Home dialysis in the US is utilized far less often than possible

  • No common language for patient experiences. Very different definitions of patient-centered care, rehabilitation, and quality of life.

  • No record of what made has working patients successful.

  • Inspections / Enforcement of existing rehabilitation regulations ineffective and infrequent. Requires minimal compliance (simple chart notation) for patient rehabilitation. Inspections of dialysis providers are not frequent enough due to insufficient funding from Congress.

  • Fastest growing segment of new patients are working age patients.

TOPICS NEEDING MEDIA and/or CONGRESSIONAL INVESTIGATION (ANALYSIS / CONCLUSIONS)

  • Patient employment HAS NEVER BEEN A TARGET of treatment or care.

  • Why isn’t patient-specific employment data tracked over time and published in any of these databases: USRDS, DOPPS, CMS, and Forum of ESRD Networks?

  • Dialysis patients are provided far too limited psychosocial services for a major organ replacement therapy. Virtually no noteworthy programs exist.

  • Very little or no professional expertise exists in dialysis patient employment and re/habilitation. Does not exist in two dominating corporations. Has minimal to no importance at national professional conferences of nephrologists and nurses.

  • System fails to capture meaningful accounts of the patients’ experiences, as well as their feedback, ideas, and criticisms. CMS and patient organizations have completely failed to represent the collective patient experience of the last forty years. There is no debate or varied points of view about what is best for patients. Major corporations have no patient focus groups. CMS often gives patients very short notice to comment on complex issues, so only sophisticated corporate sources reply effectively.

  • Patient groups are dominated and intimidated by corporate money, influence and power. Patient groups cannot exist without corporate funding.

  • Total societal costs of debilitating hundreds of thousands of dialysis patients are unknown (disability payments, family assistance, food stamps, lost tax revenues, lost opportunity costs, increased hospitalizations). Economically unsustainable for the U.S. and state economies to keep increasing the number of non-working patients.

  • Corporations can increase profits by providing minimal psychosocial services and allowing increasing patient disability and debilitation to occur. These additional unpublicized societal costs are simply passed on to taxpayers. No effort to reduce it. Companies now profit by creating disabled and debilitated (and non-complaining) dialysis patients.

  • LDOs and CMS consider their products (quality indicators) to be biochemical markers and fistula placement rates, instead of patients that are well, employed and re/habilitated.

  • Spokespersons for the medical-industrial complex avoid public discussion of patient employment and rehabilitation as it only leads to embarrassing answers (or non-answers). The entire medical-industrial complex has a collective blind spot for the importance of patient employment and rehabilitation. (The emperor has no clothes.)

  • DCI, a large non-profit dialysis provider, has better outcomes (morbidity and mortality) than Fresenius or DaVita. (Why? No one address this. Is it because Fresenius and DaVita have reduced psychosocial services far more?)

  • Many nephrologists have been focused only on reducing mortality rates and dialysis complications and have not taken a wider approach in caring for these patients. They tend to see transplants as a cure. They have not addressed increased disability/debilitation and the greatly increased societal costs of dialysis.

  • Minimal dialysis treatments regimen ignores common sense that longer and/or more frequent dialysis is better for patients. Nephrology care professionals are routinely asked at professional conferences if they would accept the treatment modality that over 90% of their patients receive. No hands go up and the question is often met with open laughter. The entire field of medicine remains committed to a 3-times-a-week, short-time hemodialysis treatment regimen, despite the scientific studies on cardiovascular disease/water volume control.

  • Medicare patients are no longer a source of needed profits for corporations. Providers must depend on two high-margin products: commercial insurance rates that are 5-20 times the Medicare rate during the first 30 months of Medicare eligibility (MSP period) and some acute, in-hospital dialysis treatment contracts for hospitalized patients.

  • Financial disincentives of MSP and the separation of Part A and B. The highest profit margin services in the industry both work against long-term patient survival and well-being.

  • EPO and injectable use dropping since implementation of “new bundle” and transfusions increasing placing patients at risk of infections and jeopardizing transplant status.

  • Corporate goals, rather than patient goals, are lobbied to Congress via LDOs, Kidney Care Partners and the Kidney Care Council, as well as patient organizations that have been co-opted to believe the corporate message.

  • Free market forces do not work. If patient is not a source of significant profit, they have little power. Patients have few, if any, practical choices and can be easily intimidated. No patient group has their back. CMS Networks, which are supposed to resolve disputes, are made up of peers of the nephrology professionals and are perceived by patients who have complained as taking the side of the facility.

  • Technology has stagnated around the equipment used for in-center, 3x/week hemodialysis treatments, and the most cost-effective for large dialysis providers. There have been few advances seen in last twenty years. Why so little miniaturization?

  • We built the wrong dialysis machines, the wrong dialysis facilities, the wrong healthcare corporations, have the wrong financial incentives, the wrong government policies, the wrong etc… all because we didn’t keep our eye on the “ball” or “prize” of employment.

  • Due to their corporate size and the fact that they are publically traded, Fresenius and DaVita must remain significantly profitable and operate as efficiently as possible. They are unlikely to invest in new technology that does not offer high-margin (profit) products. Few financial incentives exist to change.

  • New bundle is driving out all but a few corporations, which increases their financial and political power. Very little choice and few options for patients, which is even more dangerous if facilities choose to black-ball a patient.

  • Fresenius Medical Care is vertically integrated (producing its own machines, supplies, and drugs), which discourages outside entrepreneurs, competition, and new technology.

  • Industry is too inbred. Numerous financial conflicts of interest exist for nephrologists, nurses, patient groups. Often one/same person represents different/conflicting perspectives to Congress.

OVERALL LONG-TERM GOALS (results in five years):

• A new, well-patient model of care is established as the norm.

• Patient input and feedback are integral, essential components of the dialysis care system.

• Any employed patient entering this system of care is educated, empowered, and incentivized to remain working. Greatly increased employment rates.

• New markers for excellence in dialysis care established for all age groups and comorbidities. • 30-40% of population on home or self-care dialysis.

• Dramatically improved survival rates and dialysis technology FOR ALL.

POSSIBLE SOLUTIONS:

• Agree on an overarching philosophical statement on employment/rehabilitation that will change the activities and direction of all involved parties.

• A coordinated, national-level agenda is necessary, involving a collective effort from CMS, Congress, providers, nephrologists, and patient groups to increase employment/rehab. With so many “players” and diverse agendas, only a unifying “target” set for all by Congress could improve patient employment and rehabilitation.

• 5-year focus and thrust on increasing patient employment

• Congress needs to provide financial incentives to increase employment, technology development, and a diversity of approaches. The most obvious incentives are to extend the MSP period for employed patients and to provide tax breaks to mployers of dialysis patients. Consider other criteria for extending the MSP period.

  • Establish a balanced, 4-quadrant patient-centered care model (patients, government, corporate, medical professionals).

  • Redefine the function of the ESRD program as a renal rehabilitation program.

REQUESTS TO CONGRESS: WHAT SHOULD BE DONE TO BEGIN IMPROVING DIALYSIS CARE

Hold congressional hearings as soon as possible to set a new, corrective direction for the entire system of dialysis care.

  • Expose the dysfunctional system, the parties involved, and the system’s problems o Begin by asking all involved parties why the original intent of the federal program, patient employment and re/habilitation, has been ignored.

    • Ask why patient-specific employment data isn’t tracked over time and published in any of these databases: USRDS, DOPPS, CMS, and Forum of ESRD Networks?

    • Ask the leaders of this medical/industrial complex what therapy they would choose for themselves o Ask if CMS’s quality improvement programs are playing a role in improving patients’ health-related quality of life

    • Hear testimony from the most frustrated patients and medical professionals, as well as the most successful patients. Have patients and professionals testify on the benefits of employment and re/habilitation.

  • Instead of calling for more medical studies, embrace a “common sense” solution based on patient employment and re/habilitation

  • Recognize that only Congress can change the direction and activities of all involved parties in the system of care

  • As a starting point, Congress should insist on a 5-year coordinated push by all involved parties to increase patient employment. Possible actions:

    • Extend the Medicare Secondary Payer (MSP) period when patients are kept employed. (This will REDUCE Medicare costs.)

    • Provide tax breaks/credits to companies that employ dialysis patients and provide health insurance

    • Dialysis patients and other collecting disability insurance income based upon being 100% disabled should be able to attempt to return to the workforce without the fear of losing their disability insurance income if their employment gets interrupted due to their disability.

    • Provide incentives for dialysis facilities to offer treatment shifts starting after 5 pm.

    • Require large dialysis providers to hire some dialysis patients.

  • Have CMS begin measuring and publishing dialysis patient employment. Identify and publically acknowledge which facilities keep patients healthy and working over extended periods of time.

  • Develop a bigger economic picture of renal replacement therapy. Establish all societal costs of failing to target employment and rehabilitation as part of major organ replacement therapy, including disability payments, food stamps, transportation, social services provided to families, as well as lost tax revenues and lost opportunity costs.

  • Realign corporate financial incentives to deliver positive outcomes for taxpayers and patients and improve patient survival

  • Have analysis/reviews of the system of care by outsiders (industry is too in-bred).

  • Require that ACOs must be focused on patient employment and rehabilitation.

  • Have CMS develop the collective patient voice and accumulate patient experiences.

  • Consider psychosocial issues as important as medical issues for long-term survival.

  • Consider that it is time to develop a new medical specialty for a comprehensive, holistic approach to renal replacement therapy. It will specialize in a body of medical knowledge, coordinate multi-faceted care with personal priorities, keep patients at their highest level of functioning, and develop modern tools for effective patient education and motivation.

  • Demand new quality markers for OVERALL quality dialysis care to be developed.

  • Hold yearly hearings to determine progress on increasing patient employment.

QUESTIONS TO ASK

To nephrologists and corporate officer: “What treatment modality would you choose for yourself and why? Why aren’t you recommending that to your patients? Could you work if you were on conventional 3x/wk hemodialysis?

To clinic administrators and nephrologists: How much emphasis do you place on working-age patients remaining employed or returning to work by the policies and procedures you have established?

With such a multi-factored therapy, don’t you have to target an increased patient employment rate to achieve it?

Headlines: Are dialysis clinics “disability factories”? (that enrich a few corporations… while increasing state and federal social services budgets?)

To working-age patients: When you entered the dialysis care system, did it seem it was a priority of the healthcare team to keep you employed? Has anyone asked you what they could do to help you stay employed or get a job… or to make your life easier?

To social workers: If you had a caseload of 100 patients or less and non-clinical tasks (admissions, forms, transportation, insurance, AKF HIPP, etc.) were performed by someone else, what could you do to help patients keep their jobs, find new jobs, and have improved health-related quality of life?

Journalists should contact the local ESRD Network offices for patient employment data in their area.

Which clinics keep patients employed over a period of several years?

Why does DCI have lower morbidity/mortality?

Ask patients if they have the level of quality of life they had hoped for when they started dialysis? Is this what they expected after 40 years of a federally-funded medical program?

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1. As stated clearly at §1881 (II) (2) (H) of the Social Security Act, “It is the intent of the Congress that the maximum practical number of patients who are medically, socially, and psychologically suitable candidates for home dialysis or transplantation should be so treated and that the maximum practical number of patients who are suitable candidates for vocational rehabilitation services be given access to such services and encouraged to return to gainful employment”.
2. Healthcare Research Consulting Group. NxStage Report. July 28, 2009. p. 1-64
3. Advisory Opinion, No. 97-1, Office of the Inspector General
4. OregonLive, Oregon officials grill dialysis companies and the American Kidney Fund, January 4, 2012

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