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.pdfThis 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.