[Congressional Record Volume 148, Number 96 (Tuesday, July 16, 2002)]
[Extensions of Remarks]
[Page E1264]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              INTRODUCTION OF ESRD QUALITY IMPROVEMENT ACT

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                         Tuesday, July 16, 2002

  Mr. STARK. Mr. Speaker, I rise today to introduce the ESRD Quality 
Improvement Act. To address the life and death importance of quality 
dialysis therapy for End Stage Renal Disease patients, this legislation 
would codify and build upon existing quality improvement efforts in a 
variety of ways including the addition of recognition for outstanding 
clinical outcomes and sanctions for chronically substandard care.
  The 340,000 ESRD patients are the only Medicare enrollees eligible 
for coverage due to a specific medical diagnosis. ESRD patients have 
lost full kidney function and must undergo a kidney transplant or 
weekly dialysis treatments to survive. This chronically ill group of 
beneficiaries presents Congress with a special responsibility with 
regard to assuring quality and safe care.
  As the dominant purchaser of dialysis services, the Medicare Program 
must demand improvement of deficient practices. Unfortunately, there is 
evidence that substandard care is being delivered at some Medicare 
funded sites. In 2000, the Inspector General noted numerous instances 
of poor care and an oversight system that is fragmented and lacks 
sufficient accountability. The GAO reported that in 1999, only 1 in 9 
dialysis facilities underwent an unannounced inspection and that in 
1998, almost 1 in 2 dialysis facilities had not been inspected within 
three years. A February 2002 Arizona Republic article further 
highlights the need for enhancements to the dialysis quality 
infrastructure. The article illustrates some patients are receiving 
weekly dialysis in atrocious conditions--unacceptable practices 
reported include poor or absent staff training, incorrect operation of 
dialysis machines, unclean facilities, neglected quality controls, and 
mission documentation. The full article is attached.
  I'm pleased to note that the Center for Medicare and Medicaid 
Services (CMS) is currently making improvements in the quality of the 
ESRD Program such as the implementation of health outcomes standards 
and data system to assess quality of services. I regret it has taken so 
long to move forward with these efforts and I believe some deficiencies 
remain. This bill does not delay or interfere with the current quality 
initiatives, and in fact, builds upon them.
  Currently, there only minimal ESRD quality assurance provisions in 
statute or regulation. The act would establish in statute a quality 
oversight role for the Department of Health and Human Services (HHS). 
In addition, a quality coordination function with certain duties 
delineated for the regional ESRD Quality Networks. The Networks are 
contracted by CMS to administer the ESRD program and serve as a liaison 
between dialysis provider and the Department. The Network quality 
functions delineated in the bill include training and technical 
assistance for providers, data collection and analysis, establishing 
national performance standards, conducting peer reviews, monitoring 
patient satisfaction, and disseminating of best practices. In 
coordination with existing HHS and Network goals, ESRD Clinical 
Performance Measures are to be developed to serve as performance 
standards to which patient and facility clinical outcomes can be 
compared.
  The bill also requires the HHS Secretary to implement an information 
system to link service providers, Networks, and the Department and 
maintain national database that generates clinical profiles on the 
performance of dialysis facilities and providers. To provide incentives 
for high quality care and promote the exchange of best practices, 
awards for high achievement will be issued to top performing dialysis 
providers and facilities. To eliminate harmful care, provider and 
facility sanctions for substandard services are created.
  Conditions of participation in the Medicare program for providers and 
facilities would be expanded to incorporate the terms of the CQI and QA 
Programs established in the bill. Also, to further support the quality 
provision of the bill, a per-treatment fee of 0.50 cents shall be paid 
to the Networks by the HHS Secretary during the initial 30-month period 
for which dialysis facilities are currently exempted. Consistent with 
the current process, dialysis facilities would continue to pay the 0.50 
per-treatment fee beginning in the 31st month.
  It is my hope that Congress, CMS and the ESRD provider community will 
react positively to the introduction of this bill. We need to work 
together to assure all ESRD facilities funded by Medicare are doing no 
harm. Please join me in this effort by agreeing to cosponsor the ESRD 
Continuous Quality Improvement act.

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