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Medicare to dock pay for 72 FL dialysis centers

Six dozen Florida dialysis centers that failed to make the grade on some Medicare measures of quality last year will take a slight hit to the pocketbook next year.

But overall, Florida centers' performance was above the national average, according to an analysis released Thursday by the Centers for Medicare and Medicaid Services (CMS). In Florida, 20 percent of clinics will get pay cuts compared with 30 percent nationally.

Dialysis centers treat people with renal failure, including many who are waiting for kidney transplants, by using machines to remove waste and fluid from the blood.

While the pay reduction is capped at 2 percent, any cut in Medicare pay matters to the centers because the federal health program pays for almost all patients on dialysis through its End Stage Renal Disease fund.

The pay cuts are part of a federal 2008 “value-based purchasing” law meant to motivate higher-quality performance and better value for taxpayer dollars.

DaVita Lake Dialysis in Leesburg, New Smyrna Beach Dialysis and Fresenius Medical Care Saint Johns in Jacksonville were the state’s only facilities that got the maximum cut of 2 percent.

Administrators at the three facilities declined to comment or did not return phone calls.

Sixteen Florida facilities will take a 1.5 percent pay cut, according to the CMS list.

Each dialysis center is required to post its Medicare ranking.

To assess care quality, CMS looked at one measure of the blood’s waste reduction and two measures of how the facility manages anemia—a shortage of healthy red blood cells.

Dr. Mark Segal, chief of the Division of Nephrology at the University of Florida, said the performance measures are fair but can vary significantly based on the behavior and health of the patients -- for example, on how long patients stay on the machine.

So poorly-ranked facilities may be in the habit of signing people off early. Or it could be that they have many patients who don't show up for appointments on time or who won't stay for the whole session.

“Maybe there’s not enough education by the unit telling the dialysis patient how important it is for people to stay on the machine,” he said.

For patients with anemia, Medicare looks at measures of hemoglobin, which carries oxygen from the lungs to the rest of the body. It has to stay within a certain range

“A certain percentage of patients, even if treated properly, won’t be able to get (to the ideal range) if they have an underlying infection,” he said.

CMS officials said they were unable to rate the performance of about 11 percent of dialysis centers because they had too few patients who met the clinical criteria for the analysis. Those centers will not have reductions in pay.

The CMS dialysis treatment performance data can be found at

-- Health News Florida is an independent online publication dedicated to public-service journalism. Reporter Brittany Alana Davis can be reached at 954-239-8968 or by e-mail.