February 14, 2001 - Medicare's Dialysis Facility Compare web site once again is providing a database of comparative information about dialysis facilities that can be downloaded.

The amount of data about each dialysis facility has been drastically reduced in this latest release. The first release of the Dialysis Facility Compare database in January had 80 fields of information for each facility, while the new database has only 29 fields.

The anemia management data has not yet been reinserted.

Data that was eliminated in this release of the database include:

- facility chain ownership
- services provided (PD, HD, training)
- staffing ratios

RenalWEB will post new listings of the 'Top 10%' and 'Lowest 5%' of the dialysis facilities for dialysis adequacy (URR) later in the day.

February 6, 2001 - RenalWEB spoke yesterday to a staff member at HCFA about the Dialysis Facility Compare feature on the Medicare web site.

As was previously reported here, the Anemia Management data has been removed from the Dialysis Facility Compare feature pending the conclusion of an investigation by HCFA. An outside contractor was used on the project. The "downloadable" Dialysis Facility Compare database was also removed and will be unavailable until this investigation is completed.

The Dialysis Facility Compare web site now states that the Anemia Management data will again be available on February 8, but the HCFA staff member stated that this may be delayed further. The staff member also stated that the Dialysis Adequacy Data (URR) and the Patient Survival data are not in question and remain available.

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Medicare Pulls Anemia Management Data from 'Dialysis Facility Compare' Feature

February 1, 2001 - The Anemia Management data has been removed from the Dialysis Facility Compare feature on the Medicare web site. A notice states that this measure will be available again on February 8th.

The Dialysis Facility Compare database that was available for downloading has also been removed from the Medicare web site.

Some of the major dialysis providers (chains) have contacted RenalWEB to point out that the content of the first release of the Dialysis Facility Compare database was less than complete.

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Medicare's 'Dialysis Facility Compare' Data for Chains

January 30, 2001 - RenalWEB has done an analysis of the anemia management data in Medicare's Dialysis Facility Compare database for the dialysis units belonging to the five largest "chains". The results appear below along with the previously released dialysis adequacy data. The biggest "hole" in the anemia management data is for Fresenius Medical Care (FMC) facilities. There is dialysis adequacy (URR) data for 33,098 FMC patients in the database, but there is anemia management (Hct) data for only 9,912 FMC patients.

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On January 19, 2001, Medicare put the Dialysis Facility Compare feature on its web site.

The Dialysis Facility Compare feature provides 'quality of care' information on dialysis facilities that were approved by Medicare as of January 1, 2000. The owners of the dialysis facilities are also listed, which allows anyone who is curious to compare the major dialysis provider "chains".

Approximately half of the dialysis facilities in the US are owned by five dialysis providers: Fresenius Medical Care (FMC), Gambro Healthcare, Dialysis Clinics Inc. (DCI), DaVita (previously known as Total Renal Care), and Renal Care Group (RCG).

NOTE: Medicare also provides a Dialysis Facility Compare database for downloading. If you have the Microsoft Access Database application and would like to do your own statistical analyses, click here to download the Dialysis Compare database from the Medicare web site.

RenalWEB has discovered that the "download database" has several dialysis facilities that are not included in the Medicare on-line Dialysis Facilty Compare search feature. The information that follows have been prepared with the Dialysis Facility Compare database that was downloaded from the Medicare web site on January 20, 2001.

Before reviewing this information, be sure to view the Data Collection Details. According to Medicare, the source of the adequacy, anemia, and patient survival information is updated continuously and may undergo some level of review. However, not all items have been checked independently to verify accuracy.

RenalWEB has reviewed the Dialysis Facility Compare database and has found, as a general rule, the Urea Reduction Ratio (URR) and Hematocrit data to be from 1998 and the Patient Survival data to cover the period from 1996-1998.

Anemia Management Information for Dialysis Chains

One of the quality outcome measurements of the Dialysis Facility Compare feature is the percent of patients at a facility with a hematocrit (Hct) of 33 or greater (also known as anemia management).

At the current time, a Hct of 33% or higher is considered adequate anemia management. RenalWEB has a comprehensive listing of Internet resources on Anemia Management.

The national average for all dialysis facilities in the US for 1998 was 54.0%. This means that in an average US dialysis facility, 54.0% of the patients have a Hct of 33% or greater.

Using the Dialysis Facility Compare database that was downloaded from the Medicare web site on January 20, 2001, the following results were achieved by this method: The Hct score for each facility (HCTG33_F) was multiplied by the number of patients in that facility with Hct data (HCTRD_F). This product is the "weighted facility score" for each facility. The weighted facility scores were then added together and divided by the total number of patients. The resulting quotient is the average facility Hct score for the dialysis chain. Again, the national average for all US dialysis facilities was 54.0%.

Chains are listed in order of number of facilities.

Fresenius Medical Care: Feb. 6 - Awaiting new data

Gambro Healthcare: Feb. 6 - Awaiting new data

Total Renal Care (renamed DaVita in 2000): Feb. 6 - Awaiting new data

Dialysis Clinic Inc. (DCI): Feb. 6 - Awaiting new data

Renal Care Group: Feb. 6 - Awaiting new data

Dialysis Adequacy Information for Dialysis Chains

One of the quality outcome measurements of the Dialysis Facility Compare feature is the percent of patients at a facility with a Urea Reduction Ratio (URR) of 65 or greater (known as adequacy of hemodialysis).

At the current time, a URR of 65% or higher is considered adequate hemodialysis therapy. Click here for an explanation of URR and dialysis adequacy from the NIDDK web site. RenalWEB has a comprehensive listing of Internet resources on Hemodialysis Adequacy.

The national average for all dialysis facilities in the US for 1998 was 82.6%. This means that in an average US dialysis facility, 82.6% of the patients have a URR of 65% or greater.

Using the Dialysis Facility Compare database that was downloaded from the Medicare web site on January 20, 2001, the following results were achieved by this method: The URR score for each facility (URRG65_F) was multiplied by the number of patients in that facility with URR data (PURR_F). This product is the "weighted facility score" for each facility. The weighted facility scores were then added together and divided by the total number of patients. The resulting quotient is the average facility URR score for the dialysis chain. Again, the national average for all US dialysis facilities was 82.6%.

Chains are listed in order of number of facilities.

Fresenius Medical Care: 709 facilities in the database, 624 facilities had URR data, URR data for 33,098 patients. Average facility URR score: 84.3%

Gambro Healthcare: 460 facilities in the database, 370 facilities had URR data, URR data for 16,554 patients. Average facility URR score: 87.1%

Total Renal Care (renamed DaVita in 2000): 407 facilities in the database, 326 facilities had URR data, URR data for 15,016 patients. Average facility URR score: 78.4%

Dialysis Clinic Inc. (DCI): 142 facilities in the database, 110 facilities had URR data, URR data for 5,579 patients. Average facility URR score: 80.2%

Renal Care Group: 80 facilities in the database, 61 facilities had URR data, URR data for 3079 patients. Average facility URR score: 88.8%

[This message has been edited by Gary Peterson (edited 02-14-2001).]