At Brewster Ambulance Service, we serve a large population of patients who require transportation to dialysis centers for treatments. These transports range from patients in nursing facilities to patients living at home, who have been diagnosed with some degree of kidney failure and have been prescribed dialysis treatments. These treatment regimens can be temporary or long-lasting for the patient depending on the type of kidney injury or failure.
What is Dialysis?
Dialysis is a medical procedure that is prescribed to people who are experiencing some degree of kidney injury or chronic kidney disease. This ranges from patient to patient, however dialysis is prescribed when the kidneys cannot properly filter harmful waste products from the blood or balance the level of fluid and sodium in the body. It's also important to note that properly functioning kidneys also produce hormones for the body's overall health.
Chronic kidney disease, or renal disease, happens when there is a change in the structure or function of the kidney. Tumors, infection or certain medication side effects can cause kidney disease and have serious implications on the health of the body. When kidneys cannot function properly a variety of symptoms occur and dialysis treatment may be prescribed. If kidney function cannot be restored and both kidneys fail, then dialysis is needed. It is also necessary if the function of the kidneys is less than 10%, where dialysis replaces kidney function artificially.
There are two types of dialysis. Hemodialysis is when the patient's blood is filtered by a machine outside of the body, removing waste impurities from the blood. In peritoneal dialysis, a dialytic fluid is flushed through the patient's abdominal cavity, extracting the waste products from the blood. A kidney transplant is another option for patients with kidney failure.
Transportation to/from dialysis facilities
Medicare covers ambulance services to and from a patient's home to the nearest dialysis facility for treatment of End-Stage Renal Disease (ESRD) only if other forms of transportation could endanger the patient's health. For non-emergency, scheduled, repetitive ambulance services, the ambulance supplier must get a written order from the patient's doctor before ambulance service is provided.
The doctor's written order must certify that ambulance transportation is medically necessary and must be dated no earlier than 60 days before the patient receives ambulance service. If the patient is in a Medicare Advantage Plan (like an HMO or PPO), the plan may cover some non-ambulance transportation to dialysis centers and doctors.
Dialysis patients should review their plan materials or call the plan for more information. Two resources provided by the Department of Health and Human Services include:
Caring for Our Dialysis Patients
Brewster Ambulance Service developed a personalized program for all of our dialysis patients that would assure insurance provider compliance as well as the comfort of each treatment transport. A team of three (currently) registered nurses with hospital and emergency room experience now manage this program to help dialysis patients have a better experience before, during and after their treatment transports.
The Brewster Ambulance dialysis nurses travel to patient's homes and nursing care facilities where they evaluate the patients for transport eligibility. Brewster Ambulance follows strict Medicare guidelines which includes checking the patients for mobility, to see if they can stand and/or walk, and then assess whether they remain on the ambulance or are able to use another mode of transportation.
Patient evaluations are then submitted to the main office at Brewster Ambulance where they are reviewed and issued a final decision regarding compliance. When the dialysis program was first initiated, it served 72 patients. Now it currently serves over 200 patients and continues to grow. Dialysis patients are transported primarily in basic life support ambulances using stretchers, with some exceptions. Their condition is such that they need to be completely lifted and require assistance getting in and out of a dialysis treatment facility.
Because of the mandates regarding insurance coverage, ambulance transportation for dialysis patients requires a physician's written approval to be "medically necessary" for the patient's safety and well being. Dialysis patients often also require additional assistance getting in and out of the dialysis chair and help returning to their home or care environment, as they are often exhausted after their treatments.
There are also patients who are very confused such as those with dementia or Alzheimers, and patients who are flight/fall risks who need to be transported by ambulance. We have patients that can stand, sit in a wheelchair, but they may try to get up out of the wheelchair and perhaps help the driver during a transport, for example, and they need supervision by an EMT. Patients who are on oxygen and need to be regulated also require an EMT to accommodate care during transport.
The Brewster dialysis nurses coverage includes the South Shore from Boston to Plymouth and into Rhode Island. The dialysis nurses see each patient approximately every 60 days, especially in cases of chronic kidney disease where patients are receiving ongoing dialysis treatments over an extended period of time.
When the nurses visit the patient's facility, they talk with the facility nurses and sometimes the physical therapists working with the patient. They also talk to the Brewster Ambulance crews to learn how a patient fared during their last transport for treatment. In some cases, the nurses will also go visit patients with a Brewster EMT. This enables the nurses to understand more about the patient's behaviors, preferences and customize their treatment transport plan.
The key to the patient's success is that they are getting the right transportation. Medicare also needs to know that Brewster is not transporting any patient that shouldn't be transported and does its best to adhere to those guidelines. As with all of our patients, our top priority is their safety and well being.