“God Help You. You're on Dialysis.”

[thundley4]

Link

Every year, more than 100,000 Americans start dialysis. One in four of them will die within 12 months—a fatality rate that is one of the worst in the industrialized world. Oh, and dialysis arguably costs more here than anywhere else. Although taxpayers cover most of the bill, the government has kept confidential clinic data that could help patients make better decisions. How did our first foray into near-universal coverage, begun four decades ago with such great hope, turn out this way? And what lessons does it hold for the future of health-care reform?

IN OCTOBER 1972, after a month of deliberation, Congress launched the nation’s most ambitious experiment in universal health care: a change to the Social Security Act that granted comprehensive coverage under Medicare to virtually anyone diagnosed with kidney failure, regardless of age or income.

It was a supremely hopeful moment. Although the technology to keep kidney patients alive through dialysis had arrived, it was still unattainable for all but a lucky few. At one hospital, a death panel—or “God committee” in the parlance of the time—was deciding who got it and who didn’t. The new program would help about 11,000 Americans for starters, and for a modest initial price tag of $135 million, would cover not only their dialysis and transplants, but all of their medical needs. Some consider it the closest that the United States has come to socialized medicine.

Now, almost four decades later, a program once envisioned as a model for a national health-care system has evolved into a hulking monster. Taxpayers spend more than $20 billion a year to care for those on dialysis—about $77,000 per patient, more, by some accounts, than any other nation. Yet the United States continues to have one of the industrialized world’s highest mortality rates for dialysis care. Even taking into account differences in patient characteristics, studies suggest that if our system performed as well as Italy’s, or France’s, or Japan’s, thousands fewer kidney patients would die each year.

In a country that regularly boasts about its superior medical system, such results might be cause for outrage. But although dialysis is a lifeline for almost 400,000 Americans, few outside this insular world have probed why a program with such compassionate aims produces such troubling outcomes. Even during a fervid national debate over health care, the state of dialysis garnered little public attention.

Over the course of more than a year, I reviewed thousands of inspection reports and interviewed more than 100 patients, advocates, doctors, policy makers, researchers, and industry experts to get a grasp on American dialysis care. The findings were bleak: at clinics from coast to coast, patients commonly receive treatment in settings that are unsanitary and prone to perilous lapses in care. Regulators have few tools and little will to enforce quality standards. Industry consolidation has left patients with fewer choices of provider. The government withholds critical data about clinics’ performance from patients, the very people who need it most. Meanwhile, the two corporate chains that dominate the dialysis-care system are consistently profitable, together making about $2 billion in operating profits a year.

It's a very long article.

[cavegal]

My Mom had to have dialysis. What a ordeal.  First of all it reminded me of that movie with Michael Douglas  and that women doctor, they had all the patients hanging in a room using them for parts. She was allergic to the stint, made her arm the size of a watermelon.  by the way it is beyond a long article!

[MrsSmith]

As this article hits really close to my employment, just wanted to point out a few little things...

Medicare sets no staffing ratios for dialysis centers, and most states don’t either.

Medicare surveyors look for:

There must be sufficient numbers of qualified and trained staff on duty while patients are on dialysis in-center to meet the individualized needs of the patients. Consideration should be given to the acuity and care needs of patients, staff experience and areas of expertise when evaluating the adequacy of staffing. Sufficient numbers of staff must be present in the treatment area to be able to see every patient during treatment (including lunch breaks, shift change, etc.[refer to V407]); to deliver routine care, patient assessment and monitoring per facility policy; and to promptly respond to and address patient needs (such as changes in physical or mental condition) and machine alarms. Staffing assignments and schedules should demonstrate a pattern of sufficient staff coverage to ensure safe patient care.

http://www.cms.gov/GuidanceforLawsAndRegulations/Downloads/esrdpgmguidance.pdf

This link is the Medicare Surveyor instructions.  Having lived through a couple of these surveys, I find this statement ridiculous...

Regulators have few tools and little will to enforce quality standards.

  Whatever...  we literally LIVE by the Medicare, state and AAMI regs.  I can't even count the number of times I searched those regulations to answer questions from our director.  Thanks to Medicare requirements, we currently perform the sanitization of our water loop on a monthly basis...at a cost of $2000 a month.  Now, if this actually changed any outcomes, made patients any safer, it would be a bargain.  (I mean that, a $2000 cost in the medical field is cheap.)  However, our water test results have not changed at all from when I started...when we sanitized annually.  I guess it's like most other government oversight...2% of clinics have problems, so 100% of clinics are slammed with regulations and expense.    

Medicare's Comparison site, to quickly give patients the most important stats on nearby clinics.  Not only does this provide exactly what the article claims is held secret, this actually allows dialysis patients to travel...they can call ahead and set up treatments every where they go.  

  

I don't know how much Bill Peckham had to do with this article...I've been reading his blog for quite a while now, and he focuses on only the aspects he, personally, dislikes.