BRS has appraoched ART and asked if we can contribute to a project to look at writing national guidance for utility reimbursements for home HD patients, which would be an appendix to the Home HD specification.
The inconsistency in reimbursement has been raised by NKF to NHS England who have come to BRS as an MDT group to provide guidance.
BRS are looking to ART to contribute to the guidance and provide any advice or information on how this is done from Trust to Trust. NKF have already done a survey which shows huge variation.
Thoughts and comments please which can be posted on the forum or emailed direct to me if you prefer.
We have measured the water and power consumption of 4008S, 5008S and Centurion in test, run, disinfect etc and use a spreadsheet to calculate usage based on blood flow (for 5008) dialysis time and frequency of dialysis. To be honest its a bit overcomplicated and has had to be adjusted to compensate for average incoming water temps etc. , but it should be reasonably fair to all.
I originally used a consumption calculator provided by Fresenius but that was a wildly optimistic marketing tool when compared to real life measurements.
We have had patients complain that their bills have increased by a lot more - but for some of them they are spending 15-20 hours more a week at home using heating, ovens kettles etc. instead of being in a unit.
Like you Chris I started trying to do the calculations but abandoned it. It was clear that I was never going to get it accurate enough and ended up overestimating so patients were never out of pocket. I figured that that small amount extra paid to patients would add up over time to cover the cost of the power and water meters anyway, and as we have to have an electrician and plumber on site it doesn't cost that much more at the installation stage. Our patients send quarterly readings to our accounts team who insert the figures into a spread sheet and the payments are made.
Yes that's correct Chris, our plumber fits a basic water meter on the spur feeding the dialysis room and the electrician takes a spur from wherever they can and fits a meter before the dedicated dialysis sockets, so both power and water are sub metered from the existing meters. Saves a lot of hassle. Hardware wise it's about £50-60 for both meters, there was no noticeable difference in the labour costs for each trade.
We have one patient on daily nocturnal on 5008S, as are all of our patients on HHD, and he has a dedicated meter monitoring his electricity use. He also has the RO and a small heater runing on this circuit. All patients receive the same reimbursement he does. Gerry
Great clarification on reimbursement which has cleared up the bizarre view our finance dept took on being liable for water supply but somehow not the sewerage element for our metered patients.
Slightly disappointed that there is no reference to possible metering of the electric in the same way water supply is. It takes any error in estimation right out of the equation. Maybe in a future revision?
We are looking into the specs required for our IT connection system for the Quanta SC+ (self care+) machine to be used in the home. It seems that nobody uses any form of IT connection from the home to the renal unit IT system server in the UK, or at lease nobody I can find.
We use a data connection from some of our HHD patients, originally this was over a dedicated line, but now we use a VPN with the patients own internet connection, we use this for machine data collection and video calling back to the training unit.
Our water-rate paying users do not receive a water payment (as the dialysis equipment doesn't alter the bill), those on water meters do. Everyone gets an electricity payment.
Years ago, we started off using a ball park estimate, but patients complained about being short changed (they noticed their bills going up at a time when utility costs were rising steeply for all of us!).
Following this we took diligent measurements from the gear and wrote a spreadsheet into which treatment duration and frequency were entered and the estimated consumption was outputted. We tried to cover every detail, including when the gear was off (in standby) etc. Still the patients complained. Each time I re-visited the numbers to improve accuracy the reimbursement amounts went down not up! Comparing real world figures (obtained by metering -see later) to my 'laboratory conditions' measurements showed patients at home, for whatever reason, used more water and electricity that I'd accounted for. Perhaps they're not in as big a hurry at home?
After this we started to fit water and electricity meters with the equipment as it went out. Ideally we'd retrofit to non-metered patients too, but there is no funding for this work :-(
At present our meters only provide data only from which an average per-dialysis-hour figure is calculated and is applied to all home patients (those with and without meters). This is reasonable for most 'normal' treatments, but has a degree of error for very long (nocturnal) or very short treatment times as the 'fixed' consumption overheads (run-up, run-down, disinfect, etc) are spread over a great or lesser number of dialysis hours.
Our meters only account for machine & RO. We have a patient in a portacabin who also has to separately heat and light the room. That is a bridge we have yet to cross...
There is quite a spread of Utility tariffs out there, some with several tiers, standing charges etc. I wonder if it's best to remunerate on the actual tariff (chosen by the patient), insist they change supplier for the best deal, or receive a nationally agreed amount irrespective?
The meter readings we take ourselves (three monthly when we visit to swap their pre-filters). The biggest hurdle I find is getting reliable and timely treatment / duration information. As the Techs don't write the cheques, we can't be held responsible for the delays and inaccuracies that so frustrate the patients. Some clear guidance would be welcome then we can adopt best practice.
Just for interest, our patients (on 3 to 4 hour-ish) treatments are on average using 2.5KWhr per dialysis hour and 0.21cubic meters of water per dialysis hour. That includes all treatments, WRO heat disinfection, RO concentrate, softer regens, dialysis machine disinfection and the like.