About 15% of dialysis centers in the Medicare program have "serious quality problems" that warrant termination from the program, a new GAO report says.
The report, based on a review of inspections of the nation's 4,000 dialysis centers in 1998 and 2002, adds that "infrequent, poorly targeted, and inadequate inspections allow facilities' quality of care problems to go undetected or remain uncorrected."
Although CMS has increased funding for surveys of dialysis centers from an estimated $3.1 million in fiscal year 1998 to $8.2 million in fiscal year 2002, the report recommends that the agency take further action to improve oversight of the centers.
GAO says CMS should be authorized to impose immediate sanctions, such as monetary penalties or denial of payments for new Medicare patients, on dialysis facilities cited with serious deficiencies in consecutive surveys.
It also suggests that CMS beef up staff that conduct the surveys, improve support of state monitoring, and create incentives for facilities to maintain compliance with standards.
The report says that more than 222,000 patients with kidney failure visit dialysis centers several times a week to have toxins removed from their bloodstreams.
GAO says it found "a pattern of repeated serious deficiencies in successive inspections of an individual facility." It adds that "even when deficiencies are identified and facilities take corrective action, little incentive exists for these facilities to remain in compliance."
The report also finds that:
- States are supposed to assist CMS is inspecting dialysis units, but only nine states met the CMS goal to inspect 33% of the units every year.
- In fiscal year 2002, 216 facilities nationwide went nine or more years without an inspection.
- No effective sanctions are available to enforce compliance, short of terminating the facility from the Medicare program, which is rarely done.