Dialysis anomalies seen as rampant
Medicare enrollment by kidney patients more than doubled between 1984 and 1994, but expenditures tripled - to $8.4 billion - and the Health Care Financing Administration wants to find out why. The General Accounting Office found widely varying lab test rates. At one extreme, Medicare may be paying for excessive tests; at the other, patients are not receiving the tests needed to monitor their condition. The agency is recommending that Medicare profile doctors ordering tests for dialysis patients and notify contractors of unusual rates.
A related item: Defective tubing used to transmit blood to and from a dialysis machine is believed to be the cause of illnesses reported in three states, including the deaths of two people in Maryland. Tests showed a blockage where the plastic tubing is joined with a card-sized cartridge, said Tom Safranek, MD, the state epidemiologist in Nebraska.
Dialysis centers where dozens of patients became sick in Maryland, Massachusetts, and Nebraska shut down temporarily, and the manufacturer of the tubing, Gambro Healthcare of Lakewood, CO, recalled the tubing in May. The tubing was manufactured in Tijuana, Mexico, and carries lot numbers 04D15308, 04D15309, and 04D15310. The part number is 003210-500. As many as 6,000 sets of tubing may have been shipped, but only about 10% are suspect.
Following are names and telephone numbers of sources quoted in this issue:
Judy Wilson, RN, CPHQ, manager, quality resources, Methodist Hospital, HealthSystem Minnesota, Minneapolis. Telephone: (612) 993-5114. Fax: (612) 993-1334.
Donald Berwick, MD, pediatrician; president, Institute for Healthcare Improvement, Boston. Telephone: (617) 754-4800. Fax: (617) 754-4848.
Lucian L. Leape, MD, department of health policy and management, Harvard School of Public Health, Boston. Telephone: (617) 432-2008.
Ken Barker, PhD, department of pharmacy care systems, Auburn (AL) University. Telephone: (334) 844-5152.
Michael Cohen, president, Institute for Safe Medication Practices, Warminster, PA. Telephone: (215) 956-9181.
Mark Neuenschwander, The Neuenschwander Company, Bellevue, WA. Telephone: (425) 644-6797.
Charles Myers, MS, MBA, assistant vice president, professional affairs, American Society of Health-System Pharmacists, Bethesda, MD. Telephone: (301) 657-3000.
Gary R. Haynes, PhD, MD, associate professor, department of anesthesiology, Medical University of South Carolina, Charleston. Telephone: (803) 792-2322; gary [email protected].
Janet McIntyre, media relations coordinator, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL. Telephone: (630) 792-5175.
Dan Parker, vice president, public relations, Advocate Health Care, Chicago. Telephone: (630) 990-5606.
Edward Brandenburg, MBA, vice president of operations and risk manager, Community Memorial Healthcenter, South Hill, VA. Telephone: (804) 447-3151.
· Suzanne K. Powell, RN, CCM, Health Services Advisory Group, 301 E. Bethany Home Road, Phoenix, AZ 85028. Telephone: (602) 665-6109. Powell's book, Nursing Case Management: A Practical Guide to Success in Managed Care, is available through the publisher, Lippincott-Raven, at (800) 777-2295. An extensively revised version will be released in 1999.
· Linda Schoenbeck, RN, Life Care Center of Scottsdale, 9494 E. Becker Lane, Scottsdale, AZ 85260. Telephone: (602) 860-6396.
· Tina Atherton, RN, Phoenix Baptist Transitional Care Unit, 2000 W. Bethany Road, Phoenix, AZ 85015. Telephone: (602) 246-5961.
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