GOVERNMENT

GAO finds evidence of quality problems at dialysis centers

Facilities say Medicare is underfunding care for patients with renal disease.

By Markian Hawryluk, AMNews staff. Dec. 1, 2003.

Washington -- A new report on facilities that treat people with end-stage renal disease has raised troubling concerns about the quality of care provided to the nation's dialysis patients.

The General Accounting Office found that in 2000, 512 U.S. dialysis facilities provided inadequate dialysis treatment for 20% or more of their patients, and nearly 1,700 centers provided inadequate anemia treatment for 20% or more of their patients. The GAO reports that there are roughly 4,000 ESRD facilities nationwide.

"A substantial number of dialysis facilities do not achieve the minimum patient outcomes specified in clinical practice guidelines for a significant proportion of their patients," the GAO stated.

Because ESRD patients qualify for Medicare regardless of age, oversight of dialysis facilities has generally fallen to the Centers for Medicare & Medicaid Services, which relies on state survey agencies for inspections. The report found that state inspectors cited ESRD facilities for serious quality problems on a regular basis. In fiscal years 1998 through 2002, 15% of surveys found quality problems so severe that without correction, facilities faced termination from Medicare.

Even when deficiencies were corrected, centers had little incentive to remain in compliance with quality standards. Over the five-year period, 18% of facilities with serious deficiencies were cited for the same problem in successive inspections, the GAO found.

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