State of the Unit 2012

Happy New Year

Insurance News

Overcoming Obesity

State of the Unit 2012
John Hensey, Administrator

Happy 2012 to all WDI patients! This year will be one of growth and expansion for WDI. As many of you may realize, the WDI in-center hemodialysis program is nearing capacity. WDI has grown from 137 patients back in 2004 to 200 patients today. We have temporarily opened an evening shift on Tuesday, Thursday and Saturday evenings at Fitchburg to continue serving new patients.

To prepare and grow for the future, we are planning to build a new 16-station hemodialysis unit. It will replace the existing WDI-East Clinic in a new location. The project is likely to start by mid-2012 and be finished by mid-2013. Once we get Medicare approval to open the new east location, existing East patients will move to the new site. Then we will gradually close the evening shift on Tuesday, Thursday and Saturday at Fitchburg as it will no longer be needed.

We are also planning to expand space for the Home program at Fitchburg by converting some offices to exam rooms. Through this expansion plan, we will improve WDI’s ability to provide more and better service to all new and established patients.

As WDI grows, we promise not to lose sight of each of you as individual patients with unique needs. To help us with this, we will continue to encourage each patient to be very involved in their care at WDI. Ask questions, be informed and make personal decisions that help keep you independent, happy and living with the highest quality of life possible. Simple choices you can make to help you stay healthy include:

• Attending or performing all your dialysis treatments and dialyzing for the full treatment time, especially when tempted to skip a treatment or shorten your time.
• Eating the right foods and minimizing your fluid intake, despite the fact that you are always thirsty and there are many tempting but poor food choices.
• Understanding and taking all your medications as prescribed.
• Getting rid of your catheter (for hemodialysis patients, if at all possible) by scheduling and attending the appointments and procedures needed to place an AV Fistula or Graft. It takes some effort to get and maintain an AV Fistula or Graft but it is a critical part of feeling your best as a patient on dialysis.
• Finding something fun to do for exercise so you will keep doing it.
• Keeping or getting a job and/or doing volunteer work if at all possible. This really helps most patients feel better.

We believe in you! You can do it!

Important updates and reminders

• If you want to experience the highest quality of life as a patient on dialysis, WDI strongly suggests home dialysis for all eligible patients. Home dialysis patients have considerably fewer dietary restrictions, infections, hospitalizations and medications. WDI has 25 patients who dialyze in the comfort of their own home and on their own schedule. We would like to see this number double. Ask your doctor if you want to learn more about your home dialysis options.
• To keep WDI records up to date, please call the Fitchburg Clinic registration desk at (608) 270-5600 - or stop by - to update any changes to your insurance, home address, employer, phone number or emergency contact. We are proud to be providing you with high-quality dialysis care and appreciate the trust you place in us. Our primary goals, as members of your health care team, are to help you maximize your health and happiness. I hope 2012 is a great year of growth and satisfaction for all WDI patients and wish you only the best in the year ahead.
  

Happy New Year
Anastasia Korbitz, Editor

Ah, it’s that time of year again: New Year's Resolutions time.
I love them! I make and sometimes break them every year. But I think any opportunity to improve oneself is a good thing. Really, what’s the harm? I can see some of you nodding in agreement or rolling your eyes.

Resolving to change something or setting goals is not everybody's cup of tea. Some folks may find them a promise they will only break almost before they get started, other folks find the idea a waste of time and others might not want to change anything. But there are still many of us that do use the transition to a new year as an opportunity to reflect upon the last year and consider goals or changes for the upcoming year. A resolution could be something as easy as returning library books in a more timely manner, reading a stack of books that have sitting around gathering dust, calling your family more regularly or exercising more often. Other folks use this time to create bigger goals: Go on a much anticipated cruise, finish a college degree or train for a marathon.

Some people don’t like the term "goal" and some will even tell me "I don't do goals." I don't believe that. What about those of you who attend dialysis, follow the diet and manage fluids to sustain your health? That could be a goal. Maintaining good health is a good goal no matter your current health issues. Although you may not think of your health in terms of goals, you essentially are meeting goals each time you come to treatment: weight goals, lab goals, fluid goals and UF goals, just to name a few. For some of you who have been on dialysis for some time, it's become second nature to be here, so you may not even be thinking of your treatment in terms or goals, but it's good to do it!

Do you understand some of the basic goals WDI has set up for you? Do you know what your fluid gains between treatments should be? Do you know what your lab goals should look like each month? If not, ask.

We have a helpful group of health care providers that want to see you use every dialysis treatment as a goal to feel and do your best and to meet those important goals to stay as healthy as possible. Know your goals for dialysis.

So, your goal may not be to run a marathon or even return your library books on time, but since you come to see us at WDI 3 times a week - you might as well understand your treatment goals. Hey, maybe your New Year's Resolution could be to know your treatment goals. There I go again, talking about resolutions ...

Insurance News
Sharon Seefeldt, Patient Account Representative, WDI Billing

The new year is a great time to be sure patient accounts are in order and a good time to ensure you have provided any updates on your insurance to us. Be sure to update insurance information with the receptionists; Terri and Mary at the front desk at the Wisconsin Dialysis Fitchburg Clinic (608-270-5600) or with any other medical clinic you attend. Remember to also provide a copy of any new insurance cards you have received.

It’s also important that you know how the billing process works for your dialysis. We need you to be part of the team when it comes to billing for your care. Together, we can make sure we have your updated insurance information to ensure the billing for your treatment is accurate.

Most patients on dialysis are eligible for Medicare under Medicare End State Renal Disease (ESRD), a federal program that finances this disease-specific service. Since WDI is an outpatient dialysis facility, dialysis charges are paid under Medicare Part B coverage.

When a patient becomes eligible for Medicare due to ESRD and is also eligible due to age/disability, the patient is considered to have dual eligibility. In this case, ESRD rules apply before the age and disability rules. This means that if a patient has other insurance thru a Group Health Plan (GHP), Medicare is the secondary payer to the GHP for a maximum coordination period of 30 months regardless of the number of employees at your workplace and whether the coverage is based on current employment status. It is important that you know when your coordination of benefits period ends, so you are not surprised when Medicare becomes your primary payer and your GHP becomes your secondary payer.

If you have Medicare and an employer based insurance, you should call the Medicare Coordination of Benefits (COB) at 1-800-999-1118 to update your other insurance information with Medicare. Also call the Medicare COB if your employer group insurance ends, so Medicare can add a termination date to your records and therefore become your primary payer. This level of communication helps provide a smooth transition in billing for services.

Additionally, Medicare will not speak with anyone else without your permission. Therefore, if you have someone else who handles your bills, they can be on the line with you when you call Medicare. It is very important that you keep Medicare updated with these changes. Doing so will eliminate confusion, prevent bills from coming to you instead of your insurance, and ensure proper billing for your dialysis.

WCDP (Wisconsin Chronic Disease Program) program is a state-funded program that offers assistance to Wisconsin residents with chronic kidney disease issues. Members are responsible for certain copays and annual deductibles determined by the program. The WCDP program only pays after all other payments sources are exhausted.

In other words, it is the payer of last resort. The current yearly deductible under this program is $162. You can speak with your dialysis social worker about the WCDP program and to get assistance completing an application.

It's very important that you take responsibility to notify your insurance company if you have more than one insurance plan. This includes notifying your insurance if you become eligible for Medicare. This is a problem we often run into in billing. The only way for an insurance company to correctly determine the COB priority is to have all insurance coverage information. A patient cannot choose which insurance they wish to pay prime. All insurances follow the COB rules that Medicare has in place. For Medicaid, it pays after Medicare/group insurances. The WCDP program is always the last payer.

Insurance programs, including Medicare, require patients to update their information. WDI billers cannot do this for you. If we call Medicare, for example, the information we provide is noted but your file will not be updated until you call and verify the information. Commercial insurances operate exactly the same way. So, communicating is very important.

WDI billing service is provided by Angie and Sharon. You won't see us in WDI clinics, as we are located in a different building, but we are always available by phone. If you receive a bill from WDI and have questions, please call our billing office at (608) 263-7708. Remember, WDI only bills for facility dialysis charges. If you receive bills from UWHC or UW Physicians, you will need to contact those offices directly. Their phone numbers are listed on the bills.

Remember, you are part of the billing team. The bills are about your care at WDI. Keep us and all your insurance programs updated with any changes in your coverage. It will help eliminate confusion and, best of all, ensure your bills are paid. Happy New Year!

Overcoming Obesity
Dacia Andrist, Dietetic Intern

In the United States, it is estimated that more than 60 percent of the population is overweight or obese. In a world where cars have replaced walking, fast food has replaced cooking, pills have replaced lifestyle modifications and desk jobs have replaced manual labor, it is no wonder that the majority of our country struggles with their weight.

The baggage that comes along with obesity is more than carrying around extra pounds. Obesity is a risk factor for numerous health problems, including Type 2 diabetes, high blood pressure, metabolic syndrome, heart disease, stroke and several types of cancers. Not only can extra weight take a toll on your health, it can put a strain on your wallet as well. Medical expenses are nearly $1,500 more for obese individuals than their healthy-weight counterparts.

The benefits of a healthy weight are plentiful, but if you're struggling with obesity they may seem out of reach. The good news is that even a relatively small amount of weight loss, such as 5 to 10 percent of your body weight, can improve blood pressure, blood sugar and overall health. Additionally, it has been suggested that weight loss may help slow the progression of CKD.

Now that the benefits of even a small amount of weight loss are out on the table, lets discuss how you can get there. The two most important factors in weight loss are nutrition and physical activity.

If your caloric intake is greater than the energy your body uses in a day you will gain weight. If your intake is equal to the amount of calories your body uses in a day you will maintain your current weight. Finally, in order for weight loss to occur your calorie intake needs to be less than the amount of energy your body uses per day. This means that you can either decrease your food intake, increase your physical activity or do a combination of the two to start losing weight.

It is important to keep in mind when cutting back on calories to still maintain a high intake of protein to meet your needs for dialysis. Protein helps your body to maintain and build lean muscle mass. An added bonus of eating protein-rich foods is that they leave you feeling full and satisfied for an extended length of time.

WEIGHT LOSS SURVIVAL KIT

• Keep a supply of healthy snacks
• Keep a food and/or exercise journal for a week, then go over it with your dietitian to see where substitutions and improvements can be made
• Serve dinner on a smaller 7-9” plate to encourage better portion control
• Make water your primary beverage (within your fluid restriction, of course)
• Eat the vast majority of meals at home - it is difficult to control salt, fat and portion size at restaurants
• Avoid eating while watching TV - your body is more likely to ignore when you're starting to feel full or satisfied
• Follow the My Plate method. This is the revamped version of the old food guide pyramid.