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

The GAO Report

Five years ago, the Government Accountability Office recommended the following: “GAO suggests that Congress consider authorizing CMS to impose immediate sanctions, such as monetary penalties or denying payment for new Medicare patients, on dialysis facilities cited with serious deficiencies in consecutive surveys. GAO recommends that the CMS Administrator create incentives for facilities to maintain compliance with quality standards, increase use of expert staff in conducting ESRD facility surveys, and enhance the support and monitoring of state survey agencies. CMS did not indicate an intention to implement five of our six recommendations.”²

The report added: “As a result of critical weaknesses in the system established to monitor and enforce compliance with Medicare’s quality standards for ESRD facilities, full and consistent compliance with these standards has become more the exception than the rule.”²

Enforcement was also of concern, and the GAO wrote, “...there are few if any negative consequences for facilities if they are surveyed and found out of compliance with Medicare’s quality standards.”² Disclosure of deficiencies was also addressed and stated, “Currently, facilities can escape negative publicity from having multiple deficiencies, despite the fact that the statement of deficiencies prepared by the state surveyors is a public document.”² Of even greater concern was that this report cited problems at facilities that created potential for harm to patients.² This statement was the result of a review of recertification survey reports between 2001 and 2002, collected from 10 states.

To date, there are no statutory sanctions available for dialysis facilities similar to that of the nursing home scope and severity grid to determine sanction type. The lack of negative consequences, e.g., implementing similar to the nursing homes grid, continues to promote noncompliance. Many facilities that have serious noncompliance areas, that place patients in potential or actual harm, continue to go unnoticed by patients, taxpayers and other concerned individuals who support the dialysis industry. Many survey reports between 2003 and 2004, two years after this time frame noted in the report, cited deficiencies that resulted in potential or actual negative outcomes. More survey reports, from 2004 to 2006, four years after this report date, continued to cite deficiencies that resulted in potential or actual negative outcomes.

Of significant awareness is that a considerable number of these deficiencies might not have been known if it were not for the survey. Therefore, it is imperative that surveys are conducted in a timely manner to ensure ESRD compliance, resulting in quality safe care. Perhaps, investigation into an improved oversight and enforcement program would be beneficial for patients and ensure quality safe care for all.

Provider, would you want to be on the receiving end of a preventable potential or actual negative outcome, or preventable death?