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Dialysis Treatment Investigation Reveals Poor Care, High Costs

The nonprofit website ProPublica last week published a wide-ranging investigation into dialysis treatment in America.

Shoddy treatment practices and unsanitary conditions are not uncommon, ProPublica reported, and in severe cases have resulted in deaths. Furthermore, the costs of caring for patients with kidney failure exceed those in other developed countries that, like the U.S., provide government-funded universal access to treatment.

“A program once envisioned as a model for a national health care system has evolved into a hulking monster. Taxpayers spend more than $20 billion a year to care for those on dialysis — about $77,000 per patient, more, by some accounts, than any other nation.”

Dialysis consumes 6 percent of the Medicare budget,  the article notes — and if ignored that figure promises to grow.

Tennessee has one of this country’s highest rates of diabetes, which is the most common cause of kidney failure.

But even though the U.S. government’s role in dialysis care looms large, the story explains that consumers have not had access to public data that answers questions like whether patients at one clinic are more likely to die or be hospitalized than patients at another.

“Even as government policies have encouraged the spread of corporate dialysis, they have largely denied consumers the chance to use market power to push for better care. Because Medicare is the dominant payer, it has information about dialysis centers that doesn’t exist for other medical providers. Yet the Centers for Medicare and Medicaid Services has not made public key measures such as clinics’ rates of mortality, hospitalization for infection and transplantation. Regulators know how dialysis units perform by these yardsticks. So far, patients don’t.”

Because of ProPublica’s work, though, that should not be the case much longer. After a two-year battle, the website has convinced CMS to make the data available, which ProPublica promises to post shortly.

The story draws a contrast with Italy, where doctors directly manage the delivery of dialysis, spotting and addressing problems. The story suggests that technicians and nurses do much of the direct patient care in the U.S., citing a study showing that Italian patients “had more than five times as much contact with their physicians as U.S. patients.”

But even with more doctor involvement, per-patient costs are lower in Italy’s system, where patients don’t have to reach kidney failure to access the treatment and public hospitals are the treatment providers — in the U.S., two chains, Colorado-based DaVita and Fresenius, a subsidiary of a German corporation, dominate the market, ProPublica reports.

A post by Time highlights a lesson in the four-decade story of universal access to dialysis treatment, which could prove of value as the health care overhaul enacted this spring takes effect:

“The article shows the complexity of providing universal care through for-profit businesses, illustrating how perverse incentives in payment policies create a situation in which patient care is measured in quantity rather than quality.”

a figure that if ignored promises to grow,

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