How we did it: Community Physicians Dialysis Center Fairborn (CPDCF); Fairborn, Ohio

In fall, 2004, CPDCF received approval from the Centers for Medicare and Medicaid Services (CMS) and the Ohio Department of Health to begin a home hemodialysis program. Here's how they got started.

Adding a service option

It was fall of 2003 when the CPDCF management team first began discussing the idea of starting a home hemo program. They'd read about the excellent clinical outcomes of home patients at other clinics and were intrigued by the idea of home hemodialysis. The more they talked and read about it, the more their interest grew. They began seriously investigating the idea of starting a program of their own in January, 2004.

The team quickly decided that if they were going to add a new home dialysis program, they would offer nocturnal home hemodialysis (NHHD). According to Sue Powderly, RN, facility manager, the team chose to focus on NHHD for two reasons:

  1. Because of the excellent reports about patient outcomes.
  2. Because no other clinic in the state provided this type of dialysis.

"We wanted to offer something that was really a new option for our patients," explained Powderly.

First steps

The very first step toward starting the program was a cost analysis by clinic administrator Jeff Spiers. "We wanted to make sure we wouldn't lose our shirts!" laughed Powderly. When the analysis confirmed that offering NHHD would not cause financial losses, the team began their investigations in earnest.

The management team working on home hemodialysis at CPDCF included, from right to left:

  • Dr. Pius Kurian, MD, FACP, FASN, Medical Director
  • Sandra Langhout, RN, CNN
  • Jeffrey Spiers, RN, CNN, Administrator
  • Sue Powderly, RN, CNN, Facility Manager
  • Dennis Muter, CHT, Chief of Biomedical Services

To learn more about what they would be getting into, the team investigated other clinics that offered NHHD (Toronto, Seattle, and Lynchburg, VA). They held a conference call with the Seattle program to get more on the nuts and bolts of running a program. Then they scheduled an on-site visit to the Lynchburg Dialysis Clinic in Lynchburg, Virginia that is under the medical direction of Dr. Robert Lockridge.

"That visit was so exciting!" remembers Powderly, "Five of us went to Lynchburg and spent the day. We talked to patients about their experiences and they were very honest. Every single one looked and felt so good that we got really 'juiced' about offering this kind of dialysis to our patients, too."

Making a commitment

According to Powderly, the team really committed to starting a new home hemo training program on the drive back to Ohio from Lynchburg. "They have an incredible program at Lynchburg, and they believe in what they're doing," explained Powderly. "It was truly inspiring, and everybody wanted to go ahead with our own program after we saw theirs," she said.

Once the commitment was made, the staff at CPDCF applied for certification and got down to work. Many of the tasks were complicated and time-consuming, for instance, putting together a training manual of policies and procedures. "We made a donation to the Lynchburg Dialysis Clinic patient fund and they gave us the rights to use their manual as a starting point," said Powderly. Still, she and the rest of the team spent the summer of 2004 adapting the manual for their own use. "It was a huge team effort," recalled Powderly.

Administrator Jeff Spiers and Dennis Muter headed up the effort to provide safe in-home water treatment. They found a strong ally in local plumbing contractor Roger Storer. Storer developed a drain system prototype and coordinated water treatment system approvals with plumbing inspectors from all the local counties.

Throughout the process, the staff at Lynchburg Dialysis Center functioned as mentors for the team at CPDCF. "They were great," Powderly praised. "Dr. Lockridge met with Dr. Kurian, and their whole staff offered lots of helpful advice to our team."

Starting cautiously

The program's first patient started training in October, 2004, and went home the second week of December. The clinic's second NHHD patient went home in May, 2005. A third patient is expected to go home in August, 2005. "There was a bit of a delay in between the first two patients," Powderly explained, "because we decided to change reverse osmosis systems. The first one we used was just a lot of work for the patient."

CPDCF plans to add 3-4 NHHD patients per year in the first years of the program. "We want to go slowly," claimed Powderly. "We 're tracking lots of data, like hospitalizations and use of medications. We also want to be sure that everything is running smoothly." The team meets periodically to review progress, discuss any problems, and set goals.

Lessons learned

The team at CPDCF is very thankful for the advice they got from the team in Lynchburg. "It really helps to learn from others who've done it," claimed Powderly. For example, the Lynchburg team was adamant about the need to have two nurses for the home hemodialysis program. In retrospect, Powderly agrees. "You do need to have two nurses to make things work," she said. Powderly also credits "an excellent implementation plan" developed by the CPDCF administrator for making the start-up process smooth.

Her own advice? Powderly recommends that clinics contemplating a new home hemodialysis program think carefully about their motivations. "It's not just business," she said, "you have to want to do it because it's good dialysis care." In addition, she thinks that clinics should do a lot of research before they get started. Because setting up a new program involves many different, one-time tasks, Powderly thinks it helps to have a team that "likes problem solving."

So far, Powderly and the rest of the team are very pleased with their new program. "It really is a lot of work," she declared, "but how many times in your life do you get to do something like this—be a real pioneer?"

↑ Top of page