Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) processes to ensure that dialysis facilities meet quality-of-care standards, focusing on: (1) the extent to which on-site inspections of dialysis facilities are performed and problems are identified; (2) whether an effective process exists to ensure that dialysis facilities correct problems; and (3) what steps are being taken to use available monitoring resources as effectively as possible.
Matter for Congressional Consideration
|To improve ESRD facilities' incentives to maintain compliance with Medicare's conditions of participation, Congress should consider authorizing HCFA to assess monetary penalties on ESRD facilities like those it is authorized to assess on nursing homes that have severe or repeated serious deficiencies.||Legislation has not been introduced or considered by authorizing committees. However, CMS officials have proposed a legislative change that would establish generic alternative sanctions for all provider types.|
Recommendations for Executive Action
|Health Care Financing Administration||The Administrator, HCFA, should strengthen HCFA's oversight of ESRD facilities by developing procedures on how and when to use HCFA's existing authority to impose partial or complete payment reductions for ESRD facilities that do not meet Medicare quality standards for dialyzer reuse.|
|Health Care Financing Administration||The Administrator, HCFA, should strengthen HCFA's oversight of ESRD facilities by establishing procedures to facilitate better and more routine cooperation and information sharing between ESRD networks and state survey agencies, particularly in targeting facilities for on-site surveys.|
|Health Care Financing Administration||The Administrator, HCFA, should strengthen HCFA's oversight of ESRD facilities by evaluating the results of HCFA's project for using clinical outcome data to select facilities for on-site review before it recommends that states use such data as a key factor in the selection process. A central component of the evaluation should be determining the extent to which the data are sufficient to predict which facilities have a higher likelihood of not complying with Medicare's conditions of participation.|