Survey and certification. Survey and certification of new and existing dialysis sites should be promoted. The availability of dialysis facilities is currently hampered by a lack of resources at the state level as well as the prioritization rules developed by the Centers for Medicare & Medicaid Services (CMS). New facilities remain unused due to a lack of Medicare certification, which can be achieved only through the initial survey process. Recent budget shortfalls in several states have complicated the ability of state surveying agencies to meet the influx of new centers. States should ensure that their licensure and certification divisions are funded adequately and that a sufficient number of surveyors exist to meet the growing demand of new dialysis centers being completed.
Emergency planning. Special needs shelters should include dialysis patients due to the life-sustaining nature of dialysis treatment. Dialysis facilities should have priority status for return of water and electricity in the event of emergencies and should be incorporated in local, state and federal preparedness planning processes.
The ESRD community learned valuable lessons from responding to hurricanes Katrina and Rita and wants to further develop its disaster response as a national community. To this end, a Kidney Community Emergency Response Coalition was developed in 2006. The coalition includes teams focused on facility operations, patient communication, assistance and tracking, federal response (which includes CMS representatives), physician placement and pandemic preparedness. The coalition includes a variety of kidney organizations, providers, suppliers and patient organizations. A listserv has been developed which serves as a vehicle to provide routine announcements during non-emergency times and as a way to coordinate communication to all members during a disaster. A toll-free hotline can be quickly activated during a time of emergency. A website (www.kcercoalition.com) has been developed to house materials and information and to serve as a resource for the ESRD community for disaster preparedness.
