Medicare Quality of Care

The oversight of end-stage renal disease (ESRD) facilities needs improvement. Increasing the budget of the Health Care Financing Administration (HCFA) for inspecting ESRD facilities should help improve oversight, as would putting some teeth into the enforcement process. One way to give facilities more incentives to stay in compliance with Medicare reimbursement policies would be to have available the kinds of monetary penalties that can be used when nursing homes are found to have severe or repeated serious deficiencies. For example, HCFA can fine nursing homes, and the fines are not forgiven when the facility corrects its problems. Another way to strengthen oversight would be for state agencies and ESRD's networks to share information on complaints and known quality-of-care problems at specific facilities. This would help target inspection resources where they are most needed. HCFA's efforts to use available outcome data for targeting its survey efforts might also eventually help in this regard, but more testing and evaluation are needed to help ensure that the data used are sufficient to predict noncompliance with Medicare's quality standards. This testimony summarizes the June 2000 report, GAO/HEHS-00-114.

GAO noted that: (1) the oversight of dialysis facilities has several weak links; (2) as a result, there is little assurance that facilities are routinely complying with Medicare's quality of care standards, which protect patients' health and safety; (3) GAO report highlights three main areas; (4) the first is the dwindling frequency of on-site surveys; (5) the number of facilities surveyed has been dropping each year since 1993, even though the surveys show that facilities are becoming increasingly likely to have one or more serious deficiencies; (6) the second problem is that HCFA's enforcement approach does not provide strong incentives for dialysis facilities to stay in compliance with Medicare requirements; (7) HCFA's threat to terminate a facility from Medicare is sufficient to bring nearly all noncompliant facilities into compliance, but many soon slip out of compliance again; (8) they face no penalty for this behavior; (9) third, state agencies and ESRD networks often do not share information about complaints and known quality-of-care problems at specific facilities; and (10) as a result, neither has a clear picture of what the other is finding and is unable to take advantage of that information to target or otherwise modify its own activities.