1 in 3 Dialysis Centers Subject to Medicare Penalties

Cheryl Clark, for HealthLeaders Media , December 16, 2011

"The ESRD QIP program's overarching goal is the continual improvement of dialysis care provided to Medicare beneficiaries nationwide to drive better outcomes," Patrick Conway, MD, Chief Medical Officer and Director of the CMS Office of Clinical Standards and Quality said in a statement. "The ESRD QIP will evolve over time to include additional measures that promote high quality of care and outcomes."

These scores for each center are listed on Medicare's Dialysis Compare website under the heading "Certificate of Dialysis Center Performance." The score is based on three measures:

  1. Percentage of patients with hemoglobin less than 10 grams per deciliter (g/dL) (low percentage desired).
  2.  Percentage of patients with hemoglobin greater than 12 g/dL (low percentage desired).
  3. Percentage of Medicare patients with an average Urea Reduction Ratio (URR) of at least 65 percent (high percentage desired).

Medicare officials said in a statement that these scores were based on a formula that rated performance during 2010, compared with a national performance norm across the U.S. in 2008 or the facility's own performance in 2007.

The total sum of payments that would be withheld during the first year is unknown, officials said. The savings to the Medicare program, however,  could be substantial. The federal government picks up the tab for dialysis, medications, hospitalization, lab, and physicians' supplies for at least 453,000 patients who lack private insurance, at an average cost of between $57,639 and $77,506 per patient per year as of 2008, according to the U.S. Renal Data System.

Also, dialysis care is under increasing scrutiny because of widely variable but unacceptably high death rates for people who undergo dialysis. According to data accumulated last year, dialysis patients die at the rate of 20 percent per year.

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