Dialysis patients in Kansas won’t have to wait as long for new clinics to open in the future, after Congress passed a law allowing the clinics to hire private-sector inspectors.
But some health care experts are concerned about what that might mean for patient safety.
The provision was included in the budget bill President Donald Trump recently signed. It was promoted by U.S. Rep Lynn Jenkins, a Topeka Republican, and other lawmakers in places where state agencies have fallen behind on the inspections.
The Star reported last year that there were eight clinics across Kansas awaiting initial inspection, including one each in Olathe, Lenexa and Kansas City. Four others were waiting on state inspections that would allow them to expand.
Most are owned by either DaVita or Fresenius Medical Care, two publicly traded companies that have at least 70 percent of the dialysis market.
Some clinics had been waiting for years, forcing dialysis patients to travel far away to get care multiple times a week.
Jenkins and U.S. Sen. Pat Roberts celebrated the bill’s passage Thursday at a DaVita dialysis clinic in southwest Topeka that was built more than two years ago, but has yet to open.
“Every week on my way home as I drove by a state-of-the-art dialysis clinic that was ready to serve Topeka patients I grew more frustrated that bureaucratic failures allowed that facility to languish,” Jenkins said. “Thanks to this legislation, we can finally say, ‘No more.’ ”
The clinics can take patients on private insurance prior to state inspection, but most people on dialysis are covered under a special Medicare program. The federal Centers for Medicare and Medicaid Services, or CMS, contracts with states to inspect and certify dialysis clinics before they can take those patients. For most clinics, it’s not worth hiring staff until they’ve got that certification.
Federal regulations require that inspections of fully operating dialysis facilities take priority over new builds. That, plus a lapse in federal funding and heavy employee turnover within Kansas’ inspection force, caused the state to fall behind. Other states are also backlogged. But some, including Missouri, have managed to keep up.
The new law will allow dialysis clinics to get their initial certification from CMS-approved third party accreditation services like the Joint Commission, which inspects most of the country’s hospitals and psychiatric facilities.
Those services have a checkered record when it comes to ensuring patient safety. The Joint Commission, which is funded by hospital dues, has been criticized for being too tight with the industry it’s tasked with overseeing. A Wall Street Journal investigation found that it denied accreditation to only about 1 percent of the 350 hospitals that were found to have violated Medicare rules from 2014 to 2016.
Michael Abrams, a health care consultant with Numerof & Associates in St. Louis, said that sort of track record doesn’t inspire much confidence.
Abrams said he feels for dialysis patients who have to travel farther for treatment while there are clinics nearby awaiting inspection and certification. But he said they should be concerned about how safe the facilities are as well as how close they are.
“Particularly if somebody is going to stick a needle in my arm and they’re going to circulate my blood through a machine that was just used by somebody else, I’d really like to know that it’s been adequately cleaned and all the right procedures have been followed,” Abrams said. “If I were unfortunate enough to need this sort of treatment, I would not really be thrilled with this.”
Abrams said concerns about third-party accreditation groups led CMS to propose a rule requiring them to make all of their inspections public. But the groups are resisting that rule because, Abrams said, “they don’t want to be embarrassed.
“They’re pulling their punches, and they don’t want the public to see.”
Abrams said having medical providers pay fees to groups that audit them creates a system in which the auditors would hurt their own bottom line if they shut down a paying customer. He said dialysis centers should instead pay fees to CMS to fund more state inspectors and leave dialysis center certification to the government.
Abby Domenico, a spokeswoman for DaVita, said via email that CMS had already contracted on a temporary basis with third-party inspectors to address the backlog in Kansas.
The new law will make that more of a routine thing in the future, and the clinics will be able to contract with them directly. The federal government will start taking applications for third-party inspectors within 90 days and dialysis clinics could start signing agreements with them shortly after.
“We expect there to be multiple (private) accrediting bodies by the end of the year,” Domenico said.