Viewpoint: The Many Faces of Quality Care and a Need for Accountability

The Responsibility of Elected Officials

For the well-being of patients, Congress must address needed statutory repair. If Congress can meet with providers, professional organizations and patients, and address areas such as funding for pre-dialysis education, kidney education and increased provider reimbursement, then why is Congress not looking at and addressing the fact that there are continuing problems in dialysis facilities, as evidenced by survey findings? Deficiencies cited during the survey process will not be resolved by the new clinical performance measures. These deficiencies usually are based in not adhering to practices and procedures that ensure quality safe care. Some deficiencies can support poor clinical performance measures.

Surveys have a voice of their own, and provider denial and related rhetoric is an insult to many, including those patients who have experienced a potential or actual negative outcome, as well as those families who have lost a loved one as a result of a preventable negative outcome.

Congress should further address inclusion of data from survey findings on Dialysis Facility Compare, similar to Nursing Home Compare. In fact, one expert in the dialysis field states, “Presently, due to aggressive lobbying from large corporations, quality reporting is skewed to make providers look better than they are. As a result, the mortality and quality data being reported at Dialysis Facility Compare is worthless to the consumer.”³ Therefore, is it not reasonable to include data from survey findings on Dialysis Facility Compare? This data clearly illustrates the type of care a facility provides, and supports patients being empowered to make informed and educated choices and decisions. Survey data, in addition to accurate information related to clinical performance measures, illustrates if a facility is providing quality safe care. This data will give consumers information related to those facilities that provide excellent care to those who provide substandard care.

Should those patients who have been on the receiving end of a negative outcome address our elected officials? Should those families who have lost a loved one, as a result of a preventable error, address our elected officials? Perhaps, just perhaps, our elected officials need to hear from this group of individuals.

In addressing Medicare funding, one must ask, What are the priorities? Many realize the importance of educational programs, paying providers for quality care and other areas; however, determination of quality safe care is foremost. Without a doubt, it is evident that the survey process is a valuable tool that can improve and save lives. In conjunction, there must be an effective statutory sanctioning process, as stated, similar to the nursing home scope and severity grid. Quality safe care is the priority. It seems that the bottom line is that CMS and Congress must explore other avenues to ensuring all patients are receiving quality safe care.

In conclusion, all are aware, although some are in denial, that for the last eight years or more, a significant number of survey findings have shown patients are being placed in situations of preventable potential or actual negative outcomes, including death. This is unacceptable. Providers, CMS, and our elected officials, in desire of all patients receiving quality safe care, should understand that one preventable death is one too many. The sobering awakening that many preventable mistakes cost patients, not only their quality of life, but their life, must be addressed. To ensure quality “safe” care, dialysis facilities entering into the Medicare program, should be subject to certain conditions, such as the following: (a) providers pay a minimal survey fee that will ensure and result in an annual facility inspection/survey to ascertain ESRD condition compliance, and (b) provider reimbursement will be contingent upon ESRD condition compliance. In addition, dialysis facilities should be held as accountable as hospitals, and withholding of Medicare reimbursement should be considered for certain preventable negative outcomes, including death, similar to that which is being implemented for hospitals.

Provide care as you would want care to be given to yourself or a loved one. RBT

Roberta Mikles, RN, BA, is a healthcare patient advocate based in San Diego. She can be reached at RMiklesRN@aol.com

References:

1. http://oig.hhs.gov/oei/reports/oei-01-99-00050.PDF, Department of Health and Human Services, Office of Inspector General, External Quality Review of Dialysis Facilities, A Call for Greater Accountability. June 2000, June Gibbs Brown, Inspector General, OEI-01-00050

2. 2003 United States General Accounting Office, Report to the Chairman, Committee on Finance, U.S. Senate, October 2003, Dialysis Facilities: Problems Remain in Ensuring Compliance with Medicare Quality Standards. GAO-04-63 www.gao.gov/cgi-bin/getrpt?GAO-04-63

3. Statement - Joe Atkins, RN CNN MBA, CEO Medical Concepts & Innovations, Mr. Atkins has 36 years experience in the dialysis field, including 20 years in ESRD management. Mr. Atkins is a former dialysis facility owner.