Dialysis holds a special place in U.S. medicine. In the 1960’s, it was the nation’s signature example of rationing, an expensive miracle therapy available only to a lucky few. A decade later, when Congress created a special entitlement to pay for it, dialysis became the country’s most ambitious experiment in universal care.

Today, dialysis is a lifeline for almost 400,000 Americans. Yet, despite massive expense by U.S. taxpayers, Americans endure some of the worst outcomes for dialysis care in the industrialized world. One in five patients dies each year. Those that survive often grapple with frequent hospitalizations and poor quality of life.

An investigation by ProPublica found that patients often received treatment in environments that were unsafe or unsanitary. A review of inspections conducted between 2002 and 2009 at more than 1,500 clinics turned up hundreds of instances in which facilities were cited for breaches in infection control, as well as egregious cases in which lapses in care may have led to patient injuries or deaths. Though clinics are supposed to be checked once every three years on average, we found that hundreds had not been inspected for five years or more. Moreover, we found, the government was withholding critical data about clinics' performance from the public.

ProPublica obtained this data under the Freedom of Information Act and, in December, posted it in searchable form. Officials with the Centers for Medicare and Medicaid Services (CMS) are now providing this information to anyone upon request and say they are working to add it to Medicare’s Dialysis Compare web site. In response to Sen. Charles Grassley, R-Iowa, who has pressed CMS to spell out what steps it was taking to improve dialysis care, the agency said it was working on an initiative to reduce infections in dialysis clinics and would be releasing a comprehensive action plan later this year.