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The diagnosis on U.S. kidney dialysis care: deadly for patients, costly for taxpayers

Another scathing indictment of the state of medical care in the United States can be found in an article published this week (and reprinted by MinnPost) by the nonprofit investigative reporting group ProPublica.

Senior editor Robin Fields spent more than a year investigating the deeply flawed government system that oversees the mostly privately owned kidney dialysis industry in this country.

What she discovered should have all of us all fuming, but since, as Fields points out, most people on dialysis tend to be poor and/or African-American and Hispanic (often because they don’t get medical care early enough to avoid the organ failure that leads to dialysis), I’m not sure how much this investigation will change things.

I encourage you to read the story, which was also co-published in the December issue of The Atlantic magazine. Particularly illuminating is Fields’ detailed description of dialysis care in Italy, where patient survival is much higher. (About one in nine patients in dialysis care die each year in Italy, compared with one in five here. And Italy spends about one-third less per patient than we do.)

Here’s Fields’ summary of what she uncovered during her investigation:

[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. Yet the United States continues to have one of the industrialized world’s highest mortality rates for dialysis care. Even taking into account differences in patient characteristics, studies suggest that if our system performed as well as Italy’s, or France’s, or Japan’s, thousands fewer patients would die each year.
In a country that regularly boasts about its superior medical system, such results might be cause for outrage. But although dialysis is a lifeline for almost 400,000 Americans, few outside this insular world have probed why a program with such compassionate aims produces such troubling outcomes. Even during a fervid national debate over health care, the state of dialysis garnered little public attention.
Over the course of more than a year, ProPublica reviewed thousands of inspection reports and interviewed more than 100 patients, advocates, doctors, policy makers, researchers and industry experts to get a grasp on American dialysis. The findings were bleak: At clinics from coast to coast, patients commonly receive treatment in settings that are unsanitary and prone to perilous lapses in care. Regulators have few tools and little will to enforce quality standards. Industry consolidation has left patients with fewer choices of provider. The government has withheld critical data about clinics’ performance from patients, the very people who need it most. Meanwhile, the two corporate chains that dominate the dialysis-care system [Colorado-based DaVita and Fresenius, a subsidiary of a German corporation] are consistently profitable, together making about $2 billion in operating profits a year.

The industry responds
The dialysis industry claims that ProPublic has misreported the facts. The mortality rate of U.S. kidney patients is falling and patients generally receive good care, Dr. Allen Nissenson, chief medical officer of DaVita told the Denver Post.

The article is “profoundly disappointing,” Nissenson added. “It took some information and did not clearly explain it or (present) it in a way that people could understand the issues.”

Read the article and make up your own mind. ProPublica has also published some companion pieces on its website that provide background on the reporting of this story. Included is a leaked memo from Kidney Care Partners (KCP), an advocacy and lobbying organization for dialysis providers, patient groups, drug companies and others, telling its members how to respond to the ProPublica article.

Comments (1)

  1. Submitted by Ray Schoch on 11/10/2010 - 11:26 am.

    We should not be surprised, with medicine having been allowed to become a corporate endeavor rather than a public service, that profits are maintained while quality of care deteriorates. The companies, after all, are in business to make money. That’s their reason for being.

    The leaked document doesn’t reveal any evil plan, particularly, just an effort on the part of the kidney treatment industry (and I use that term advisedly) to make sure their side of the issue gets attention, as well. I’m not a physician, so I’m not qualified to judge the accuracy of the information presented in the memo, but presume, since it’s going to be the basis of the PR campaign, that the facts included are at least reasonably accurate.

    What seems more important, however, and as one of the commentators mentioned about the PR response, is that it doesn’t address the more meaningful issue of why / how kidney patients in Italy manage substantially lower mortality at substantially lower cost. There’s no denial of lower-quality outcomes in the U.S., it’s just that, in true PR fashion, outcomes are generally not mentioned at all. Why make comparisons that will only show that someone else is doing a better job, and for less money?

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