Patricia Denny

As a renal dietitian I am concerned about the proposed ESRD bundling if it is to include oral medications. Dialysis providers cannot provide oral meds to dialylsis patients on an on-going basis. If you want to save Medicare money in ESRD management in this country, return to the committee where a panel evaluates if a patient is appropriate for dialysis or not. I have seen many, many patients through my extensive yrs in dialysis who are being dialyzed and the pt has no idea what is going on or what is happening to them. The family insists dialysis be done, and the MD feels medically liable if they do not dialyze, as there is a lack of tort reform in this nation. Thus the MD orders dialysis as a "last resort," due to the above. The pt is not part of this decision, is medically very frail, and suffers throughout the dialysis period, finally dying from their multiple diseases. Increase funding for Hospice and stop the above nonsense. And keep Sarah Palin out of this, she will take it out of context and accuse you of Death Panel. Select dialysis candidates more carefully/judiciously and keep bundling of oral meds out of the mix. I thank you. Respectfully, Patricia E Denny RD Long time renal dietitian, Buffalo NY