Journalism in the Public Interest

Feds to Follow ProPublica, Release Dialysis Clinic Data

Officials with the Centers for Medicare and Medicaid Services told Sen. Grassley they are now providing Dialysis Facility Reports, statistical compilations on each of the nation’s 5,000-plus dialysis clinics, to anyone upon request and are trying to add the reports to Medicare’s Dialysis Facility Compare website.


(Roberto (Bear) Guerra)

Federal regulators say they are moving to make once-confidential data about the performance of kidney dialysis clinics more readily available to the public.

The move, disclosed in a letter to Sen. Charles Grassley, R-Iowa, follows a ProPublica investigation last year that revealed substandard care and weak oversight in some clinics.

Officials with the Centers for Medicare and Medicaid Services told Grassley they are now providing Dialysis Facility Reports, statistical compilations on each of the nation's 5,000-plus dialysis clinics, to anyone upon request. They also said they were trying to add the reports to Medicare's Dialysis Facility Compare website.

Practically speaking, patients already have access to the data, though not from the government: ProPublica obtained the reports from CMS late last year under the Freedom of Information Act and posted them in December.

Still, the plan reflects a shift in approach for CMS, which has used public money to collect and analyze the data in the reports for more than a decade but has never shared it with the almost 400,000 Americans whose lives depend on dialysis.

CMS regulates dialysis clinics because most dialysis treatments are paid for by Medicare under a special entitlement created in 1972. In December, Grassley pressed the agency to spell out what steps it was taking to improve the system, which has among the highest mortality and hospitalization rates in the industrialized world.

His request was prompted by ProPublica's stories, which showed that patients often received treatment in environments that were unsafe or unsanitary. Our review of eight years of inspection records for more than 1,500 clinics turned up hundreds of lapses in care, some of which 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.

In their response to Grassley, CMS officials acknowledged that more than one-third of states had fallen short of inspection targets in fiscal year 2009. They said they had introduced tougher standards that had improved the quality of these checks, making them more comprehensive.

Since 2006, the agency also has introduced more frequent, targeted inspections for underperforming facilities, and officials said they were considering hiring an outside contractor to assist states with overdue inspections.

Grassley said the changes described by CMS were welcome, if overdue.

"More scrutiny and transparency are good for consumers," he said. "However, it shouldn't take an investigative media exposé and pressure from Congress to make these improvements happen. Ensuring decent care at dialysis facilities should be standard operating procedure for CMS. Patients deserve it, and the taxpayers are paying for it."

According to CMS' letter, there are still plenty of opportunities for further progress: 15 percent of the dialysis clinics inspected in the last two fiscal years were found to have deficiencies serious enough to warrant termination from the Medicare program if left uncorrected. The citations handed out most frequently were for inadequate infection control procedures and substandard physical conditions.

CMS officials told Grassley they were working with other federal agencies on an initiative to reduce infections in dialysis clinics and would be releasing an action plan summarizing the agency's dialysis-related efforts later this year.

valerie schneider

March 29, 2011, 3:27 p.m.

I want to be informed of any investigative results of dialysis center. I live in the Denver, Co. area.

Thank you

I have read several of the articles relating to this topic. I work in the industry. Has anyone ever thought that some people placed on treatment should not be doing the treatment due to co-morbid conditions that actually lead to their deaths.  Why would family allow their family member to be placed on dialysis if they are 92 years old, have a cardiac history, or cancer, or severe out of control diabetes? Are there peopled placed on dialysis that should not be doing it?  Has anyone in this great nation looked at European, Canadian, or similiar countries and their socialized look at treating certain co-mobid conidition or advanced age and placing them on dialysis.  In USA we do not discriminate on age, physical or mental health.  We dialysis any who want to be dialyzed.  Those that pay their taxes…would they want to tell their loved ones, “no, you’re too old or too sick to be on dialysis”.  What about the taxpayers, lawmakers, CMS taking a good look at not only the quality of care on dialysis, but what is being done in other countries.

Interesting. I wonder if there are reports on plasmapheresis?

I agree with Judy Y. why indeed.

Now ProPublica needs to do a thorough investigative (read: undercover) report on the organ donation industry in America.  Why are there over 110,000 individuals (...the tip of the iceberg) languishing on the waiting-to-die list?  The list just keeps getting longer and longer, while thousands die every year.  The organ donor program is not much more than a public relations slight of hand—millions are spent with little positive results, if any.  It is a monopoly run by one cloaked organization.

We have the SOLUTION to end this dilemma, but the powers that be are not interested in upsetting their profitable apple cart.

This is why ALL non-profits should be investigated. This is a direct result of deregulation/privatization! Privatization costs the public more via the misuse of tax dollars. For one instance, why do privatized non-militarized personnel make 3 times as much as our soldiers do, doing the same job?

It is about time that CMS posts the Dialysis Facility Reports (DFR) to their Dialysis Facility Compare (DFC) site. I have been trying to get CMS to post dialysis facility surveys (inspection reports) to the DFC for many years and have been outspoken about it. If CMS can post the DFR to the DFC, then they can post each and every survey (inspection) to the DFC site.

CMS needs to understand, of which I have been informed of late they are aware,  that bullying, retaliation and reprisal, either over or covert exists in many units, not all, but many. As a Dialysis Patient Safety Advocate, I communicate, almost on a daily basis with patients who have experienced some level/degree of retaliation - e.g. for reminding staff to implement a correct practice, for asking questions, etc. Yes, this is alive in many units. Patients have told me they even fear to tell the surveyors (inspectors) of their experiences (negative) for fear the ‘unit will find out and it will be worse for me’.

Once again, I ask, “CMS, please, please post the dialysis facility surveys (inspections) to your website. Dialysis facilities do not have to, per regulation, post their surveys in a conspicuous place as do nursing homes. During the open public comment for the new regulations (federal) we suggested such. Did it happen? NO. For providers, staff to tell a patient ‘you can get the survey f rom the state’ might be okay, but let’s be realistic. Many patients, for various reasons, are not in a position to do such. Why would a provider NOT want to post their most recent survey, especially, if they continually profess care is good.
I have taken it upon myself to post the 2010 surveys *(California) to our website The reason for this was because so many patients/families contacted me to obtain such for them out of fear the unit would find out… and they would experience some level of reprisal. California Department of Public Health released to me, upon request, surveys for 2010. We encourage all readers of this article to go to the site to read and understand they type of care many patients receive in many units. This is why these surveys need to be posted to the CMS website - dialysis facility compare. These surveys tell a story of their own and show the day-to-day care that patients receive
Roberta Mikles RN BA
Director, Advocates4QualitySafePatientCare

This is fantastic. Now, let us ask CMS to post the dialysis facility surveys (inspections) to the dialysis facility compare website. These surveys show the REAL day to day care that is given, showing preventable errors that occur.  To view the California 2010 facility surveys (inspections) you can see them at our site
Roberta Mikles RN BA, Director

How do you request the reports from CMS?

Roberta Mikles

March 30, 2011, 9:49 a.m.

If you are seeking the ‘dialysis faciity report’ you can obtain that from the Propublic org tracking site, as CMS is adding these to their ‘dialysis facility compare’ website. However, if you want the dialysis facility survey (inspection report) you can call your state - Department of Public Health (might be called different in different states) and ask for the department that licenses and certifies the dialysis facilities. Then tell them you want a copy of the survey and any complaints that have been filed because there are also investigations conducted when a complaint is filed.  Some states might charge a fee per page, others might not. This is why,  being tax payer dollars support such, that CMS SHOULD post these surveys on their site. By not doing this over the last many years, and not doing such now, CMS continues to halt true transparency, in my opinion. Further, we know the federal goverment is working towards decreasing infections in facilities and I was part of one of these meetings, however, it is truly sad that the most cited deficiency is infection control. What does this tell you about those providing care if they can not follow their own facility policies and procedures. It is taking the federal government to try and correct this problem because, as far as I am concerned, providers have not done what they should, otherwise, we would be seeing LESS cited deficiencies in this area ....
Roberta Mikles

I commend for staying with this, but after a decade in this program before I retired I have several questions:  (1) who specifically complied this facility-specific date, the ESRD Networks (part of the industry) or CMS staff?;  (2) who at CMS approved the final content of the data, and did the CMS survey and certification staff raise any internal objections regarding the adequacy of its content?; (3) has the amount of survey funding for ESRD facilities been increased so that inspections of all facilities can be performed every three years?  If not, why not, and when will this happen?, and can this be made mandatory via a change in Title 18?; (4) will state agencies continue to be funded and will any ESRD facility inspections be performed during the impending GOP shutdown of the national government, and who will be available as “essential personnel” at the CMS regional offices and the national office to review inspection results in the event that any require immediate action?; (5) why would CMS ever consider hiring a private sector contractor to conduct facility inspections instead of providing adequate funding to the states and is this even legal under current federal law?; and (6) why is Republican Senator Grassley sending in this request for additional information from CMS and not the Democrat who runs the Senate Finance Committee (did I miss an election?).  I am highly skeptical of the for-profit segment of the dialysis industry and also Senator Grassley, and this comes from direct experience.

Great work! Now we need funding for data analysis - the data need to be examined carefully by epidemiologists, health services researchers, biostatisticians, providers and consumers.

The Office of General Counsel/DHHS has requested CMS to inform them if surveys of health care facilities would be conducted during a government shutdown.  Since the states would still be open for business, they would, and this occurred during the last shutdown in the 1990s.  However, CMS regional office personnel must be available to review inspection reports and authorize action against facilities in noncompliance, including “serious and immediate threats” that require follow up inspections and 23-day termination (from Medicare) notification.

Why are there no consequences for patient compliance issues?  Patints don’t come to their treatments, they sign themselves off early from their treatments, refuse to follow dietary and fluid restrictions, skip medications and compromise their health with the above and the use of street drugs that impair their decision making skills and physical status and we at dialysis have to constantly attempt to “fix” them.  When will limits for these irresponsible actions be initiated?      When will the patient be held accountable?

Judy - I don’t think there is any federal authority under Title 18 for the Secretary to compel a beneficiary to show up for an appointment, take meds, stick to a diet plan, etc.  This issue was raised more than once by industry association representatives and individual dialysis suppliers before and after the proposed rule for the current conditions for coverage were published in February 2005.  Facilities need to document everything so that patient noncompliance does not distort the overall quality of care at a facility or regarding any individual patient.

How is the information currently available from Propublica any improvement from what has been available for years on CMS Dialysis Facility Looks like the same information.

richard carrancejie

April 14, 2011, 9:37 a.m.

my dialysis clinic in birmingham,al, had not been inspected for 8 years until i decided to contact our u.s. senators and congressman.I found out recently that our clinic had not been re-certified for 8 years also. i had to contact federal agencies and the white house and regina benjamin to get this clinic investigated by federal inspectors.i had to also contact federal agencies to get the state to release inspections reports to me. some people do not want us to have access to these inspection reports because some clinics were not inspected in years.

This article is part of an ongoing investigation:

Dialysis: High Costs and Hidden Perils of a Treatment Guaranteed to All

Nearly 40 years after Congress created a unique entitlement for patients with kidney failure, U.S. death rates and per-patient costs are among the world's highest while the biggest for-profit providers flourish.

The Story So Far

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.

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