Most Chronic Kidney Disease patients who conduct Dialysis in the United States receive their Treatments at a Medicare-certified Dialysis Facility three times a week. That is why concerns have been raised about the quality of care being delivered to End-stage Renal Disease Dialysis patients given that 85% of facilities are classified as For-profit and only 15% are considered Non-profit. Concern is ever growing as findings consistently reveal that For-profit Dialysis Facilities have a 13% or higher risk of mortality (death) when compared to Non-profit counterparts, regardless of chain status, according to a study published in the Clinical Journal of the American Society of Nephrology.
Even patients that opt for Dialysis Treatments at home are linked to a Dialysis Facility for training, regular check ins, evaluation and necessary treatment adjustments. Hence, any patient conducting Dialysis (In Center or Home) is connected to a Dialysis Organization and such a divide in survival between For-profit and Non-profit institutions should certainly be of concern to Home Dialysis patients as well. This is especially the case since the number of Dialysis Facilities nationwide have been steadily increasing, which is almost entirely due to the growth of For-profit Dialysis Facilities throughout the country.
Most Chronic Kidney Disease and Dialysis patients will likely ask, "What is the cause for such a large disparity in survival rates among patients?" Well, the Nurses’ Union contends that "For-profit Dialysis results in documented patterns of reduced staffing, less patient education, lower quality needles and tubing, and a history of profitable anemia drugs used at levels that hurt patients — all factors linked to a shorter life expectancy for Dialysis patients in the United States."
Typically, For-profit Dialysis Organizations are also less expensive for the City or State than Public Facilities which offer Dialysis. A New York Times report suggested that a Dialysis Company calculated expected savings by replacing nurses with lower-paid technicians, and increasing the patient capacity of each Dialysis Unit which in some cases could create a 20% profit margin. Often, Public Facilities or Non-profit Dialysis Companies cannot reach such margins because usually they must pay higher fringe benefits (pay for the performance of services).
Still, Dr. Robert J Rubin (MedPage Today) suggested that there is no difference between For-profit and Non-profit Healthcare. Joseph Sala (Vice President at Atlantic Dialysis) agreed and noted that the most recent data showed that its centers met or exceeded national and state norms, “Our mortality across the board has improved; it continues to improve.” Yet, a study published by the U.S. Department of Health and Human Services - Agency for Healthcare Research and Quality revealed, "a number of earlier studies have suggested that factors related to practice patterns, such as dialysis dose, vascular access, and injectable drugs (including epoetin therapy [Epogen, Procrit], vitamin D, and iron) can influence patient outcomes."
Mr. Sala still contends that a local, Physician-owned Dialysis Company such as Atlantic Dialysis is different from the publicly traded chains that have fueled opposition to For-profit Dialysis. Given the intense national scrutiny by Chronic Kidney Disease patients and advocate organizations, it is surprising that Health Policy regarding this issue has not been robustly updated. Patients can help protect themselves by doing the following:
- Make sure staff follows hand washing protocol
- Ask if your Dialysis Machine was cleaned appropriately and not just wiped down with one (1) disinfectant wipe. Click here for preferred Dialysis Machine cleaning procedure.
- Keep in close communication with Nephrologists regarding Anemia Improvement, Hemoglobin numbers and Kt/V cleaning.
- Bring all concerns you have to the immediate attention of your Healthcare Team and/or your ESRD Network.
- Make sure you monitor your monthly labs and make necessary adjustments with the help of your Healthcare Team.
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