How Far Does a Patient Have to Travel to a PD clinic?

Is there a Medicare or other agency guideline as to how far a patient has to travel to a PD clinic. For instance, if there is a PD clinic close to the patient’s home and the doctor tells the patient he has to go to another clinic which is much further away, does the patient have any recourse?
I had heard that if the clinic is more than 30 miles from their home and there is a closer one, they can go to the closer one.


Medicare does not require that patients go to the closest clinic to their home. Home dialysis patients do not need to go to the clinic as often so distance from the clinic may not be as big an issue for them as for patients that do their dialysis in a clinic 3x/week as long as transportation to/from the clinic is not a problem. Medicaid may limit transportation help to/from the closest clinic that provides the services (PD) that the patient needs.

With a new dialysis patient, the kidney doctor may be referring the patient to the closest clinic that is certified by Medicare to train patients for PD and to provide ongoing support services to them or he/she may be referring the patient to the clinic where he/she admits and follows patients. You can find clinics that are certified to train and follow PD patients on the Home Dialysis Central “Find a clinic near you” database linked from the homepage at

If you’re talking about a patient who is already on PD at a clinic and the doctor is telling that patient he/she needs to change to another clinic, it could be because the doctor will no longer be seeing patients at that clinic. If that’s the case, the patient has the option to change clinics to keep his/her doctor or stay at the clinic and switch his/her care to another doctor who practices there.

On the other hand, if the doctor and clinic want the patient to go transfer to another clinic and the transfer is not something that the patient wants, this is called “involuntary discharge.” The ESRD regulations limit the reasons that a clinic can discharge a patient involuntarily to the following reasons and require the facility to follow certain steps as follows if the reason is in this list:

I Standard: Involuntary discharge and transfer policies and procedures. The governing body must ensure that all staff follow the facility’s patient discharge and transfer policies and procedures.

The medical director ensures that no patient is discharged or transferred from the facility unless –
(1) The patient or payer no longer reimburses the facility for the ordered services;
(2) The facility ceases to operate;
(3) The transfer is necessary for the patient’s welfare because the facility can no longer meet the patient’s documented medical needs; or
(4) The facility has reassessed the patient and determined that the patient’s behavior is disruptive and abusive to the extent that the delivery of care to the patient or the ability of the facility to operate effectively is seriously impaired, in which case the medical director ensures that the patient’s interdisciplinary team—
(i) Documents the reassessments, ongoing problems(s), and efforts made to resolve the problem(s), and enters this documentation into the patient’s medical record;
(ii) Provides the patient and the local ESRD Network with a 30-day notice of the planned discharge;
(iii) Obtains a written physician’s order that must be signed by both the medical director and the patient’s attending physician concurring with the patient’s discharge or transfer from the facility;
(iv) Contacts another facility, attempts to place the patient there, and documents that effort; and
(v) Notifies the State survey agency of the involuntary transfer or discharge.
(5) In the case of immediate severe threats to the health and safety of others, the facility may utilize an abbreviated involuntary discharge procedure.[/I]

If the clinic involuntarily discharges a patient, it is supposed to make a good faith effort to find the closest facility to the patient’s home that will accept the patient in transfer.