End Stage Renal Disease (ESRD) facilities must meet certification requirements to receive Medicare reimbursement from the Health Care Financing Administration, Department of Health and Human Services (DHHS). State survey agencies, operating under contract with DHHS, assess compliance with conditions and standards for all Medicare facilities. The survey process has been criticized by renal professionals and organizations for its lack of objective criteria, because thresholds have not been established, and for the lack of a severity index. The current process promotes subjective decision making in determining facility deficiencies. Efforts to reorganize the survey process to make it more outcome-oriented are being initiated and, while this is laudable, there is no assurance that the process will be effective. Network #5 conducted a pilot study of state survey results to profile data for Medical Review Board (MRB) analysis and to identify potential areas where educational activities could be focused. Network #5 consists of dialysis and transplant providers in the District of Columbia (D.C.), Maryland, Virginia, and West Virginia. There are 139 dialysis facilities and 13 transplant centers serving over 7,000 dialysis patients. This pilot study was a retrospective analysis of surveys conducted in dialysis units that were operational as of August, 1988. This study did not include transplant providers.