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For-profit kidney dialysis: Profits before people

Written by Diane Archer

In a recent episode of Last Week Tonight, John Oliver takes on the kidney dialysis industry, particularly DaVita, the for-profit company that controls a large piece of the kidney dialysis business in the U.S. Oliver exposes the various ways for-profit kidney dialysis companies put profits before people, compromising people’s health.

For background, End Stage Renal Disease (ESRD) or kidney failure is the 9th leading cause of death in the U.S.  Today, 500,000 adults have ESRD; 7,000 outpatient clinics provide dialysis. Another 17 percent of the adult population has chronic kidney disease, which can turn into kidney failure, if not detected and properly treated, People with kidney failure need dialysis–a three to four-hour process, three times a week, by which people’s blood is withdrawn, cleaned and returned to their body–to stay alive.

The number of people needing dialysis has grown substantially since 1972, when Richard Nixon expanded Medicare to cover anyone with ESRD. At that time 10,000 people had ESRD.

Oliver makes a compelling case that DaVita and other for-profit dialysis companies are not providing people with ESRD the care they need. For example, Oliver reveals that at least some DaVita employees appear to promote dialysis over kidney transplants. Yet, dialysis is not a long-term solution for people with ESRD, whose risk of death increases each year. They need a kidney transplant, if they are eligible for one, which can prolong their lives significantly.

Oliver also highlights DaVita’s poor infection control practices, alleged improper payments to doctors to refer patients to DaVita and overcharges to Medicare for drugs. (Seven years ago, Pro Publica reported unsafe and unsanitary conditions in many dialysis facilities.) While denying any wrongdoing, DaVita settled a lawsuit alleging that DaVita gave kickbacks to doctors for referring them patients, for $389 million. Again denying any wrongdoing, DaVita settled a whistleblower suit claiming that DaVita overcharged Medicare for drugs, for up to $495 million.

DaVita and one other for-profit company, Fresenius (which denied any wrongdoing but agreed to a $250 million settlement of a lawsuit alleging that it caused patients fatal heart problems and strokes) own seven in 10 of the dialysis clinics in the U.S. It’s hard to understand how Medicare gives many of these clinics a four-star rating for the quality of their patient care.

The cost of dialysis is enormous, 1 percent of the federal budget. In 2013, Medicare spent $31 billion on dialysis treatments for people with kidney failure. DaVita posted $789 million in profits in 2016.

Medicare needs to do a better job of overseeing DaVita, Fresenius and other for-profit dialysis companies to ensure, among other things, that they help patients understand the value of a kidney transplant over dialysis, and provide good quality care to their patients.

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