Backlog is keeping dialysis patients from using centers closer to home

A long wait for something around the corner
Certification backlog is keeping dialysis patients from using centers closer to home

By TODD ACKERMAN
HOUSTON CHRONICLE
Oct. 25, 2009, 10:21PM

Bruce Garren must travel to Tomball for dialysis, even though there is a treatment center in his hometown of Magnolia. That one is waiting for certification to accept Medicare and Medicaid patients — and has been waiting for more than a year.

The frustrating part of Bruce Garren's thrice-weekly drive for dialysis treatment in Tomball comes less than a mile from his house, when he passes a recently opened but barely used Magnolia facility.

Garren, a diabetic whose kidneys have been failing for the past three years, says it's as if the facility is taunting him, beckoning but forever out of reach. Licensed by the state more than a year ago, it still awaits the certification that will enable it to accept Medicare patients.

“I give it this puppy dog look that says, ‘Let me come in,' but the routine is getting old,” says Garren, 62, formerly a commercial food-service designer. “It's become a joke to us Magnolia patients, the licensed unit in our backyard that none of us can go to, that's just a curiosity on the way to Tomball.”

Garren is one of thousands of Texans suffering from end-stage renal disease who must travel lengthy distances for treatment because the Centers for Medicare and Medicaid Services is too backlogged to certify all the state's new dialysis centers in a prompt manner. The vast majority of the new centers have been licensed by the state and take private-pay patients, but they need to be CMS-certified before they can be reimbursed for Medicare patients, who represent about 90 percent of people on dialysis.

Nowhere is the problem worse than in Texas, where many more centers await CMS certification than any other state, some as long as two years. As of Oct. 1, there are 54 new centers in Texas awaiting certification, according to the state Department of Health and Human Services.

The problem — particularly acute in rural areas and disproportionately affecting minorities — has twice prompted a bipartisan Texas congressional delegation to write CMS, calling on it to expedite the certification of the state's “idle” centers. Earlier this year, the delegation asked for answers to pointed questions about the process that leads to the delay.

“Because of the delay, the facilities are currently faced with the decision of either scaling back operations or closing facilities,” said the April 14 letter, signed by Texas U.S. senators John Cornyn and Kay Bailey Hutchison and 27 House members. “Either outcome would threaten the quality of life for the patients and cause economic loss to the community.”
An eye toward funding

In a July 30 response, CMS Acting Administrator Charlene Frizzera said inadequate funding, the growing numbers of providers and added quality assurance responsibilities have made it hard to keep up with the demand. But she added that increased funding in fiscal year 2009 began to make a difference and said President Barack Obama's proposed 2010 budget, if passed, will provide resources to enable more progress.

There's no question end-stage renal disease is exploding in Texas, the result of a population that's becoming older and more obese . According to the National Kidney Foundation, about 40,000 Texans currently require dialysis treatment, which cleanses the blood when the kidneys stop functioning. That's about double the 1990 amount.

But the certification problem only started in the past few years, when government funding for such CMS functions flattened out and dialysis centers mushroomed around the state. Between 2004 and 2008, for instance, the number of such facilities grew to 76 from 56 in Harris County and to 457 from 353 in Texas.

As a result of the Texas delegation's letter, CMS certified 22 of the centers in recent months. But because more centers received state licensure in that time, there's been only a small dent in the problem's overall scope, and no one has any idea when more certifications will follow.

“I've stopped even guessing at this point,” says Brad Edwards, the administrator of the DaVita Magnolia Dialysis Center, which opened in July 2008 but still awaits certification. “I keep going to the center hoping this will be the day the surveyor comes, but that day never comes. I would have thought for sure we'd be certified by now. DaVita built here because they knew there was such a need.”
A difficult trip

CMA rejected the center's summer request for priority certifying, despite an accompanying letter-writing campaign from about 25 area patients forced to go instead to Tomball. The request, sent in June, argued that certification was especially important as hurricane season approached, citing dialysis deaths during and after Katrina and Ike.

Among the letter writers was Garren, who, before being furnished a driver by his insurance, sometimes had to make the drive himself, despite amputated toes and blindness in one eye. He says no one wants to accompany him because he “drives by Braille, between the speed bumps in the middle of the road and the rain groove on the other side.” On disability social security, he said the price of gas was killing him.

Another letter was written by a Magnolia municipal court judge whose wife, on private insurance, was the center's only patient for months. Judge John Purvis, who got to know many of the patients forced to go to Tomball, said “it's ridiculous they've had to wait over a year and the facility's still not certified.”
Not a priority?

The congressional delegation's letter questioned that funding is really the problem, noting that CMS last year received the full amount it requested. It said the problem is really a new agency policy that makes dialysis center inspections a distant priority behind agency responsibilities such as nursing homes .

An agency spokeswoman, suggesting no change is forthcoming, told the Chronicle that the frequency of future dialysis center inspections will depend on the workload level of higher priority matters.

“It's a step forward that 22 new centers are now CMS-certified and open to all patients, but dozens are still idle because the process itself has fallen behind the demand,” said Jess Hall, president of the Texas division of the National Kidney foundation. “Those impacted include businesses that might not survive, local communities needing more jobs in a high unemployment economy and patients for whom ready access to care is critical.”

todd.ackerman@chron.com

http://www.chron.com/disp/story.mpl/metropolitan/6685846.html