in Houston, Texas
Shoddy dialysis care, growing public costs across America; Houston clinics highlighted in investigation
Friday, Nov 12, 2010, 03:30PM CST
By Lee Ann O'Neal
dialysis
A ProPublica investigation published this week tells the nearly four-decade-old story of universal access to dialysis care in America. The journalism group's findings of shoddy care and outsized, growing public costs are worth a read, as America implements healthcare reform.
 
The pricetag on this service is $20 billion a year, or $77,000 per patient, a rate that has outpaced that of countries like Italy, where patients have better health outcomes even though the cost is less. The story takes us to an Italian clinic, which the writer says is representative of the country's approach: Dialysis sessions last longer, doctors have more contact with the patients, and it's easier for patients to access specialists and get care before their condition progresses to kidney failure. Unlike the U.S., where more than 80 percent of dialysis clinics are for-profit, care in Italy is still largely in the hands of public hospitals.
Regional health authorities pay more per treatment than Medicare. ... But per-patient costs are lower because Italy's indirect expenses, particularly for hospitalization, are smaller and because coverage includes drugs as well as dialysis.
The story also highlights hard-to-get data that, if made more widely available by the government, might encourage clinics to take better care of their patients.
 
With so much American government involvement in the dialysis market --- Medicare is the "dominant payer" --- the public might expect reams of readily available information on clinics' performance. Not quite. ProPublica has been wrangling with the Centers for Medicare and Medicaid Services for two years over just such information.
"The Centers for Medicare and Medicaid Services has not made public key measures such as clinics' rates of mortality, hospitalization for infection and transplantation. Regulators know how dialysis units perform by these yardsticks. So far, patients don't."
The CMS has finally decided to release the data, which ProPublica plans to make available on its site. To illustrate how useful the data can be, the story draws an example from Houston.
"Innovative Renal Care and Midtown Kidney Center, clinics about two miles apart in Houston, had similar stats on (a federal comparison website) in 2007, including "as expected" survival rates. But the full data show that Innovative Renal's average annual death rate -- after factoring in patient demographics and complicating conditions -- was 34 percent higher than expected. Midtown's average rate was 15 percent lower than expected. (The federal website) Dialysis Facility Compare has since changed Innovative's survival rating to "worse than expected," but how much worse? The unpublished 2009 data reveal that the clinic performed more poorly, versus expectations, than 92 percent of all facilities nationwide. Innovative Renal's administrator, Scott Sullivan, said the clinic had a difficult patient pool, but its most recent results have shown improvement. 'We've put things in place to make sure those numbers are corrected,' he said."

Read the full report here.

Contact Lee Ann O'Neal at leeann@texaswatchdog.org or at 713-980-9777.

Photo 'Plugged into Dialysis' by Flicker user newslighter used via the Creative Commons license.

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