Monday, July 27, 2009

Dialysis Facilities-Is this discrimination? New Units Inspected, what about existing units?

In reading through this article, I was, once again, disgusted with the entire CMS system of oversight, or lack thereof. I am reminded of the time, I spoke with the State of Texas' Inspection Division and was told that there were facilities that had not been inspected timely -- these existing facilities, need to be inspected. Centers for Medicare and Medicaid Services (CMS) has an agreement with each state that dialysis facilities will be inspected every three years. However, many dialysis facilities, e.g. in Texas, California, and many other states, have not been inspected in years. Recently, I have spoken with several staff, who have told me that their facility has not been inspected in close to five, or more years. (California). How can patients be assured that they are receiving quality safe care? Even with the newly revised Conditions of Participation, patients can not be guaranteed that their facility is in compliance. Of course, CMS, to my understanding, believes that there might not be the same need for states to survey facilities due to the mandated quality improvement regulation. However, staff, in facilities, will also state that often problems are not brought to the QI committee until there is a negative outcome.

The survey process, even when it is not consistent, still identifies that which many staff do not. This has been evidenced by survey findings, for years and years. Identification of practices that place patients in either potential or actual negative outcome situations, that are not observed, or corrected, through management oversight, are, in fact, often, noted by surveyors.

I support the opening of new dialysis facilities timely. I am, more than, aware that patients have to drive hours to get treatments. Some too tired to drive, or feeling exhausted after treatment, drive long distances to get their life-saving treatments. Indeed, when facilities are not within a reasonable distance then problems can arise. I believe that facilities, when closer to a patient's home, provide a safety net, versus a facility that is an hour from a patient's home. However, I also believe that if new facilities can be inspected timely, in order to provide life-saving treatments to patients, then the same should apply (inspections conducted timely) for existing facilities. Providers are pushing for their new facilities to be open because they are losing money, along with other reasons they give. Recently, I spoke with staff, at a new facility. Staff, awaiting at the facility, being paid for just sitting and waiting. I would suggest that Texas, return, after these facilities have been inspected, and (1) make note of the number of patients that are in each facility and (2) reinspect the facility for compliance. I am sure it might be quite interesting to see if that which the providers are stating is actually true. If patients leave one unit to go to another unit, one of the units might not have enough patients perhaps to stay open. (Recently, in Oregon, a facility did not have enough patients, in a certain geographical area, and needed to close its doors).

My question, and the question of many --- Is this a type of discrimination ,when CMS will make a decision to timely inspect a new facility, however, CMS will not enforce their agreement with each state to inspect a facility every three years? Do patients, receiving treatment in facilities that have not been inspected in over three years have a right to know if their facility is in compliance? CMS is suppose to protect Medicare beneficiaries and ensure they are receiving quality safe care. However, without inspections, even with clinical indicators in place, there are practices that place patients in situations of potential or actual harm. Often, again, these are not brought to attention of management until there is a negative outcome. Shame on CMS for continuing to allow states, for years and years, to not inspect facilities timely.

Another aspect is the CMS blames the state for not conducting timely surveys and the states blame CMS. However, reality is such that the patient is caught in the middle.

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