The chief medical officer at the Centers for Medicare and Medicaid Services (CMS) responded Tuesday to a scathing article on dialysis care in the U.S. by acknowledging that his agency is failing to adequately oversee the taxpayer-funded procedure.
"We have been not able to perform the oversight functions as frequently or as thoroughly as we might like to," Barry Straube told NPR.
"We are hindered by funding that comes from Congress in order to perform regulatory oversight visits for all of the 17 different provider sites that CMS is charged with regulating. And the funding that is provided to the agency is insufficient in order to be able to meet the statutory requirements in terms of frequency and thoroughness of those sites."
Straube's comments come as The Atlantic magazine and the investigative outfit ProPublica published a year-long investigation into kidney-failure care, which is covered by Medicare. The article found that the U.S. mortality rate is worse than in most other developed countries that spend far less per patient, in large part because of a dearth of state and federal regulations regarding staffing ratios and training.
Straube told NPR that part of the problem was that Congress hampered the agency's oversight powers when it told the agency several years ago to focus on annual visits to nursing homes at the expense of other facilities, including dialysis centers.
He also said the article fairly described conditions at some facilities but overstates the problem overall.
"My main quibble with the article is that it sounds like one would not want to have dialysis in the United States," he said. "This is a lifesaving treatment that the vast majority of people are being treated very well in very clean facilities that hopefully make very few mistakes."
But ProPublica's year-long review of more than 1,500 clinics in California, New York, North Carolina, Ohio, Pennsylvania and Texas from 2002 to 2009 found that surveyors came across filthy or unsafe conditions in almost half the units they checked.
"Hundreds of clinics were cited for infection-control breaches that exposed patients to hepatitis, staph, tuberculosis and HIV," the article says. "Prescription errors were common: 60 clinics had at least five citations for them."