...kidney disease (CKD). That is estimated at about 20 million people. People with CKD may not feel any symptoms in the early stages, so treatment most likely has not been started. When a person often finds out they are in need of treatment, they may already be in kidney failure or end stage renal disease (ESRD). This paper will discuss the reimbursement mechanisms presented in the Sullivan article, the economics of providing ESRD treatment from the organization's point of view, patients options and potential trade-offs related to cost, quality, and access to treatment, and the ethical implications of treatment options based on cost evaluation. Reimbursement Mechanisms The major reimbursement mechanism presented in article End Stage Renal Disease Economics and the Balance of Treatment Modalities is Medicare. The system in place at this time is the fee for service with additional charges for medication and medical testing (Sullivan, 2010). The current reimbursement structure is based on a three times a week structure, because hemodialysis (HD) is the primary treatment for ESRD (Sullivan, 2010). According to Sullivan (2010) "The most ideal treatment for patients with ESRD is transplantation" (p.45). The reimbursement for peritoneal dialysis (PD) is the same as that of HD. With the passing of The Medicare Improvements for Patients and Providers Act of 2008, the payment structure will eventually become a bundled rate (Sullivan, 2010). This should help to control cost associated...
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...heart failure is a progressive and systemic disease process that involves the interaction between the heart and kidneys. (Krishnan, 2007). Over time, worsening heart failure coupled with progressive kidney failure leads to diuretic resistance, consistent fluid volume overload and refractory heart failure. (Francis, 2006). Fluid balance is a goal for ESRD patients and should be one of the priorities for health promotion and prevention education. Fluid Overload and the Peritoneal Dialysis Client It is important to note that the client in this paper was diagnosed in 2007 for ESRD and hemodialysis treatment was initiated for this client right away. Initially, patient was getting three times a week dialysis treatments in-center. However, in the last three years, the client’s dialysis treatments were raised to four times per week to avoid fluid overload. Per client’s report, within the last year he would have 1-2 episodes of shortness of breath every three months ending in hospitalizations for congestive heart failure (CHF). In one of the client’s hospitalizations early this year, he was introduced to another treatment modality for ESRD patients. Client pursued peritoneal dialysis based on his nephrologist’s recommendation of said modality. The client’s perception of illness is greatly tied in to his hospitalizations and symptoms associated with CHF. These symptoms are what patient considers hindrance to his ability...
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...In an acute case of renal failure, an advanced practice nurse would utilize secondary prevention to prevent further damage to the kidneys. In this instance, the advanced practice nurse would advise the patient to change eating habits, such as a renal diet and fluid restrictions to maintain adequate kidney functions. Tertiary prevention with chronic kidney failure (greater than 6 months of kidney failure) would be for a patient to continue dialysis treatments weekly and take medication for life sustenance. When it comes to financing weekly dialysis treatments, End-Stage Renal Disease (ESRD) patients benefit from the Medicare/ Medicaid and the Affordable Care Act. According to Watnick (2017), “ESRD- centered accountable care organizations will be the future model for kidney care of Medicare beneficiaries”, which has been announced since completing the ESRD demonstration project under the Centers for Medicare and Medicaid Services (CMS)’ passage of the Affordable Care Act (ACA) (Watnick,...
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...Pathophysiology for G,L ESRD: renal failure is progressive, from acute to chronic, then end stage. In ESRD, the kidneys fail to function. Once in chronic renal failure, damage to kidneys is progressive and irreversible. The nephrons are damaged, can't function and don't recover. Surviving nephrons then hypertrophy and increase their rate of filtration, reabsorption, and secretion. Compensatory excretion continues as GFR decreases. This leads to retention of water, waste products, oliguria, and even hypertension because the kidneys cannot excrete. Also due to ESRD, BUN, creatinine, are high, GFR decreases, resulting anemia, metabolic acidosis. Hypertension: progressive damage to major organs like the kidneys, brain or heart, lead to hypertension. The kidneys, through the renin-angiotensin system help control blood pressure, by releasing angiotensin II a vasoconstrictor, and aldosterone, which leads to sodium and water retention. Impairment in this system affects blood pressure. Also changes in blood vessels cause hypertension, if their force of contractility is increased due to blockage or structural changes. Diabetes mellitus: it is known as type 2 diabetes mellitus, and is as a result of relative insulin deficiency. The pancreas produces either normal or excessive amounts of insulin but the body s unable to use it effectively, so glucose levels remain elevated, thus know as insulin resistance. Also, failure of the pancreas to produce enough insulin to overcome this insulin...
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...many have only a few choices when it comes to renal replacement modalities. According to Chapman, M., Fink, N., Finkelstein, F., Marsh, J., Meyer, K., Powe, N., Wu, A. (2004), every year in the United States, nearly 90,000 patients with chronic kidney disease progress to ESRD and begin renal replacement therapy. Most patients optimally would prefer a kidney transplant, but many may not have the ability to find a donor and must get on a transplant list. So while they wait for a suitable kidney donor their only option is dialysis. End Stage Renal Disease patients have two choices of dialysis, either hemodialysis or peritoneal dialysis. Chronic dialysis can impose a considerable burden on patients and their families, with regards to health care and their quality of life. Many statistical studies have been done to compare the qualities of life with ESRD patients who are on hemodialysis and peritoneal dialysis. According to Lausevic, M., Nesic, V., Stojanovic, M., Stefanovic, V. (2006), health-related quality of life is a multidimensional concept that includes physical functioning, social functioning, mental health, and general health perceptions. This paper will discuss certain nursing issues, with regard to ESRD patients and their choice of renal replacement modalities, and review the literature from which this information was collected, and the statistical methods used and how the data was analyzed. Nursing Issues The choice of renal replacement modalities is usually a personal...
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...Collaborative Approach to End Stage Renal Disease Patient Care Chronic kidney disease (CKD) affected 15.1% of the U.S. population in 1999-2000. During the fifth stage of kidney disease, kidney failure occurs. This is known as end-stage renal disease (ESRD). As of 2006, 25% of the Medicare budget was being used for the treatments for CKD and ESRD patients. As the baby boomers age, these numbers are expected to rise as well. An innovative and collaborative approach, such as a patient-centered medical home (PCMH), to ESRD treatment will provide higher quality patient care while reducing cost (Odum &Whaley-Connell, 2012). A case study using the PCMH approach will be conducted. Case Description Natalie is a 53-year-old African American woman. She...
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...Depression and decreased perception of social support are associated with mortality in several studies of ESRD patients (Cukor, Cohen, Peterson, & Kimmel, 2007). Decreased marital satisfaction, lower socioeconomic status, and disturbances in family dynamic can affect how a patient perceives social support (Cukor et al., 2007). Social support is intended to benefit the patient and their ability to cope with stress of having ESRD (Cukor et al., 2007). Support is divided into three types: instrumental, informational, and emotional (Cukor et al., 2007). Instrumental support provides material aid, such as financial assistance (Cukor et al., 2007). Since Medicare supports all renal dialysis patients of any age, this is an example of instrumental support for Amanda. Informational support refers to providing helpful information such as guidance (Cukor et al., 2007). Studies show that religious and spiritual beliefs are associated with decreased perception of burden of illness, decreased depression, and increased perception of social support, and better satisfaction with life (Spinale et al., 2008). The social worker can help bring a Chaplin to speak to Amanda about her spirituality. Another form of guidance is having a patient who had similar experiences with End Stage Renal Disease talk to the patient through a mentor program. Emotional support involves expressing empathy and providing encouragement of emotional expression (Cukor et al., 2007). Health-care professionals can intervene...
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...Background Many people, both young and old, utilize Medicare/Medicaid for the treatment of several chronic illnesses such as kidney disease and End Stage Renal Disease (ESRD) which is the last stage of chronic kidney disease and is characterized by permanent irreversible kidney failure. ESRD patients include those who are treated with dialysis—and those who have a functioning kidney transplant. According to the National Kidney Foundation’s website (National Kidney Foundation, http://www.kidney.org/kidneydisease/threesimpletests.cfm) the numbers are epidemic as many as 25 million American adults are diagnosed with chronic kidney disease. In an effort to combat kidney disease and to find treatment cures, the National Institute of Health (NIH) spends $655 million on kidney disease research and Medicare spends approximately $24 billion per year or approximately more than $35 billion towards the care for over 525,000 patients with end-stage kidney failure alone. Individuals with end-stage renal disease (ESRD)—irreversible loss of kidney function—require either dialysis or kidney transplantation to survive (add cite). Dialysis replaces the filtering function of the kidneys when they fail to operate properly and transplantation involves the transplanting of a donor kidney to an ill patient. There are two methods of dialysis and both have advantages and disadvantages—no one type of dialysis is best for everyone. The dialysis method that people select are based on what their provider...
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...The inequality between supply and demand is both expensive and fatal. In this paper, I will focus on the problem with insufficient kidney available for transplant, analyze its social and economic effects in the United States and evaluate the problem and a possible solution using economic sociology principles. Social and Economic Costs Currently, there are over 100,000 end-stage renal disease (ESRD) patients on the waiting list for a kidney transplant in the United States. (National Kidney Foundation, 2014) Patients have to wait anywhere between 5 to 10 years for a deceased organ. While they wait for available organs, most patients endure a four-hour session in a dialysis center three times per week. In 2009, the annual cost of taking care of an ESRD patient is around $70,000. The total cost was estimated to be over $40 billion. (USA Today, 2009) Because of Medicare rules written in the 1970’s, hemodialysis is a covered service, and no politician who desires to be re-elected will ever suggest eliminating hemodialysis coverage despite the cost. Aside from the financial cost, ESRD results in significant morbidity and mortality. Individuals with no chronic kidney disease are more likely than those with chronic kidney disease (CKD) stage 3 to 5 to be alive 1 year after a heart attack. (National Kidney and Urologic Diseases Information Clearinghouse,...
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...Chronic Kidney Disease Abstract Chronic kidney disease is a progressive disease that destroys the function of the human kidneys. This purpose of this research paper is to present an introductory profile of the disease. The profile includes a description of the disease, leading causes, how it is diagnosed, and its stages. Current statistics of the individuals impacted by the disease and mortality are provided. This paper will also explain the progressive nature of the disease and how the kidneys are damaged. Finally, the treatment goals and actions for the different stages of the disease are laid forth. Chronic Kidney Disease Kidneys are vital organs that regulate the body’s fluid level, filter toxins, control blood pressure, and more. A human cannot live without at least one functioning kidney. Chronic Kidney Disease (CKD) is a progressive disease that destroys the operating capacity of the kidneys. CKD impacts millions of Americans and is often undiagnosed until it is in an advanced stage. The human body attempts to compensate for the disease and, in doing so, worsens the condition. CKD is usually caused by another underlying cardiovascular condition. Treatment for CKD seeks to slow the progression of the disease by relieving the underlying condition. Once CKD has reached its final stage, kidney function is insufficient and renal replacement therapy is required. Chronic Kidney Disease (CKD) was formerly known as chronic renal failure (Haynes & Winearls...
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...The urinary system is another one of the major organ systems that is essential to life. It eliminates nitrogenous wastes from the body and regulates water, electrolytes, and acid-base balance of the blood (pg. 7 textbook). However, such diseases can affect people both physiologically and psychologically. End-stage renal disease (ESRD) is known to have a poorer result related to the person’s health-related quality of life (HRQOL) and also have depression (Park). According to the author of this article, Ji In Park states that these issues should be noted as “physical problems” since they are “related to morbidity and mortality rates.” According to Park, a hypothesis was made about whether planned dialysis makes a difference with the quality...
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...Date: 04/20/14 Class: HLT -362-0191 Applied Statistics Exercise 16 Mean and Deviation 1. The null hypothesis is for the study is: “There is no difference in the levels of empowerment, self-care self-efficacy, and depression of patients with ESRD who attend an empowerment program versus those who do not.” 2. What was the average baseline depression score of the experimental group subjects? The average or mean baseline depression score of the experimental group was 14.00. 3. Compare the baseline and the posttest means of the self-care self-efficacy variable for the experimental group. Was this an expected finding? Provide a rationale for your answer. The experimental group’s mean self-care self-efficacy posttest score (mean = 96.00) was 6.44 points higher than its baseline mean score (mean = 89.56) because on average the experimental group subjects scored higher on the posttest than at baseline or the beginning of the study. This was an expected finding because it was hypothesized that after the completion of the empowerment program, the experimental group’s self-care self-efficacy skills would improve. This finding indicates that the empowerment intervention had a positive impact on the self-care self-efficacy of ESRD patients. 4. Which group showed more variability or greater dispersion in their depression posttest scores? Provide a rationale for your answer. The experimental group’s posttest scores were slightly more dispersed as demonstrated by the larger...
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...unaware of their condition ("CDC, National chronic kidney disease "). This number continues to grow every year due to an increase in the incidence of hypertension, diabetes, obesity, and the aging population. CKD can develop into end-stage renal disease (ESRD) rapidly without intervention, and the only treatment currently available is renal replacement therapy or kidney transplant. The cost of treating those in the United States with ESRD in 2009 was approximately $40 billion dollars, and this cost continues to grow each year ("National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) "). Moreover, patients who develop kidney disease pay an even higher price with their life. Studies have shown that CKD is associated with a higher rate of cardiovascular disease as well as all other related mortalities (Kurth, de Jong, Cook, Buring, & Ridker, 2009). An adult with CKD is 16-40 times more likely to die before reaching ESRD than an adult without the disease ("CDC, National chronic kidney disease "). The rate of CKD is on the rise and could potentially be the largest source of health care expenditures in the United States annually. If we do not develop an intervention approach to delay the progression of CKD, ESRD could become an epidemic, and it is therefore imperative that an effective approach for slowing the...
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...Health Care Delivery Systems Ja*** Sta***** 04/12/2011 Health Care Delivery Systems Exam Paper The challenges faced in our most extreme healthcare facilities The Dialysis, Correctional, Mental Health, and Substance Abuse health care facilities are four very diverse settings in many ways. Yet in others they are similar. They represent many of the aspects of society that are orphaned, discarded, or swept under the rug, challenging both the caregiver and patient alike. Each represents an environment of extremes. Professionals must exercise the highest degree of vigilance in order to successfully provide patients with the care they need under the unique circumstances that each environment presents. In many ways each one of these facilities has a captive cliental with little or no choice but to be compliant or face dire consequences. In the dialysis setting compliance is enforced by the simple fact treatment is necessary to maintain their life. The correctional setting is harsh and restrictive with many imposed limitations, presenting the potential for serious health risk to inmate and care provider alike. The mental health facility is challenged by the lack of stability within the mind of the patient who is viewed as having “disordered thinking” presenting healthcare providers with the challenge of helping someone who is unable to follow orders or unwilling to even be treated. Substance abuse facilities have a patient base of substance dependent clients who present many...
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...only for interval/ratio level data) and standard deviations (the measure of dispersion for interval/ratio data) to describe their study variables. 2. What was the mean posttest empowerment score for the control group? Answer: Mean = 97.12. 3. Compare the mean baseline and posttest depression scores of the experimental group. Was this an expected finding? Provide a rationale for your answer. Answers may vary. The experimental group subjects scored lower on the depression posttest (mean = 13.36 vs. the baseline score of mean = 14.00), meaning that they were less depressed after the completion of the empowerment program. This was an expected finding, because the researchers hypothesized that the empowerment program would be beneficial to ESRD patients and result in a decrease in their depression scores. However, the difference in the depression baseline and posttest means for the experimental group was only 0.64, which is less than what might have been expected. 4. Compare the mean baseline and posttest depression scores of the control group. Do these scores strengthen or weaken the validity of the research results? Provide a rationale for your answer. Answer: The mean baseline and posttest depression scores of the control group were identical. Both means equaled 10.40, which indicates that there was no change in the level of depression of the control group subjects...
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