By Liz Anderson, MSW, LCSW How can you find the right dialysis facility for you? Fortunately, patients today can find out more about their dialysis facility than ever before! There is information available in the Federal guidelines for dialysis and free information can be found online. This article will tell you how to find that information and provide a sample checklist of questions to ask the facility staff if you are considering a new dialysis unit. The first things you might want to know are the Federal regulations for dialysis facilities. The Federal regulations, or Subpart U Regulations, describe what dialysis facilities must do in order to receive Medicare payment. You can find that information at www.esrdnet5.org/subpartu03.pdf. These regulations outline how the facility’s governing body and management should be arranged, what patient care policies should be in place, what information should be addressed in patients’ care plans, and patients’ rights and responsibilities. This information might help you determine exactly what you are looking for in a dialysis unit. Information Available Online Medicare’s Dialysis Facility Compare (www.medicare.gov/dialysis/home.asp) offers a great deal of information for patients about dialysis treatment, including facility characteristics and quality indicators. The following are included in the facility characteristic’s section: address and telephone number of the facility; the facility’s initial date of Medicare certification; shifts starting at 5 p.m. or later (if you need your treatments in the evening); the number of treatment stations; the types of dialysis offered (in-center hemodialysis, peritoneal dialysis and home hemodialysis training); facility ownership type (profit or non-profit); chain name (if applicable). You can find the following quality measures as well: the percentage of patients at a facility with a Urea Reduction Ratio (URR) of 65 percent or greater, known as adequacy of hemodialysis; percentage of patients treated with Epogen® with a hematocrit of 33 percent or greater; patient survival information. Keep in mind that the quality measures section of the Web site gauges how well the dialysis facility is administering healthcare to all the dialysis patients in the dialysis unit. For instance, if the dialysis facility you are interested in has only 78 percent of patients with a URR greater than 65 percent, but a facility five miles away has 95 percent of its patients with a URR greater than 65 percent, you might assume that the dialysis facility five miles away is doing something differently in providing care to have such a large number of patients receiving adequate dialysis. If you believe your dialysis facility’s numbers are low, it might be beneficial for you to make an appointment with the administrator or medical director to discuss your concerns. What about information that is not reported? Hopefully, one day there will be a way for dialysis patients to report their satisfaction with a dialysis facility to help other patients decide where to go for treatment. In the meantime, you should talk to the staff at the facility. If you are choosing a unit for the first time, or transferring to another unit, make an appointment to meet the staff and have an open discussion about your expectations and the facility’s expectations. Other Issues to Consider The distance that you travel to get to treatment does impact your quality of life and is something you want to take into consideration. Do remember, however, that some of the issues outlined here should weigh more heavily on your decision to choose a facility. Transportation is another important consideration. Is there public transportation available to the unit? If your insurance pays for your transportation, you should check with the insurance company to find out if it will pay for you to travel to a specific facility. Conclusion The most important thing that you can do in choosing a dialysis facility is to do your homework! Visit the Dialysis Facility Compare Web site at www.medicare.gov/dialysis/home.asp to find out how the facility rates. Make an appointment with the nephrologist or dialysis facility staff to ask some questions. Talk to your family about your options and know the resources that are available. You can also call your ESRD Network to get additional information. ESRD Networks work with dialysis providers and transplant centers to assure that patients receive quality care. Always remember that if you are not satisfied once you start your treatment, you have the opportunity to transfer your care to another dialysis unit. Having knowledge about what the dialysis facility is required to do, and information about what a dialysis facility can do beyond the minimum standards will help you find the best unit to meet your needs. Questions to Ask: If there is an emergency situation, for instance a hurricane or natural disaster, does the facility have a plan in place? If there is a natural disaster, the dialysis facility might have a plan to treat you at another facility or to have you follow a special diet until you can dialyze at the facility again. How does the dialysis facility educate patients about new treatment options and changes in treatment? Dialysis facilities may have a designated staff person responsible for keeping patients up-to-date on new available treatments. Does the facility offer a chronic kidney disease (CKD) education program? If you have not yet started dialysis, receiving education early will help you become a more proactive and informed participant in your healthcare. What kind of resources does the facility have available for patients? Some facilities have computers for patients to use to educate themselves about kidney disease. Are there support groups offered by the dialysis facility? If so, you might want to find out when they meet and if patients or staff lead them. Who is the medical director? How often does the medical director come to the dialysis facility? Is there a method to measure patient satisfaction in the unit? At times, some dialysis facilities will survey patients to find out if they are satisfied with their care. You can ask the facility if the results are available for patients to see. What percentage of patients in the dialysis facility have an AV fistula? As you probably know, AV fistulas are the preferred access for hemodialysis. Are the patients in the dialysis facility involved in their own care? The facility may offer a program for you to do your dialysis at home. Every dialysis facility should encourage you to participate in care plan team meetings. Is there coordination of care? If you are hospitalized, the staff at the dialysis unit should communicate with the hospital about when to expect your return to the unit. How does the facility staff handle patient concerns? A dialysis facility should have a procedure in place to address patient grievances. Does the facility accept your insurance plan? While the majority of patients are Medicare recipients, sometimes there can be conflicts with insurance. Will the facility help you if you need to travel to another city? Sometimes with corporate chains, a patient can easily travel from one unit to another. What does the waiting room look like? Hopefully, the dialysis facility waiting room will have educational materials for patients and families. Sometimes facilities will have bulletin boards and computers available, too. If you or your family member is under age 18, you will need to ask if the facility accepts pediatric patients. There are some dialysis facilities that specialize in pediatrics only. If you or your family member is not fluent in English, ask if there is a translator available. How does the dialysis facility assist you in referral for transplant work-up? What treatment modalities does the dialysis facility offer? Some facilities will train patients to do home hemodialysis or peritoneal dialysis. Liz Anderson, MSW, LCSW is the Social Services Director for the Mid-Atlantic Renal Coalition, ESRD Network 5. Her areas of expertise include dealing with patient and staff conflict and promoting patient-centered care. This article originally appeared in the July 2004 issue of aakpRENALIFE, Vol. 20, No. 1. |