Bottom line benefits

Dialysis is big business.

And city officials are bringing for-profit dialysis companies into our city’s public healthcare system.

Two multinational companies – Fresenius and Davita Healthcare Partners – dominate the industry. And the money they make is astonishing. Last year, DaVita’s CEO made nearly $28 million, making him one of the highest earning corporate heads in the country.

Kidney failure is the only chronic disease that Medicare pays for. That should help patients get the treatment they need, but with a lot of money at stake, all too often it means that profit is the first concern.

Corporate lobby at work

The quest for profits in dialysis is turning into a cat-and-mouse game. The dialysis industry has dozens of lobbyists in D.C., working hard to keep the cash flowing. Until 2011, dialysis clinics collected payment for each dose of Epogen they administered.

In an effort to make sure clinics weren’t giving too many doses to up collections, Medicare moved to a flat-fee system for dialysis payments. The consequence? According to The New York Times, “the use of the drug plunged, while the dialysis companies’ earnings margins rose.” Without a financial incentive to give patients Epogen, usage dropped much more than had been expected when the flat fee was set.

Congress responded earlier this year with plans to cut the fee dramatically – and dialysis industry lobbyists swung into action. They threaten that the fee cut would force dialysis clinics in low-income urban neighborhoods and rural areas to close. The U.S. Dept. of Health and Human Services will issue its decision by Nov. 1. Many members of Congress who once supported the cut are now urging otherwise. The $8 million in campaign contributions from the dialysis industry and its sophisticated lobbying campaign may well pay off nicely if profit is the measure of success.

Outsourcing dialysis at HHC

Last year, HHC’s board of directors voted to outsource inpatient and outpatient dialysis to Atlantic Dialysis Management Services. An agreement is still in the works, but NYSNA strongly opposes privatizing this key health service.

The evidence leaves no doubt that patients pay with their health when the profit motive enters dialysis. Our research shows that the HHC privatization plan and proposed staffing model will lead to significant cuts in patient care, with nurse-to-patient ratios doubling or even tripling and nurse hours per patient cut up to 60 percent.

Patients at risk

Studies of for-profit dialysis operations make clear that patients pay dearly for cuts like this. Compared to nonprofit centers, for-profit dialysis results in higher mortality rates (up to 13 percent higher than in a nonprofit) as well as increased hospitalizations and longer hospital stays (up to 17 percent higher than in a nonprofit).

A 2010 study published in the Journal for Health Services Research found that patients treated at Fresenius centers had a 10 percent higher risk of death than did those receiving care at a nonprofit, and patients at DaVita clinics averaged a 24 percent greater risk of death. The Food and Drug Administration is currently investigating if Fresenius failed to abide by federal regulations and warn patients of a potentially lethal risk connected to one of its products.

HHC nurses put patients first – always. That is what we are about, all day, every day. We continue to challenge the HHC board’s decision to outsource dialysis.