End-stage renal disease facility

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Dialysis machines like these may be used in an end-stage renal dialysis facility.

An end-stage renal disease facility (ESRD facility, dialysis facility, or dialysis center) is a medical facility that operates to assist people with irreversible loss of kidney function (stage five), requiring a regular course of dialysis or a kidney transplant to survive. The facility may operate independently, as part of a hospital-based unit, or as a self-care unit that furnishes only self-dialysis services.[1]

ESRD facilities in the United States

In 1972 the United States Congress passed legislation authorizing the End Stage Renal Disease Program (ESRD) under Medicare. Section 299I of Public Law 92-603, passed on October 30, 1972, extended Medicare coverage to Americans if they had stage five chronic kidney disease (CKD) and were otherwise qualified under Medicare's work history requirements.[2] The program officially launched on July 1, 1973. Previously only those over 65 could qualify for Medicare benefits. This entitlement is nearly universal, covering over 90% of all U.S. citizens with severe CKD.[3]

The Centers for Medicare and Medicaid Services (CMS) describes four types of ESRD facilities[4]:

  • Renal transplantation center - "a hospital unit which is approved to furnish, directly, transplantation and other medical and surgical specialty services required for the care of ESRD transplant patients"
  • Renal dialysis center - "a hospital unit that is approved to furnish the full spectrum of diagnostic, therapeutic, and rehabilitative services required for the care of ESRD dialysis patients"
  • Renal dialysis facility - "a unit that is approved to furnish dialysis service(s) directly to ESRD patients"
  • Self-dialysis unit - "a unit that is part of an approved renal transplantation center, renal dialysis center, or renal dialysis facility, and which furnishes self-dialysis services"

Patients undergoing dialysis at these facilities require two important documentation steps: the patient assessment and the patient plan of care. U.S. Federal regulation requires a comprehensive 13-point assessment, including current health status, laboratory profile, and nutritional status. Additionally, a comprehensive plan of care must be written, detailing "the services necessary to address the patient's needs" per the previously mentioned patient assessment.[1]

Additionally, CMS implements a quality incentive program for ESRD facilities, reducing payments to those facilities that do not meet or exceed certain performance standards.[1][5]

Further reading

For a more global look at dialysis centers:


  1. 1.0 1.1 1.2 Peden, Ann H. (2011). "Chapter 5: Dialysis". Comparative Health Information Management. Cengage Learning. pp. 147–176. ISBN 9781133708124. http://books.google.de/books?id=aXAJAAAAQBAJ&pg=PA147. Retrieved 29 March 2014. 
  2. "P.L. 92–603, Approved October 30, 1972 (86 Stat. 1329)". Compilation of the Social Security Laws. Social Security Administration. http://www.socialsecurity.gov/OP_Home/comp2/F092-603.html. Retrieved 29 March 2014. 
  3. "Outpatient Dialysis Services Payment System" (PDF). MedPAC. September 2006. Archived from the original on 21 July 2007. https://web.archive.org/web/20070721144509/http://www.medpac.gov/publications/other_reports/Sept06_MedPAC_Payment_Basics_dialysis.pdf. Retrieved 29 March 2014. 
  4. "End Stage Renal Disease Facility Providers". Centers for Medicare and Medicaid Services. 9 April 2013. http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/DialysisProviders.html. Retrieved 29 March 2014. 
  5. "ESRD Quality Incentive Program". Centers for Medicare and Medicaid Services. 5 March 2014. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/index.html. Retrieved 29 March 2014.