Dialysis Facilities: Problems Remain in Ensuring Compliance with Medicare Quality Standards
GAO-04-63
Published: Oct 08, 2003. Publicly Released: Nov 07, 2003.
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Highlights
Most patients with end-stage renal disease (ESRD) must rely on dialysis treatments to compensate for kidney failure. Currently, over 222,000 ESRD patients visit dialysis centers several times a week to have toxins removed from their bloodstreams. While dialysis care has improved overall, questions remain regarding the quality of care provided by some of the nation's roughly 4,000 ESRD facilities. We examined (1) the extent and nature of quality of care problems identified at dialysis facilities, (2) the effectiveness of state survey agencies in ensuring that quality issues are uncovered, corrected, and stay corrected, and (3) the extent to which the Centers for Medicare & Medicaid Services (CMS) funds, monitors, and assists state survey activities related to dialysis care.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Centers for Medicare & Medicaid Services | To create incentives for facilities to maintain compliance with Medicare quality standards, the Administrator of CMS should establish a goal for state agencies to reduce the time between surveys for facilities with condition-level deficiencies. |
CMS indicated that no action will be taken on this recommendation. It pointed out that, in 2002, its Budget Call Letter to State Agencies reduced the goal for the maximum time required between surveys from 6 years to 3 years. As of 2007, it planned to convert this frequency goal into a state performance standard. It also noted that any facility that is found to have condition level non-compliance receives at least one revisit and more if necessary.
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| Centers for Medicare & Medicaid Services | To create incentives for facilities to maintain compliance with Medicare quality standards, the Administrator of CMS should publish facilities' survey results on its Dialysis Facility Compare Web site. |
CMS reported that there are insufficient resources to accomplish this task. GAO maintains that public-reporting of dialysis facility performance indicators can provide a needed incentive to maintain compliance with quality of care standards.
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| Centers for Medicare & Medicaid Services | To help surveyors identify and systematically document deficiencies, the Administrator of CMS should strongly encourage states to assign ESRD inspections to a designated subset of surveyors who specialize in conducting ESRD surveys. |
CMS indicated that alternative action has been taken to address the intent of this recommendation. The agency has implemented the Surveyor Technical Assistant for Renal Disease (STAR) system for end-stage renal disease (ESRD) facility surveyors in selected states and has plans to expand its use nationwide. (An automated computer program for use on a tablet personal computer, STAR is designed to guide surveyors through the ESRD survey and certification process. It provides regulatory text, survey guidance, and reference material related to the ESRD survey process.)
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| Centers for Medicare & Medicaid Services | To help surveyors identify and systematically document deficiencies, the Administrator of CMS should make ESRD training courses more available to state surveyors, which may nclude increasing the number of classes and slots available as well as varying class location. |
In FY 2004, CMS for the first time offered two sessions of its end-stage renal disease (ESRD) Basic course, one in May 2004 in Minneapolis and the second in August 2004 in Denver. Approximately 160 students attended, compared to the 100 ESRD Basic course slots offered in FY 1999 through FY 2003.
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| Centers for Medicare & Medicaid Services | To enhance the support and monitoring of state survey agencies, the administrator of CMS should amend its regulations to require that networks share facility-specific data with state agencies on a routine basis. |
CMS reports that steps have been taken to encourage better communication between Networks and state survey agencies (SSA). The agency noted that, in 2003, SSAs began receiving annual facility-specific data that can be used to better target facility oversight activities. GAO continues to believe that, while these data are useful to SSAs, information collected through Networks' quality improvement projects and patient complaint investigations can also help identify poor performing facilities and should, therefore, be made available to SSAs on a routine basis.
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| Centers for Medicare & Medicaid Services | To enhance the support and monitoring of state survey agencies, the administrator of CMS should ensure that regional offices both adequately monitor state performance and provide state agencies ongoing assistance on policy and technical issues through regularly scheduled contacts with state surveyors. |
Although CMS reported adding specific state performance standards for end-stage renal disease (ESRD) surveys, it has not indicated any actions on the part of CMS Regional offices to enhance monitoring and assistance to state agencies.
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Full Report
Topics
Blood diseasesDialysisDiseasesHealth care facilitiesHealth care servicesHealth surveysInspectionMedicareNoncompliancePatient care servicesPerformance measuresQuality of careQuality-of-care