Dialysis delays: Kansas clinics sit unused for years awaiting state inspections

Kansas is dotted with eight nearly new kidney dialysis clinics that sit mostly unused because the state is two-plus years behind on inspecting and certifying them.

Another four clinics want to expand services but can’t as they await state inspections.

The delays are forcing Kansans like Marsha Voss of Olathe to travel past new facilities and get treatment for life-threatening kidney diseases at older facilities farther away.

Voss, who is legally blind and uses a motorized wheelchair, has to go to a treatment center in Lenexa three times a week instead of a new one in her neighborhood that would save her 1 1/2 hours each trip.

“The way it is now I leave at 10:30 (a.m.) and I don’t get home until 5:30 (p.m.) and that’s mainly because of the transportation,” Voss said.

Federal funding for inspectors has been cut in years past and Kansas has not made up the difference. That’s led to turnover in the health facility inspection force and a backlog for new dialysis centers which, by federal law, take a backseat to inspections of other types of facilities and existing dialysis centers with problems.

Kansas is not the only state with long delays. But some others have dipped into their own budgets to recruit and retain enough inspectors to keep from falling behind.

As of last week, the Missouri Department of Health and Senior Services had no dialysis centers awaiting their initial surveys.

The federal Centers for Medicare and Medicaid Services contracts with health departments in each state to do the inspections. Without them, the dialysis centers can’t bill Medicare, which covers 85 percent of Americans in kidney failure.

Those are the patients who need new dialysis centers the most, said Syd Stevens, the administrator of Midwest Nephrology Consultants.

“It’s really not fair that they have to wait to get in,” Stevens said, “and it’s really not fair if you’re dialyzing farther away from you and this unit is ready and waiting three blocks down (the) street.”

There’s a specific provision within Medicare that extends eligibility to people on dialysis.

Even those who can continue working while their kidneys fail only use their employer-based coverage for their first 30 months of dialysis. After that, Medicare automatically becomes the primary coverage and the employer plan becomes secondary.

Stevens said dialysis centers roll out the red carpet for patients still under employer plans because commercial insurance pays more. Even at the certified facilities, Medicare patients are often relegated to less convenient time slots.

“Basically, as a Medicare patient you’re left out … and those chairs can be coveted,” Stevens said.

The clinic near Voss has been waiting for Medicare certification since January 2016. It has the capacity to see about 70 patients. Without certification, it sees four.

Facilities waiting across Kansas

There are two clinics awaiting certification in Topeka, including one that’s been waiting since October 2015. The others are in Olathe, Garden City, Pittsburg, Manhattan, Lenexa and Kansas City.

Clinics waiting for the go-ahead to expand services are in Junction City, Manhattan, Chanute and Wichita.

“We are seeing delays across the board,” said Kurt Koptish, a division vice president who oversees all the DaVita dialysis centers in the Kansas City area.

Matt Keith, a spokesman for KDHE, said the problem lies with CMS regulations that prioritize other inspections unless there are special circumstances, like a lack of other dialysis options anywhere nearby.

“Dialysis centers may petition CMS to have their initial surveys moved into a higher priority tier if they can make a clear and convincing case of need in their area to CMS,” Keith said via email. “If CMS agrees with the petitioning facility, it will give KDHE clearance to move an initial survey of a dialysis center onto the schedule.”

Koptish said DaVita also has long certification delays in Iowa, and a nephrology news website published a story last year citing two-year waits for initial inspections in New Mexico and waits of as long as five years in Oklahoma for facilities looking to expand services.

But Missouri provides a stark contrast.

“They typically survey within about 90 days,” Koptish said.

Kansas Sen. Vicki Schmidt, a Republican from Topeka, said turnover within the state inspection force has been a problem. Five of the eight positions changed hands last year.

Schmidt said legislators should take a look at market pay rates for inspectors to make sure Kansas is competitive, because it’s a waste for the state to train them only to see them go elsewhere.

“That kind of turnover has crippled this program,” Schmidt said.

Jenkins proposes privatization option

The Lenexa facility is owned by Fresenius Medical Care, a German-based company. It and Colorado-based DaVita are the corporate giants of the kidney dialysis industry, with about 70 percent of the market share and almost 4,000 locations across the United States.

Their financial fortunes have grown as chronic conditions like diabetes and high blood pressure have pushed more and more Americans toward kidney failure. As of 2013 there were almost 500,000 Americans on dialysis, arranging their lives around thrice-weekly treatments, some waiting years for transplants that may never come.

Cameron Lynch, Fresenius’ senior vice president of government affairs, said the Lenexa location has been awaiting an initial inspection since it opened nine months ago. He said it’s treating patients on private insurance, but “currently serves less than 10 percent of the patient population it could serve if it had CMS certification.”

Koptish said the four patients at the DaVita facility near Voss are also all on commercial insurance. A waiting list of Medicare patients has formed there, as slots at another DaVita location on the southwest edge of Olathe become increasingly scarce.

“It’s running at 95 percent capacity, so it’s pretty much full,” Koptish said. “Right now there is a pretty strong need in the community.”

The Kansas City, Kan., center awaiting inspection, which is also owned by DaVita, is at the bottom of KDHE’s priority list. Koptish said that means it will probably be more than two years before it’s certified.

Fresenius and DaVita are supporting a bill introduced by U.S. Rep. Lynn Jenkins, a Republican from Topeka, that would allow the federal government to contract with private sector companies to do the dialysis center inspections.

But even if the bill passes, the regulation-writing and contracting process would take months, so there’s no quick fix for Kansans like Voss.

If the DaVita facility near her home were CMS certified, it would be within range of her assisted living facility’s shuttle bus. But instead Voss rolled outside Wednesday to wait for the JO — Johnson County’s bus service — to take her nine miles north to a DaVita facility in Lenexa.

Voss has been on dialysis for 3 1/2 years. She said she supports the Jenkins bill, but she’d also like to see Kansas invest more in inspectors.

“I’m not a rocket scientist but if it takes two weeks (to get certified) in Missouri and two years in Kansas you know it’s got to do something with the money in Kansas,” Voss said. “It really makes us look like we don’t know what we’re doing.”

This story was originally published August 5, 2017 at 7:00 AM with the headline "Dialysis delays: Kansas clinics sit unused for years awaiting state inspections."