Almost 40 years ago Congress expanded Medicare to cover dialysis treatment for all Americans suffering from kidney failure--regardless of age or income. Today taxpayers shell out $20 billion annually to provide the life-saving procedure for some 400,000 patients. Although the United States spends more per patient than virtually every other country, its mortality rate for dialysis care is among the highest in the industrialized world, according to the watchdog group ProPublica.
In an ongoing investigation, ProPublica discovered an alarming number of clinics that provide substandard care in unsanitary conditions. The result are needless hospitalizations and avoidable deaths. Equally troubling is the weak oversight of the dialysis industry. Checks of clinics, known as recertification surveys, are supposed to be conducted by state regulators every three years. But the frequency of government inspections of these 5,000+ facilities varies widely by state. In California--which has the biggest backlog in the nation--at least half the dialysis clinics haven't been inspected in five years or more. And some 10 percent haven't been checked since 2000.
Federal authorities have pressed California to boost its inspections or face withholding of funds. But federal money for recertification hasn't kept up with the growing number of clinics. That and the state's budget crisis has hampered oversight. And so the backlog continues to grow.