Medicare agency creates quality standards for treatment of kidney disease

Donald Berwick, the new Medicare administrator, lauded the new regulations as a “landmark advance for improving the quality and safety of care that Medicare beneficiaries receive while on dialysis treatment.”

“Since most patients with [end-stage renal disease] are also Medicare beneficiaries,” he added, “the ESRD [quality incentive program] is an especially powerful tool in transforming care in America’s dialysis centers.”

Nearly 350,000 people are being treated for ESRD under Medicare, according to the Centers for Medicare and Medicaid Services (CMS), at a cost of nearly $9 billion a year. The disease — a condition where the kidneys are no longer able to remove excess fluids and toxins from the blood — disproportionately affects low-income minorities.

Medicare’s coverage of end-stage renal disease has come under intense scrutiny over the past few weeks. After more than a year of reporting on the quality of care at the nation’s dialysis facilities, the investigative journalism outfit ProPublica last month began publishing a series of critical articles.

“The United States continues to have one of the industrialized world’s highest mortality rates for dialysis care,” reporter Robin Fields wrote last month. “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 patients would die each year.”

The new regulations establish performance standards, a scoring methodology that CMS will use to rate providers’ quality of dialysis care, and a sliding scale for payment adjustments based on the facility’s performance. Facilities that do not meet the new standards will face a payment reduction of up to 2 percent depending on how poorly they fare.

The facilities will also be required to post their scores in a “prominent location in a patient care area.”

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