From the Field: New Bill Cuts Facility Certification Delays and Expands Telehealth Options

Rick Collins

Ridiculously lengthy delays in getting new dialysis facilities certified might finally be going away. H.R. 3178, sponsored by ten members of the House of Representatives, would allow new facilities to be certified by government-approved agencies other than Medicare.

In this age of few agreements between political parties, this bill appears to have great appeal to both parties as it is cosponsored by six Republicans and four Democrats. At the time of this writing, the bill has been moving quickly through the legislative process. The bill was introduced in the House on July 11, sailed through committees, and was passed by the House 14 days later. The bill was sent to the Senate the next day.

The fact that the bill is cosponsored by three Representatives from Texas is no surprise since the Lone Star State has experienced some of the most extreme delays in the country. It is not uncommon for new facilities in Texas to wait 18 months to two years to be surveyed by the state. Delays of a year or more are also being experienced in other states.

The delays in certification have scared away potential investors in dialysis for years. From time to time I am contacted by physicians, current end-stage renal disease (ESRD) facility owners, and other potential investors who ask me about the revenue they could expect from opening a new outpatient dialysis facility. The call normally goes well until I mention the huge delays they will experience in becoming certified.

Potential investors are often in disbelief when I describe the delays. A common response I receive is, “Wait a minute. You are telling me that after I spend more than a million dollars building a facility, buying equipment, and hiring at least an RN and a medical director, that I have to start one or two patients and treat them while receiving little or no income for 18 to 24 months? That’s crazy!”

As a result, these investors shift their money to another arm of healthcare and the number of independently owned facilities continues to drop. Dialysis chains have also become frustrated with the delays and yet no one has been able to get anything done until now.

Initial Certification Visits in 90 Days

Once the bill is enacted, within 90 days the secretary of Health and Human Services must begin accepting requests from national accreditation bodies who can meet the conditions and requirements necessary for certifying outpatient dialysis facilities. Within 180 days of enactment, new ESRD facilities must receive an initial survey within 90 days. Thus, 6 months after the enactment of the bill, new facilities will have to wait no longer than 3 months to receive their initial visit from surveyors.

Monthly Visits to Home Patients via Telehealth

Another key element in the bill is a provision that would allow physicians to treat more home dialysis patients via telehealth beginning in 2019. Current laws make it almost impossible for most renal practitioners to treat patients via telehealth because neither the patient’s home nor dialysis facility are included as approved originating sites. The new bill approves both of those sites and allows home patients to receive their monthly ESRD-related visits via telehealth with greater frequency.

Under the bill, face-to-face visits would be required during a home patient’s first 3 months of treatment, but after that, such visits would only be required once every 3 months.

Keep Current on Regulations

One of the biggest stumbling blocks to maximizing your practice’s or facility’s revenues is when physicians, clinicians, managers, and/or administrators are unaware of new reporting requirements that affect reimbursement. Even more frustrating is when key people refuse to change their ways after being informed of the new requirements.

Keeping yourself informed and adapting to new regulations will improve the financial health of your practice or facility. The time and cost spent on staying informed and making needed changes will pay significant dividends over time.

Rick Collins is the chief operating officer of Sceptre Management Solutions, Inc., a company specializing in billing for outpatient ESRD facilities, nephrology practices, and vascular access. Your questions are welcome and he can be reached at or 801.775.8010.