United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2000-06-23 monographic deposited born digital 42 p. GA 1.13:HEHS-00-114 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-00-114 P0b002ee18039d4a6 f:he00114 DGPO 2010-08-12 2011-03-28 GAOREPORTS-HEHS-00-114 machine generated eng fdlp REPORT GAOREPORTS-HEHS-00-114 HEHS-00-114 Noncompliance Patient care services Safety standards Urologic diseases Health care facilities Health care programs Health services administration Sanctions Inspection California New Jersey Texas Oregon Washington Medicare Program Medicare End Stage Renal Disease Program Letter Report HEHS Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) processes to ensure that dialysis facilities meet quality-of-care standards, focusing on: (1) the extent to which on-site inspections of dialysis facilities are performed and problems are identified; (2) whether an effective process exists to ensure that dialysis facilities correct problems; and (3) what steps are being taken to use available monitoring resources as effectively as possible.<p/>GAO noted that: (1) over the past 7 years, the number of HCFA-funded inspections of dialysis facilities has declined significantly; (2) these unannounced inspections, commonly called surveys, which are HCFA's primary tool for ensuring that facilities meet standards protecting patients' health and safety, were conducted at only 11 percent of the dialysis facilities eligible for recertification in 1999, compared with 52 percent in 1993; (3) when such surveys were conducted they showed that noncompliance is a problem; (4) to enable more frequent surveys, HCFA has requested a threefold increase in funding for on-site inspections in its budget request for fiscal year 2001; (5) this funding level would support a survey of all dialysis facilities every 3 years; (6) while increasing on-site surveys will likely encourage more facilities to improve conditions, the enforcement system provides little assurance that corrections will be sustained; (7) essentially, HCFA's only current enforcement tool is to terminate a facility from the Medicare program if it does not correct its deficiencies; (8) the threat of termination brings nearly all facilities into compliance for a while, but they do not necessarily stay that way; (9) in every state GAO visited, GAO found instances in which facilities that had corrected their problems were found to have serious problems shortly afterward; (10) Congress has authorized HCFA to use other enforcement tools, such as the denial of payment for Medicare services, but HCFA maintains that this authority would have limited effectiveness and applicability; (11) HCFA is planning to use clinical and outcome data more extensively in deciding which facilities to survey and monitor more closely; (12) although the information HCFA intends to use may help in that regard, it has limitations as well; and (13) these data are designed to give a picture of the care being provided to end-stage renal disease (ESRD) patients generally, but they are often not current, detailed, or reliable enough to detect specific facilities that are providing substandard services. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-00-114/html/GAOREPORTS-HEHS-00-114.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-00-114/pdf/GAOREPORTS-HEHS-00-114.pdf GAO/HEHS-00-114 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-00-114 Letter Report GAO/HEHS-00-114; Medicare Quality of Care: Oversight of Kidney Dialysis; Noncompliance Patient care services Safety standards Urologic diseases Health care facilities Health care programs Health services administration Sanctions Inspection California New Jersey Texas Oregon Washington Medicare Program Medicare End Stage Renal Disease Program