HCFA: Watch for racial bias in kidney transplants
Health care providers could risk federal sanctions if they do not ensure that all patients with renal failure, regardless of race or ethnicity, are being evaluated for kidney transplantation, according to a warning issued recently by the federal Health Care Financing Administration (HCFA) in Washington, DC.
HCFA is taking steps to provide improve enforcement and provide technical assistance to dialysis centers, which must assess all patients for transplantation as part of the patients’ long-term care plans.
"Medicare rules require that all patients with kidney failure be evaluated and informed about transplantation," says HCFA administrator Nancy-Ann DeParle. "We want to be sure this is happening and be sure there is equal opportunity for transplantation when needed, regardless of a patient’s race."
Medicare provides insurance coverage for most Americans with permanent kidney failure, paying for dialysis treatment and transplantation. HCFA’s warning came in conjunction with the release of a study by John Ayanian, MD, and colleagues at Harvard Medical School in the New England Journal of Medicine. The investigators interviewed a sample of patients with kidney failure and found that black end-stage renal disease (ESRD) patients were less likely than white ESRD patients to want a transplant (76.3% vs. 79.3% among women, and 80.7% vs. 85.5% among men).
DeParle says Medicare will take a three-pronged approach to addressing transplant assessment disparities. The program will remind all certified dialysis facilities of its requirements that all ESRD patients are to be assessed for and fully informed about transplantation as part of the patient’s long-term care plan.
HCFA also will work with the state survey agencies in evaluating the study findings and paying particular attention to dialysis facility compliance with regulations. State survey agencies inspect ESRD and other health care facilities to determine their compliance with Medicare certification requirements.
Medicare also will work with the ESRD network organizations to identify ways that the networks can work with the patients, the renal community, and the dialysis facilities in their area to increase transplant assessment rates. ESRD network organizations monitor the quality of care provided in dialysis facilities and assist facilities to improve patient care as opportunities present themselves.
"All three approaches will enforce and reinforce Medicare’s commitment to its ESRD beneficiaries by assuring that they will receive the quality of care that they depend on, including the opportunity to be fully informed about and assessed for transplantation," DeParle says.
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