ProPublica Dialysis Facility Tracker Featured on NBC Nightly News

By Peter Laird MD

The recent ProPublica article on dialysis facility reports is featured on a  Brian Williams NBC nightly news special report showing how the lack of information may have contributed to the death of one patient at Dutchess Dialysis Center in Poughkeepsie, NY in 2006.  This is a center that had a much higher than expected rate of death but was listed by CMS as "expected" death rate on its Dialysis Facility compare.

The NBC clip highlights the difficulty that dialysis patients have had obtaining needed information until ProPublica made available the dialysis facility tracker. It further highlights the entire issue of lack of informed consent for dialysis patients to hear of all renal replacement options at the onset of the need for such treatment. Not only do patients rarely hear of home hemodialysis from their health care team, even worse, they previously could not tell which units were better than others to make an informed choice since CMS released only partial data on these facilities and worse yet, hid the true death rates by terms of expected death rate even many times the facility in question had much higher than average death rates.  In such, the ProPublica Dialysis series has entered a new arena of not only investigative reporting, but actual consumer choice by making available this data for the very first time.

Comments

[Brian Riddle - Lynchburg, VA]

Its about time that those on dialysis can look up information on their clinic. This is long overdue. The only thing is, one group who should be able to view these results never will. I am referring to those who dialyze in center. The onves involved most are going to be kept out of the loop.

I believe that each dialysis center should be required to post their results in a public area and hand them out to every new dialyzor that comes through the door.

[Bill Peckham]

that's a good idea Brian. Their surveys too.

[roberta mikles]

And, we can thank Robin Fields for allowing patients NOW to be able to make more informed choices. I have had several patients contact me after reviewing this data and realizing they have other choices of a dialysis facility than the one they are going to.. in fact, several I have referred to home dialysis.

Brian YES YES YES and yes.. For six years, I have stated, over and over to some at state level and some at federal level, including in submitted public comments for such as the newly revised Conditions... all dialysis facilities should be mandated, as are nursing homes, to post their surveys in a conspicuous place in their facility for viewing. Interesting that this NEVER got into the new Conditions? HMM wonder why? CMS' first responsibility is to protect patients and it is my opinion that they have not done a very good job. If providers, as stated in the propublica articles, profess that their outcomes are good, no problems, etc.. I beg to differ.. One can have good outcomes and the surveys clearly show that many patients in many facilities are being placed in situations of potential or actual harm. In fact, in Calif there were facilities that had deficiencies and when the state returned the same deficiencies were cited. For example. http://www.qualitysafepatientcare.com/looking-deeper-into-delivery-of-care.php This is just one example where the so-called outcomes (hgb/URR) were identified as a bit above or below state/national averages, but the day to day operations placed patients in harms way. And, we will be adding more. So, what I ask is, in good conscious, how can any provider, etc., state that outcomes are good and there are no problems, esp after reading certain surveys. Again, we ask, 'is this the care that you would want?"
Roberta Mikles
www.qualitysafepatientcare.com

[Kitty Pie]

All,
First off, I would like to thank everyone involved with the nephrology discipline, for taking initiative towards and/or vesting in the dialysis patient population. As an RN in the field, I see every day, how this morbid disease takes over peoples lives. This patient population is a uniquely vulnerable one, that up until recent years, have sort of been "under the radar". However, with ESRD reaching epidemic proportions, largely as a result of diabetes and high blood pressure (especially in the baby boomer population) it is so critical that we get the word out to have it recognized along with more "well-known" illnesses such as cancer or heart disease.
That being said, I think that we all must remember that because the renal patient is so complicated (remember, kidney disease affects the bones, the cardiovascular system, never-mind other comorbids that become more of an issue when kidney failure evolves). Any vested caregiver, be it nephrologist, Nurse, Dietician (BTW the dietitians deserve WAY more credit than they often get), or patient care technician, we are always researching the disease and its treatment. We are and striving towards providing the BEST care possible and becoming experts in the field.
A large portion of my job focus is on quality improvement issues in addition to patient car/disease management education as an effort to decrease morbidity and mortality.Yes, mistakes are made and we all wish they didn't happen. Yes, communication needs to improve in multiple areas, not only between provider and patient, but between provider to provider as well. However, for as much "bad" that we hear about (and yes, I hear some stories), we often do not hear the good...and believe me, theres a lot positive patient outcomes that go highly unrecognized. For each "less than committed" staff person (whom I take personal interest in weeding out of the industry), there are ten others that are committed to their patients. However, for every ten of those vested caregivers, there are hundreds more patients in need of that high quality of care! We are TRYING people!!! Its NOT an exact science...or an adequately staffed one for that matter.
I'm all for posting quality results in the dialysis facilities where they can be viewed by the public. However, with those results needs to be some level of explanation or patient information handout that discusses what goes into achieving or not achieving positive outcomes; and how the specific role of the provider vs that of the patient or caregiver. If we don't involve our healthcare clients and encourage them to vest in themselves, whatever the disease my be, the outcomes will ALWAYS be less than desirable. We may never be able to keep up with the provider to patient ratio...but, we also will never be able to follow patients around 24/7 (although we can come close). Therefore, lets get the word out, and make our patients EXPERTS in their own care who feel comfortable approaching their providers and getting involved for their own good. Also, lets hone in on and provide extra attention to the geographical areas where the worst outcomes are seen and help those patients who are quite obviously UNDERSERVED.

[MooseMom]

I agree completely w/Kitty Pie in that an educated patient is more likely to be a healthier patient. All patients need to learn what optimal care is and how to recognize if they are not getting it. For instance, patients in clinic can be taught what the best infection control protocol is and how to watch and make sure their PCT is following that. Educating patients is certainly laudable, but keep in mind that an educated patient is going to be more likely to really watch what is going on. Will you support better communication between patients and clinic so that if a patient has a complaint, s/he won't be targeted for retribution of some kind? This happens more than you think.

[Peter Laird, MD]

Dear Kitty, thank you for your service to your patients and keeping the duty towards them to over see your fellow workers and their standards as well. We need more of you today.

I readily understand that many people are very devoted to their profession and to their patients in America, yet many of practices in the American dialysis units are quite unique to our land only and in my opinion and others, is the major contributing factor to poor outcomes. High UF rates, sodium modeling, Re-use, short dialysis times, the long weekend where we have a 45% increased mortality on Mondays and Tuesdays, high catheter use, low buttonhole use, late referrals and lack of informed consent all lead to poor outcomes while at the same time the industry garners soaring profits.

Unfortunately, it will take more than the good will of professional people performing their own duties well and demanding the same of their colleagues, we need to look at the philosophies and practices of our American style dialysis which is performed much faster, and more violently than Europe, Japan and Australia. Slower, gentler and longer and more frequent is the name of the game.