Medicare Quality of Care:

Oversight of Kidney Dialysis Facilities Needs Improvement

T-HEHS-00-136: Published: Jun 26, 2000. Publicly Released: Jun 26, 2000.

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Pursuant to a congressional request, GAO discussed the Health Care Financing Administration's (HCFA) processes for monitoring the quality of dialysis facilities for end stage renal disease (ESRD) patients.

GAO noted that: (1) the oversight of dialysis facilities has several weak links; (2) as a result, there is little assurance that facilities are routinely complying with Medicare's quality of care standards, which protect patients' health and safety; (3) GAO report highlights three main areas; (4) the first is the dwindling frequency of on-site surveys; (5) the number of facilities surveyed has been dropping each year since 1993, even though the surveys show that facilities are becoming increasingly likely to have one or more serious deficiencies; (6) the second problem is that HCFA's enforcement approach does not provide strong incentives for dialysis facilities to stay in compliance with Medicare requirements; (7) HCFA's threat to terminate a facility from Medicare is sufficient to bring nearly all noncompliant facilities into compliance, but many soon slip out of compliance again; (8) they face no penalty for this behavior; (9) third, state agencies and ESRD networks often do not share information about complaints and known quality-of-care problems at specific facilities; and (10) as a result, neither has a clear picture of what the other is finding and is unable to take advantage of that information to target or otherwise modify its own activities.

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