Choosing a Dialysis Center: A Checklist
Practical questions to ask about shifts, transportation, vascular access, staffing, your rights, grievances, and transferring dialysis centers.
Start with the basics you can check online
Many people are simply sent to the center where their kidney doctor works. You can go elsewhere: according to Medicare's booklet Medicare Coverage of Kidney Dialysis & Kidney Transplant Services, you have the right to get treatment at another facility at any time, though it could mean changing doctors. Before you visit, use our directory or Medicare's Dialysis Facility Care Compare to check:
- Location and distance from home or work. In-center hemodialysis usually means about three trips a week.
- Shift times, including whether the center has a shift starting at 5 p.m. or later.
- Services offered: in-center hemodialysis, home hemodialysis training, and peritoneal dialysis.
- Number of stations, which gives a rough idea of the facility's size.
- Ownership: whether the facility is for-profit or non-profit and whether it is part of a chain.
- Star rating and individual measures, plus patient experience survey results.
Questions about your schedule and getting there
- Which shifts have openings? Can I get an evening shift if I work during the day?
- Does the center offer in-center nocturnal (overnight) dialysis?
- How are shift changes handled if my job or caregiving schedule changes?
- What happens if I am running late or miss a treatment?
- How do other patients get here? Can the social worker help me arrange rides?
Transportation matters. Original Medicare covers ambulance trips to the nearest dialysis facility only when other transport could endanger your health. Some Medicare Advantage Plans cover other rides, so check your plan. Your facility's social worker can help you explore options.
Questions about your care
- Vascular access: How does the center help patients get a fistula? According to NIDDK, an arteriovenous (AV) fistula is considered the best option for hemodialysis because it provides the highest blood flow, is less likely to become infected or clot, and lasts longer. A catheter is meant as temporary access. Care Compare reports each center's fistula rate and its long-term catheter rate.
- Adequacy: How often is my dialysis dose (Kt/V) checked, and will someone explain my results?
- Staffing: Who will run my treatment, a nurse or a trained technician? Who do I ask when I have a question during treatment? How often will I see my kidney doctor, dietitian, and social worker?
- Home options: Does the center train patients for home dialysis, or can it refer me to a center that does?
- Transplant: How does the center help patients get evaluated and placed on a transplant waitlist?
- Policies: What are the rules on eating during treatment, visitors, and reuse of dialyzers?
Know your rights
Every Medicare-certified dialysis facility must follow the federal patients' rights rule (42 CFR 494.70). Among other things, you have the right to:
- Be treated with respect and dignity, and receive information in a way you understand
- Privacy and confidentiality in your treatment and medical records
- Be informed about all treatment options, including home dialysis and transplant, and get information about options the facility does not offer, including scheduling options for working patients
- Be told about the facility's policies, including reuse of dialysis supplies and charges for services Medicare does not cover
- Be told how to file complaints (grievances) inside the facility and outside it
- File a grievance without reprisal or denial of services, in person, anonymously, or through a representative
- Receive written notice 30 days before an involuntary discharge, except in cases of immediate threats to the health and safety of others
The facility must post a copy of these rights where patients can see it, including contact information for the State survey agency and the ESRD Network.
How to file a grievance with your ESRD Network
ESRD Networks are organizations that work with CMS to monitor and improve kidney care. According to CMS, 18 Networks operate across the United States and its territories, and each must have procedures for evaluating and resolving patient grievances.
- Try the facility first if you are comfortable. Ask for the internal grievance process, which you have a right to be told about.
- Contact your ESRD Network if the problem is not resolved or you prefer to go outside the facility. Find yours through the Forum of ESRD Networks directory, the notice posted in your facility, or 1-800-MEDICARE. You can ask to stay anonymous.
- Contact your State survey agency for concerns like claims of abuse, medication errors, poor quality of care, or unsafe conditions.
Your facility cannot take action against you for filing a complaint.
Transferring to a different center
- Check that the new center has an opening on a shift that works for you and accepts your insurance.
- Ask whether your current kidney doctor treats patients there, since changing centers could mean changing doctors.
- Ask both centers to coordinate the transfer of your records, orders, and lab results.
- If you are traveling, ask your social worker well ahead of time about arranging treatment at another center.
- If you have trouble finding a facility willing to accept you, you have the right to file a complaint, and your ESRD Network can help.
This checklist is general information, not medical advice. Talk with your kidney care team about what is right for you.