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Dialysis Treatment Investigation Reveals Poor Care, High Costs

The nonprofit website ProPublica last week published a wide-ranging investigation into dialysis treatment in America.

Shoddy treatment practices and unsanitary conditions are not uncommon, ProPublica reported, and in severe cases have resulted in deaths. Furthermore, the costs of caring for patients with kidney failure exceed those in other developed countries that, like the U.S., provide government-funded universal access to treatment.

“A program once envisioned as a model for a national health care system has evolved into a hulking monster. Taxpayers spend more than $20 billion a year to care for those on dialysis — about $77,000 per patient, more, by some accounts, than any other nation.”

Dialysis consumes 6 percent of the Medicare budget,  the article notes — and if ignored that figure promises to grow.

Tennessee has one of this country’s highest rates of diabetes, which is the most common cause of kidney failure.

But even though the U.S. government’s role in dialysis care looms large, the story explains that consumers have not had access to public data that answers questions like whether patients at one clinic are more likely to die or be hospitalized than patients at another.

“Even as government policies have encouraged the spread of corporate dialysis, they have largely denied consumers the chance to use market power to push for better care. Because Medicare is the dominant payer, it has information about dialysis centers that doesn’t exist for other medical providers. Yet the Centers for Medicare and Medicaid Services has not made public key measures such as clinics’ rates of mortality, hospitalization for infection and transplantation. Regulators know how dialysis units perform by these yardsticks. So far, patients don’t.”

Because of ProPublica’s work, though, that should not be the case much longer. After a two-year battle, the website has convinced CMS to make the data available, which ProPublica promises to post shortly.

The story draws a contrast with Italy, where doctors directly manage the delivery of dialysis, spotting and addressing problems. The story suggests that technicians and nurses do much of the direct patient care in the U.S., citing a study showing that Italian patients “had more than five times as much contact with their physicians as U.S. patients.”

But even with more doctor involvement, per-patient costs are lower in Italy’s system, where patients don’t have to reach kidney failure to access the treatment and public hospitals are the treatment providers — in the U.S., two chains, Colorado-based DaVita and Fresenius, a subsidiary of a German corporation, dominate the market, ProPublica reports.

A post by Time highlights a lesson in the four-decade story of universal access to dialysis treatment, which could prove of value as the health care overhaul enacted this spring takes effect:

“The article shows the complexity of providing universal care through for-profit businesses, illustrating how perverse incentives in payment policies create a situation in which patient care is measured in quantity rather than quality.”

a figure that if ignored promises to grow,
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Painters’ Union Opens Stimulus-Funded Nuclear Training Lab

Workers can train for jobs in the nuclear power industry at a $107,000 federal stimulus-funded computer lab housed at a union hall in Chattanooga, which workers began using last month, the Times Free Press reports.

“Local Union 226 of the International Union of Painters and Allied Trades on Wednesday debuted its Nantel Computer Training Lab, which provides access to tests needed to work in a nuclear power facility. The tests are part of a nationwide Internet-based system — the National Academy for Nuclear Training e-Learning system — that provides free courses in areas such as plant access and radiation protection.

“The lab is open to anyone, regardless of occupation or union affiliation, trying to find work in a nuclear power facility, Susie Friel, director of the lab, said.”

In other stimulus news, a recent claim by President Obama that the federal stimulus has been delivered speedily and under-budget is only half-true, according to the news website ProPublica together with PolitiFact, a site that rates the truthfulness of politicians’ statements.

Obama made this claim during an interview on the most recent 60 Minutes: “One of the interesting things about the Recovery Act was most of the projects came in under budget, faster than expected, because there’s just not a lot of work there.”

ProPublica and PolitiFact researched the statement and found it to be a stretch. A big problem is that there’s just no data available to test the statement in an empirical way.

But ProPublica did its own number-crunching, analyzing the stimulus money that flowed through the Federal Highway Administration. It found that 45 percent of the projects have been completed, and of those, 51 percent were completed earlier than the estimated date.

“Several hundred projects had no estimated date.

“In the case of the Federal Highway Administration, Obama could rightly claim that ‘most’ projects have come in faster than expected (though barely, at 51 percent). But this is just one agency.

“As with the claim about projects coming in under budget, Obama would have been on firm ground had he said ‘many’ projects have come in faster than expected. Many have. But many have not. And if the claim is based on meeting a deadline to outlay funds, the overall target of 70 percent was reached — barely — by the end of September. That’s only faster than expected if you expected the government to fail.”

Read more here or here.