Tag Archives: kidney transplant

Failing Fla. transplant program misled media, employees, patients

Writing in the The Florida Times-Union, reporter Jeremy Cox used public records requests to find that a kidney transplant program at a local safety net hospital had been at risk of closure by federal regulators prior to its abrupt closure in January. It had “failed to meet six of 12 federal standards.”


Image from Wikimedia Commons

Furthermore, Cox writes, the records revealed “that hospital officials intentionally misled local media outlets about the full extent of the program’s breakdown. In a memo to Shands spokesman Dan Leveton about how to address the media, Steven Blumberg, vice president of planning and business development, said, ‘If asked, we will say that a program with low volumes is not economical to operate and that quality can be ensured with higher volumes.'” That statement, of course, makes no mention of looming federal intervention or a failure to meet basic quality standards.

Cox’s writeup should serve local reporters well as a sort of “anatomy of a failed transplant program,” as he delves into the regulatory process and exactly where the hospital went wrong.

For those of you who were, like myself, unfamiliar with the institution, Cox writes that “Shands is run by a private not-for-profit company, but it is widely seen as Northeast Florida’s safety-net hospital. The city of Jacksonville gives the facility about $23 million a year to care for the city’s poor, and it gets millions more from the state.”

ProPublica releases ratings of 5,000 dialysis providers

On the heels of a successful FOIA request related to Robin Fields’ dialysis investigation, ProPublica has published a database evaluating dialysis clinics on 15 different measures. The information has been available to state health agencies for years, but this is the first time it’s been released for general public consumption, Fields writes.

Patients have long chosen dialysis clinics based only on location or physician recommendation, even though the data shows a wide variation in quality among the 5,000-plus such facilities nationwide.

In more than 200 counties nationwide, the data show, the gap between facilities with the best and worst patient survival, adjusted for case-mix differences, is greater than 50 percent. In areas such as Allegheny County, Pa., or Franklin County, Ohio, each with upwards of two dozen clinics, the differences are even more substantial, exceeding 200 percent.
There is also wide variability in how often patients at different clinics are hospitalized for septicemia. Although septicemia cases can be unrelated to dialysis, it is a significant risk for patients, who typically have their blood cleaned of toxins three times a week. Nationally, the rate was about 12 percent a year for 2006 to 2008. But in dozens of counties, the spread between facilities with the highest and lowest rates was more than 25 percentage points.

Like Dollars for Docs, this new database should provide plenty of ready localizations of of the story.

Dialysis program: Experiment in socialized medicine comes with high costs, risks

ProPublica’s Robin Fields has put together an artful examination of the nation’s Medicare-funded dialysis system. Part history and part investigation, it explains how this massive anomaly of government-run medicine came to be, and how it demonstrates the promise and peril of so-called socialized medicine.

The reporting has had an immediate impact, both upon the dialysis industry (read leaked plans for their response here) and upon the federal government. For health journalists, the federal response is particularly interesting, as it involves the disclosure of previously hidden data, and a classic government excuse.

ProPublica first asked CMS for the clinic-specific outcome data it collects — at taxpayer expense — two years ago under the Freedom of Information Act. The agency declined to say whether it would release the material until last week, as this story neared publication. It subsequently has provided reports for all clinics for 2002 to 2010. ProPublica is reviewing the data and plans to make it available for patients, researchers and the general public.

The reasons CMS has given for withholding the information until now is that some measures are disputed or lack refinement. Regulators and providers can put the data in perspective, officials had said, but patients might misinterpret the information or see it as more than they really want to know.

As befits something destined for publication in The Atlantic, Field’s piece might take more than one sitting to fully digest. And, if you haven’t yet had that second sitting, you’ll have missed some particularly nifty bits of comparative journalism, particularly where Fields compares the U.S. system to that in Italy, where the costs are significantly less and patients “got half the average dose of Epogen given to U.S. patients, perhaps because there’s no profit incentive to give them more.”

In Italy, about one in nine dialysis patients die each year. In the United States, that number is one in five. In dialysis treatment, there’s a trade-off between speed, cost and outcomes. And even high-rated Italy has had to make a few sacrifices, as evidence by comments from an Italian doctor:

“The decision to make dialysis faster wasn’t a scientific decision, it was a managerial decision,” he says. “It’s to allow you to do four shifts a day and make money.” He schedules just two shifts a day to accommodate longer treatment times.

Fields ends the piece on a high note. There’s hope for future efficiency in the dialysis system, thanks to a new program of bundled payments that will supplant the current system in which clinics see the actual dialysis as a “loss leader” and profit instead from heavy use of well-reimbursed drugs.

ProPublica promises more stories about this throughout the week, so be sure to check back its site for developments. Fields discussed dialysis on NPR today, as did Dr. Barry Straube, the chief medical officer at CMS.

Kidney swap connects six in small Mo. town

lickingJoy Robertson of KOLR-Springfield, Mo., tells the story of the coincidences and generosity that led to six residents of Licking, Mo., (population 1,471) swapping kidneys in a St. Louis hospital. Here’s a quick timeline, to give you an idea of how it all came together.

  1. Licking resident Stephanie Hood needed a kidney.
  2. Friends Randy and Melissa Lewis wanted to donate one for her, but neither was a match.
  3. Randy decided to donate his kidney anyway.
  4. Carrie Goforth, a 29-year-old Licking mother on dialysis, was a match for Randy.
  5. Meanwhile, Melissa Lewis decided to donate her kidney as well.
  6. Hers went to Gern Beasley, another Licking resident.
  7. Finally, Stephanie Hood, the patient who started it all, also got the kidney she needed. Her donor? Her cousin Diane. From Licking.

Reporting on kidney donation

Josephine Marcotty of the Minneapolis Star Tribune recently wrote a series addressing the increasing demand for kidneys, a need spurred by an aging population, increases in diabetes, obesity and high-blood pressure. In a recent AHCJ article, she explained how the story came together and how other reporters can follow in her footsteps and expand upon her work.

Why aren’t some on dialysis referred for transplants?

Pittsburgh Tribune-Review reporters Andrew Conte and Luis Fabregas have released the results of an extensive investigation into kidney transplant and dialysis. Conte and Fabregas found that some dialysis patients hadn’t been told that kidney transplant is an option, even though the procedure, for which patients should get on waiting lists as soon as possible, could add years to their lives. Last year, the duo claimed a top AHCJ award for their work on a similar topic, liver transplants.

The financial consequences of their findings are particularly timely. Kidney conditions account for a fifth of Medicare spending, and “a new kidney costs the federal Medicare program $50,000 less per patient than conventional dialysis,” Conte and Fabregas report.

More than 32,000 of the 105,653 people who started treatment for kidney failure in 2006 were not informed about the option of kidney transplantation, according to the latest available information reported to the Centers for Medicare & Medicaid Services.

Nearly 44 percent of the uninformed simply were not assessed for transplant, the data show. In other cases, patients were deemed to be medically or psychologically unfit for a transplant, or unsuitable because of age.

Private insurers keep dialysis clinics humming

The reporters found that these issues, which have existed for decades, are at least partly attributable to the “inertia” of a system in which dialysis centers need to pull in new patients with private insurance in order to offset the cost of providing dialysis to Medicare and Medicate patients, whose government reimbursements do not cover the full cost of the procedures.

Some doctors say the payment system creates unhealthy incentives for providers to focus on filling their clinics when they should be primarily concerned with making sure patients receive information about transplantation as soon as possible.

Kidney transplants can extend lives by 10 years or more

In this story, Conte and Fabregas continue to build their case. Now that they’ve shown the financial impact of not referring dialysis patients for transplantation, they move on to the human impact. They use numbers, experts and analysis to show why transplantation is a far better decision, healthwise.

Experts: Crucial to get on waiting list as soon as possible

Finally, reporters bring everything together by showing that informing a patient of the possibility of the transplant and getting them on a waiting list is key to ensuring their continuing health.


Washington Post videojournalist Pierre Kattar Jr. tells the story of joining an eight-person kidney donation chain in order to overcome incompatible blood types and donate a kidney to his ailing father, 61-year-old Pierre Kattar Sr. (Hat Tip to kobreGUIDE)

For more on kidney donation chains, see Mat Dowling’s NJ.com multimedia series covering a six-person chain in New York and New Jersey.