Medicare's Chief M.D. Speaks About Dialysis

Kidney i i

hide captionOver 400,000 people in the United States are on dialysis. The payments are covered almost entirely by Medicare.

Diagnostic Applications of Microarray Organ Transplantation
Kidney

Over 400,000 people in the United States are on dialysis. The payments are covered almost entirely by Medicare.

Diagnostic Applications of Microarray Organ Transplantation

A new yearlong joint investigation between The Atlantic and ProPublica has found many problems with dialysis in the U.S. The cost of treatment is among the world's highest, while the U.S. mortality rate for dialysis patients is one of the world's worst: One in four patients will die within 12 months of starting treatment. And striking problems were found in some dialysis facilities: unsanitary conditions, high rates of patient infections and few official inspections from Medicare, which offers comprehensive coverage to kidney failure patients in the U.S. and is supposed to inspect dialysis facilities once every three years.

Dr. Barry Straube is the director and chief medical officer for the Centers for Medicare and Medicaid, which has provided dialysis treatments, organ transplants and medical visit costs to any patient diagnosed with kidney failure in the United States since 1972. He joins Terry Gross today to respond to the criticisms present in the investigation published by The Atlantic and ProPublica. (The author of that report, Robin Fields, also appears on today's Fresh Air.)

"There definitely is truth in the fact that the [Center for Medicare and Medicaid Services] in its regulatory role, overseeing the quality of care in dialysis facilities, has not been able to perform as many surveys and therefore perform that type of oversight as well as it might like to have," Straube says. "We are hindered by funding that comes from Congress in order to perform regulatory oversight visits for all of the 17 different provider sites that CMS is charged with regulating. And the funding that is provided to the agency is insufficient in order to be able to meet the statutory requirements in terms of frequency and thoroughness of those sites."

Several years ago, Straube says, Congress told CMS to focus on annual visits to nursing homes, at the expense of other facilities, including dialysis centers, which were put on a lower-priority track.

"We have been not able to perform the oversight functions as frequently or as thoroughly as we might like to," he said.

But Straube says although Fields' investigation points to important issues, it overstates the degree of problems with dialysis centers in the real world.

Dr. Barry Straube i i

hide captionDr. Barry Straube is currently the chief medical officer at the Centers for Medicare and Medicaid Services.

Center for Medicare and Medicaid Services
Dr. Barry Straube

Dr. Barry Straube is currently the chief medical officer at the Centers for Medicare and Medicaid Services.

Center for Medicare and Medicaid Services

"When I read the article about an hour or two ago, it makes it sound like any dialysis unit that a patient walks into is subject to these problems, and that's simply not true," he says. "The vast, vast majority of the units are not as described in the several examples, which are completely true examples, but not illustrative of most dialysis units. ... That doesn't forgive our responsibility to try to identity those facilities that are not up to standards and then take whatever actions we can to make them better. My main quibble with the article is that it sounds like one would not want to have dialysis in the United States. This is a lifesaving treatment that the vast majority of people are being treated very well in very clean facilities that hopefully make very few mistakes."

Straube also talks about the lessons Medicare has learned from its 40-year dialysis experiment — and the ways in which the experiment might influence new debates on health care reform.

"[Paying for dialysis] was absolutely necessary because as Robin's article described, patients were dying before the onset of this program in the 1970s. There are some situations, as we proceed with health care reform, that we have to recognize without insurance being present — either generally or for specific conditions — people will die," he says. "I think the first thing that we need is having everybody have access to health care — not just in terms of having something close by but [by] having health insurance to be able to pay the bills to get health care that we all deserve. ... We have 25 million Americans with chronic kidney disease, estimated right now. That is many or more than patients who have diabetes in this country. And if we don't address those patients with chronic kidney disease, we are going to have many, many, many more ultimately requiring dialysis services."

Dr. Barry Straube is board certified in internal medicine and nephrology and is currently the chief medical officer for the Centers for Medicare and Medicaid. He also is the acting director of the Office of Clinical Standards and Quality.

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