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As Hospitals Struggle to Free Up Beds — and Nursing Homes Lock Down — In-House Dialysis Provides Relief

Published: 05/06/2020

By Lyndee Yamshon | Excerpted from original version.

By waiving the three-day stay requirement for post-acute skilled nursing coverage under Medicare, the federal government has clearly indicated a desire to free up hospital beds by relying more heavily on nursing homes to provide higher-acuity services.

Residents who require routine dialysis treatments are some of the most at-risk patients — and although this population is not the current focal point, if not treated safely inside nursing home walls, they may be endangering themselves and others when traveling in and out of outpatient clinics three days per week.

“Stakeholders right now in the health care industry need to realize that dialysis patients … need to be placed in nursing facilities that have on-site home hemodialysis to reduce the exposure and transmission of the disease that is part and parcel with an outpatient dialysis center transfer,” Dialyze Direct chief compliance officer and general counsel Jonathan Paull told SNN last month, adding that as more dialysis patients are transferred to nursing homes, additional hospital beds will open up — beds very much needed during the pandemic.

The New Jersey-based Dialyze Direct offers in-house dialysis machines and staffing in nine states, and is expanding. So far, the company has seen varying responses to dialysis needs, based on region, in terms of deciding how to discharge these patients.

While some hospitals have quickly rolled out SNF-based hemodialysis strategies, with expedited government-based emergency approvals, other states show hospitals still discharging those with kidney failure back into the community.

A few states are starting to conduct more discharges to nursing homes for dialysis treatment. Paull highlighted the New York Department of Health in working to facilitate faster approvals of dialysis dens in facilities, as well as some Florida independent hospitals and nursing homes developing on-site hemodialysis initiatives.

But these programs are still too far and few between, and more needs to be done involving local departments of health and other state agencies in partnering to safeguard this population by avoiding unnecessary exposure to the virus, Paull said.

Dialyze Direct provides services in 10 states across the country, with hundreds of nursing homes as clients in each state. The company has created a telehealth model for nephrologists and their patients in order to speed up admissions and provide faster care while alleviating exposure and possible transmission of the virus.

Licensed in every state where the company provides care, the virtual program allows providers to review files, create orders, and conduct physician visits, sometimes working in tandem with registered nurses.

[Dialyze Direct] carefully screening staff and working with nursing homes to ensure they are conducting due diligence on their end. Both companies applauded their hard-working staff for showing up with a positive attitude.

“Those people are the real heroes right now that are going out there on the frontlines and providing care,” Paull said.