By John A. Schall, MPP

There is good news to report! On April 3, 2008, the Centers for Medicare & Medicaid Services (CMS), released a final rule that will modernize the nation’s dialysis centers. This will improve the quality of care for patients receiving dialysis.

This is great news for thousands of Americans. According to CMS, “The final regulation will enhance the quality of care available to more than 336,000 Medicare beneficiaries with end stage renal disease (ESRD) who receive dialysis treatment from more than 4,700 Medicare approved renal dialysis facilities across the US.”

Major Advances
The rule focuses on patient rights, patient safety and the patient’s participation in the development of his or her own plan of care. Among other things, the new rule requires clinics to discuss advanced directives with patients. Pertaining to patient’s rights, a facility-level grievance process must be in place. This process must explain how clinics answer patient issues and concerns.

Moreover, the rule explains that clinics must develop a detailed plan of care customized to the patient’s unique needs. Even better is the new policy that a clinic must provide a 30-day written notice before a patient is involuntarily discharged. This alleviates some of the injustices encountered by patients at some clinics. Another improvement is in the facilities and their staff. Federal requirements were included because dialysis technicians are usually the primary caregivers in most dialysis facilities. Also, patient care technicians will now need to meet minimum qualifications and training requirements. They must have a high school diploma or equivalency and at least three months experience under direct supervision of a registered nurse. They must also complete a training program that would include specific topics and be approved by the medical director and governing body.

As for the dialysis centers, each facility is required to develop a quality assessment and performance improvement (QAPI) program. The purpose of the program is to track the facility’s performance in patient health outcomes and demonstrates how the facility will improve the quality of care for patients receiving dialysis.

Other Improvements for Patients
In addition, beneficiaries will also benefit from the following updates in the rule:
•Adopts updated Centers for Disease Prevention and Control (CDC) guidelines for hemodialysis facilities to increase patient infection control procedures.
• Adopts updated American Association for Medical Instrumentation (AAMI) water quality guidelines to promote safer water for dialysis use.
• Requires defibrillators in every dialysis facility, to allow facility staff to respond rapidly to individuals who may be having a heart attack.
• Incorporates sections of the 2000 Life Safety Code, which upgrades fire safety standards.
• Increases Medical Director involvement in the outcomes of the QAPI program and involuntary transfers or discharges.

Long Overdue
The final rule comes after years of advances in dialysis technology and standard care practices. Three decades have passed since any updates have been made. The last time any revisions were made in the federal guidelines was in 1976!

According to CMS, “The final rule meets CMS’s overall goal of protecting patient safety, enhancing ongoing quality improvement, and improving patients’ experience receiving dialysis services. CMS continues to work to improve the quality of health care by measuring and improving outcomes of care, educating health care providers about quality improvement opportunities, and educating beneficiaries to make good health care choices.”

The American Association of Kidney Patients’ Executive Director and CEO, Kris Robinson, should be praised as well. For years she has fought to improve healthcare quality for kidney patients. Ms. Robinson, herself a transplant patient, has been an important part of the effort to advance regulations for patients.

The final rule is a long-awaited step in the right direction. CMS should be noted for their effort and encouragement to promote a higher quality of care for dialysis patients. These are important issues that are vital to thousands of Americans each and every day. We salute CMS and AAKP’s Kris Robinson for making a difference.

John A. Schall, MPP, is a vice president at Jefferson Government Relations.

This article originally appeared in the July 2008 issue of aakpRENALIFE.

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