For-profit dialysis chains have higher mortality rates than non-profit dialysis chain
Concerns have been raised about the quality of care being delivered to end-stage renal dialysis (ESRD) patients, given that most large dialysis providers are for profit (FP) entities. Of the five largest dialysis chains, the lowest mortality risk was found among patients treated at a nonprofit (NP) chain, according to Yi Zhang, Ph.D., and colleagues at the Medical Technology and Practice Patterns Institute in Bethesda, MD. Compared with the nonprofit chain, mortality risk was 19 percent higher at one FP chain and 24 percent higher at a second FP chain. Overall, patients from FP facilities, regardless of chain status, had a 13 percent higher risk of mortality than NP facilities.
Most U.S. patients with ESRD receive hemodialysis treatment three times a week from Medicare-certified dialysis facilities. Since 1991, the number of chain-owned dialysis facilities has grown more than 11-fold. Today, roughly 85 percent of the FP and nearly one-third of the NP facilities are operated by large corporations. Some contend that lower resource use in the delivery of dialysis by FP facilities compromises the health outcomes of dialysis patients. 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, vitamin D, and iron) can influence patient outcomes.
This study evaluated and compared the use of all three major injectable drugs among dialysis facilities. The findings suggest that patients from the NP chain who used the least amount of injectable drugs had the best survival. If all other chains were to follow the resource use of the NP chain, costs of injectable drugs might be reduced without compromising patient outcomes, with the caveat that the provider will not excessively lower doses.
The study included 3,601 free-standing dialysis facilities and 34,914 Medicare patients with ESRD during 2004. The study was supported in part by the Agency for Healthcare Research and Quality (HS18697).
See "The effect of dialysis chains on mortality among patients receiving hemodialysis," by Dr. Zhang, Dennis J. Cotter, M.S.E., and Mae Thamer, Ph.D., in the June 2011 HSR: Health Services Research 46(3), pp.747-767.
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