WASHINGTON (AP) – Some 300,000 Americans with failed kidneys stay alive by getting their blood cleaned three times a week at dialysis centers. But a new report says too many of those facilities provide inadequate treatment.

Government officials hope quality will improve in January when new Medicare payment rules give physicians financial incentives to examine dialysis patients more frequently. The change means a pay raise for kidney specialists who see dialysis patients at least four times a month, and a pay cut for those that have less frequent exams, now believed to be the norm.

That’s only one of a series of quality of care questions surrounding dialysis, where inspections are few and far between. Medicare’s chief says while he longs to send more inspectors to the nation’s 4,000 dialysis centers, doing so will require more money from Congress.

Kidney disease is rising at an alarming rate, and the number of people requiring dialysis or a transplant to stay alive is expected to double in the next decade. Medicare, the health insurance program for the elderly, pays for dialysis for Americans of any age, with costs already totaling $16 billion a year.

A recent report by congressional investigators says there isn’t enough federal oversight to force needed improvements at a significant number of dialysis centers.

The General Accounting Office found:

-At 512 facilities in 2000, blood tests show a fifth of patients received inadequate dialysis treatment. Pereira cautions that some undoubtedly were new patients not yet receiving the full benefit of the dialysis. But others either weren’t prescribed enough dialysis or weren’t on the machines long enough at each visit to do the job.

-At 1,700 dialysis facilities, 20 percent or more patients received inadequate drug treatment for anemia – a deficiency in red blood cells that is common with kidney failure.

-A growing number of centers – 216 at last count – has gone nine or more years without an inspection of whether they comply with quality standards.

-Among those inspected since 1998, 15 percent had violations serious enough that if not corrected, would warrant expulsion from Medicare. Worse, almost a fifth of those were repeat offenders. Problems included using contaminated water for dialysis, medication errors and too little physician involvement in patient care.

“The oversight and enforcement of this industry is stuck in the Stone Age,” says Sen. Charles Grassley, R-Iowa, who three years ago urged improvements that didn’t happen.

Other problems likely are going unreported because patients fear centers will quit treating those who complain, Grassley wrote to Medicare in a demand for change.

“We have no choice, we have to live with these people,” says Amy Staples, 45, of Laredo, Mo. “If we stopped the treatment at any point, we would die.”

Staples recalls the day two pints of her blood drained onto the floor because her nurse, also the dialysis center director, missed a tubing connection while chatting with another employee. At another center, she had to argue to regain two hours of treatment lost to a broken machine.

The GAO recommends that Congress allow Medicare to order dialysis centers caught with serious violations to pay fines. It also suggests that Medicare concentrate inspections on centers with a history of problems.

The dialysis industry says problems stem from low Medicare reimbursement rates that make it harder for facilities to compete for highly trained technicians and nurses.

In 12 years, Congress has allowed only a 3.6 percent payment increase to dialysis centers, and some are losing money, says Dr. Raymond Hakim of Kidney Care Partners, an alliance of dialysis providers and advocates.

Medicare is studying that complaint.

The January change in doctor payments is separate and unpopular with kidney specialists who say monitoring by phone instead of in-person exams is fine for many patients, especially in rural areas.

But Medicare’s Dr. Barry Straube, himself a nephrologist, says dialysis patients fare better when kidney specialists see them weekly. Hence, Medicare is switching from a flat monthly fee to nephrologists to payments pegged to the number of patient exams.

Meanwhile, dialysis patients can check Medicare’s Web site – http://www.medicare.gov – to compare what’s known about the quality of individual dialysis centers before choosing one. Look for measures such as the percent of patients getting adequate dialysis.



EDITOR’S NOTE – Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

AP-ES-12-01-03 1752EST



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