Maximo (Max) Cervera (60) is well known in Trinity Health’s Saint Mary’s Emergency Department (ED) and on the inpatient unit of the hospital. He lives with end stage renal disease (ESRD) and has been a regular patient for at least three years.
Under usual circumstances, patients with ESRD receive dialysis several times a week in an outpatient setting. Typically, patients are dialyzed three times a week with a day of rest between, so the treatment is less taxing on their bodies.
Because Max has special circumstances, Medicaid would cover “Emergency Services Only” (ESO) for him. That meant Max had to wait until he became very ill, go the ED, undergo evaluation, be admitted, and stay two to three days in a row on an inpatient unit to receive his treatment — each week!
“I love Saint Mary’s hospital. Every time I go, they treat me with respect and courtesy. Everyone knows me,” said Max.
Getting treatment was not only exhausting and debilitating, but it became his full-time job.
Thankfully that scenario ended on April 1, 2022, when the Michigan Department of Health and Human Services Medicaid policy on the treatment of ESRD services for Medicaid patients eligible for ESO changed.
It was the first time Max, and several other patients like him, were covered in Michigan for treatment in an outpatient facility and no longer had to be admitted to a hospital to receive their care.
Collaboration was Key
Before the change in April, Trinity Health Saint Mary’s ED staff and the dialysis unit worked within the parameters of Medicaid’s then-policy so Max could receive the lifesaving care he needed. When the policy changed for the better on April 1, the staff were thrilled for Max, even though they had come to think of him as family and would miss him.
Trinity Health colleagues worked with Denise Horoky, dialysis coordinator for Patient Pathways1, a program of DaVita, Inc., to arrange for Max’s ongoing renal care. Denise provides patient education and placement for renal patients who are discharged from a hospital to receive ongoing care in an outpatient clinic. In fact, this collaboration between Trinity Health and DaVita is so important that Denise’s office has been in Saint Mary’s for a decade. It’s amazing what can happen when organizations work together.
Denise was able to “find a chair” for Max — meaning reserve a hemodialysis chair in a local outpatient clinic — so he no longer had to be hospitalized for Medicaid to cover his treatment. She worked proactively to ensure his transition from inpatient to outpatient care was seamless. Max’s first appointment was April 5, 2022.
Max is grateful for the break between treatments he now has. “I feel good now,” he said. Still, there are times when he returns to Trinity Health for evaluations. “Whenever I go back to Saint Mary’s, people say hello to me. They all know me. They treat me like a celebrity,” he added.
Appreciation All Around
On the day of Max’s final treatment, Denise and others threw a party.
“It started with me getting a card and cupcakes, but it escalated quickly,” said Denise. “I gave a card to some of our colleagues to sign, and they made signs and hid in the hall waiting for Max to be wheeled out of dialysis. Most of us were in tears, including Max, who is so appreciative of the care he received at Saint Mary’s from everyone. I am so blessed to work in a hospital with such wonderful staff. Their care for our patients is unlike anything I have seen in my many years in health care.”
Clinical Nurse Leader Rebecca Valko knows Max well. “Patients like Max really do become family…we always felt he deserved better treatment and are grateful for this change in policy. Saying goodbye was a heartfelt moment. On the last day of his dialysis, we clapped for Max as he left the floor, and he was crying.”
Trinity Health Saint Mary’s Program Coordinator of Case Management Jennifer Chaffer noted the united effort between Trinity Health and Patient Pathways made on Max’s behalf: “Denise Horocky from Patient Pathways is an amazing, accessible, collaborative partner with our case managers. They LOVE working with her!”
This admiration goes both ways. “I’m so lucky to work at Trinity Health Saint Mary’s,” said Denise. “I can’t say enough good things about them. Everybody there is phenomenal. They are some of the most compassionate and caring people. They make me feel like part of their team. I love them.”
Max loves the Trinity Health team too. He appreciates the wonderful treatment he received. “God provided for me. I recommend Saint Mary’s to all my friends and family. They treat me good, and for me, it is the best hospital. I feel like I’m home.”
1 A program of DaVita, Inc.