WASHINGTON – Nearly 10 percent of U.S. dialysis facilities with “worse than expected” patient-mortality rates are in Maryland, according to the Centers for Medicare and Medicaid Services.
Of the 141 facilities nationwide that state health agencies said had patient-mortality rates higher than what is expected at an average dialysis facility, 14 were in Maryland.
But administrators of the Maryland facilities said the numbers do not reflect on the care they provide: They said they just have more senior citizens, who often have multiple ailments.
“We have a very high mortality rate, because our average patient is 80 years old,” said Donna Atwell, an administrator at Dulaney Towson Dialysis Center.
Federal officials concede that a high mortality rate may not mean a particular clinic is a dangerous dialysis facility — although it is certainly something to consider. The government posts mortality rates and two other measures of quality of care at dialysis centers on the Web site Medicare.gov.
“I think they were a little scared by it,” said Eileen Zerhusen at the Centers for Medicare and Medicaid Services, of dialysis patients who have been contacted as part of a separate survey of the Web site.
So far, she has heard that not only do patients appreciate the mortality-rate measure, but in fact want more information regarding patient health. Medicare.gov gets 8 million hits per week, but officials could not say how many of those Web surfers look at the dialysis facility comparisons.
But a spokesman for Gambro Healthcare — which represents two Maryland facilities that were on the high-mortality list — said the numbers alone do not tell the whole story.
“Those are both long-term care or nursing home facilities, and all of the patients in those facilities have a lot of co-morbidities and would have higher mortality rates than the average dialysis center clinic,” said Ed Egger, the Gambro spokesman.
Egger said that patients may die for other reasons than kidney disease.
“They are very sick individuals and not like a lot of our patients, who take care of themselves and can be on dialysis for 30 years,” Egger said.
He said there are 400,000 patients in the country on dialysis — which takes up the function of kidneys to remove waste from a person’s blood.
Kidney-failure deaths are on the rise in the nation and the state, according to the U.S. Renal Data System. But in Maryland, the number of end-stage renal disease deaths more than doubled, from 836 in 1992 to 1,757 in 2001, while the national deaths rose at a slightly slower rate, going from 38,698 to 75,454 in the same period.
Officials from the government and the facilities agreed that patients should call and ask facilities with high-mortality rates to explain themselves.
But comparison shopping is not always an option, said Linda Palmer, a spokeswoman for the American Kidney Fund, which helps patients pay for incidentals that health insurance does not cover. Kidney disease can sometimes go for years without being diagnosed, she said.
“By the time someone needs a dialysis facility, they are down to 10 or 15 percent kidney function,” Palmer said. “Very often, a person who is not aware they have a kidney disease will go to an emergency room for treatment, and very often their first dialysis treatment will be right there at the hospital.”
The important thing, she said, is to have the information available and let patients know that these places have high mortality rates.
Zerhusen said that regardless of what the quality measures mean, kidney disease is often fatal, and mortality rates are an important — although unpleasant — measure to consider.
“With the patients, that’s a hard to concept for them to think about,” Zerhusen said.
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