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Good morning all
With the cost of living rising, the subject of electric/water rebates has landed on my desk. Please could I ask what your trust rebates home patients for electric and water and how the figure has been worked out. We pay for water used but only to the patients on meters, the electric rebated is £80 or 180 depending on whether the patient has a standard treatment or nocturnal. I'm not sure where these figures came from its something that had been worked out before my time here, we did carry out a experiment here to work out the usage under workshop conditions and at the time it was comparible but with the rises in rate lately i'm trying to find out if there is a national framework that is being worked to, is the BRS document the only reference for this?
thanks
John
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Hi John,
We have measured and calculated water and power reimbursement rates for 5008 with Aqua Uno and NxStage.
They are based on the patients tariff from their latest bill, frequency, dialysis time, blood flow rates (affects dialysis flow in 5008) etc.
Includes disinfections, test times, RO reject ratio and a small fiddle for average incoming water temperature.
Not perfect but useable.
I can send you the spreadsheets if you like.
We have found that some patients bills go up even more than expected, because they are spending maybe 20 hours more a week at home using their heating, lighting, cooker etc.
Chris
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Hi Chris , yes please that would be helpful especially the nxstage info, so do your patients recieve rebates calculated from this information monthly or do you pay a fixed tariff based on an average across the whole patient group
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Hi again,
Those who claim are paid quarterly. They need to provide a bill showing water or power tariff which is entered into individual calculations for each patient.
Last year annual Fresenius claims varied from around £70 to £325 for power and £85 to £260 for water.
NxStage was much less for both £50 -£180 for power and £20-£30 for water (many don't claim for water). No water cost if using bags.
Chris
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We have done this for various scenarios. The overall consumption is dependent on treatment times, blood flows, disinfection regime, dialysis frequency, RO type (hot or not) and other factors, so a flat rate would never be fair to all.
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Administrator
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If anyone wants a copy of the formula our Trust uses for reimbursement then just drop me an email.
Seems to be a very hot topic at the moment!
Ian Wilde
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Hi Ian,
Your email is bouncing back saying it's quarantined for me. I'll have a copy please, ahead of meetings to review payments over here.
Thanks
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Administrator
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Hi Garry, will email you them direct.
Ian Wilde
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Administrator
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Done 
Ian Wilde
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I've metered both water and power on our home installs for some years now. It would be interesting to compare this data to sites that do fixed sum reimbursements. Ian would you forward your formula to me also? and if anyone else who can provide that info, I'd appreciate it.
I'm still waiting for it come through from our finance dept. but I'd be happy to share our consumption data for 5008S/WRO300H/softener setup.
thanks
fraser.gilmour@dchft.nhs.uk
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This was a headache for far too long. We estimated, we measured in the workshop, we based calculations on actual home patient consumptions, and somebody was always unhappy. We tweaked to over estimate. We rounded up. The complaints continued.
It was a nightmare!
The estimation became ever more cumbersome as we tried to refine it to cover treatment, standby, RO heat cycling etc individually.
In the end we gave up.
All our patients now go home with an electricity meter and a water meter (if they're not on water rates). They are reimbursed for what the machine and RO uses on their actual tariff (and other ancillaries if plugged into the metered sockets). With one exception (who has a cabin) heat and light aren't covered.
Back when we were estimating the last figures we used were 0.3 cubic metres and 3.1kW per dialysis hour. Reimbursement was reliant on getting accurate treatment durations for the period, which was always an issue too. Less energy is required in summer, more in winter, but over the year it averaged out.
Looking at our current log, using actual readings a 3 per week patient uses around 4.5 to 5.0kW/hr and 0.3 to 0.4cube per day (averaged over the whole week, including dialysis and non-dialysis days). This is just meter reading divided by number of days, and does not account for number of treatments, duration or pump speeds etc. It does allow us to keep an eye on things, and that nobody is plugging in a 3 bar electric fire ;-)
A high user (5 or 6 per week) uses 6.75kW/hr and 0.55 cubes. A low user gets through 3.9kW/hr electricity and 0.2 cubes of water
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similarly to Matt, we started taking measurements/estimating ongoing consumption before giving up in favour of direct metering, and from the data coming back from the accountant I can see that it varies quite a bit from patient to patient.
Our HHD patients do any regime from 3x3.5hr up to 5x3hr sessions, and are free to adjust the schedule to accommodate their plans, none are on nocturnal yet. We run HDF as standard with 5008S/WRO-300H/5L softener. The RO is permanently on standby/flush mode at 4hr/5min cycles, with auto thermal disinfect twice per week. The softener is set at 0.6 cu/m for our hardness level, so regen after every two treatments. It's possible our water consumption is a bit higher due to the lack of autostart/stop when using the WRO-300 with a 5008, I suspect the RO may be left running after the post treatment disinfection quite a bit.
With this setup and averaging out the consumption data we see figures ranging from 98 to 119 kwh/month and 7.5 to 11 cu/m/month. All patients submit bills to evidence their unit rates and are paid a sum based on these when they send in a reading to the accounts team.
Rather harshly our trust has decided not reimburse anything for NXstage or APD patients, although I think this may change.
Thanks to everyone for sharing their reimbursement formulas
Fraser
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