Throughout the past decade, the survival rates of patients on dialysis have improved. But the story of kidney failure is more than just an uplifting tale of triumph. It also illustrates how financial incentives and government policies have undermined patient care.
In the 1960s, kidney disease killed over 100,000 Americans a year. Then, dialysis entered the American consciousness. Two inventions helped make it possible. A Dutch doctor invented a machine like an artificial kidney, and a Seattle doctor developed a vascular access device. However, the technology was limited to a few patients. In addition, the clinics that provided dialysis for patients often used drugs that the dialysis giants sold.
The two largest providers, former DaVita’s executive CEO, Kent Thiry, and Nephrology Associates, are dominated by for-profit companies. These corporations also control the drugs and labs that dialysis patients use. Their executives have also moved into the home-dialysis market. They also operate pharmacies.
Although financial incentives have helped corporations dominate the dialysis industry, they have also hindered patient care. There are few tools available to regulators to enforce quality standards. And the government has difficulty imposing fines on providers that aren’t nursing homes.
Some dialysis clinics don’t meet federal requirements for a registered nurse at each site. Others must turn over patients more quickly, saving money by extending the technician’s time. Another problem is that many clinics operate like factories, using their employees to perform more than the number of patients allowed. The result is patients who receive treatment in dirty settings.
There are three types of dialysis: hemofiltration therapy, peritoneal dialysis, and hemodialysis. Each carries its risks, and patients need to ask their doctor about minimizing the risks.
The hemofiltration therapy method uses a filter to remove waste products from the blood. It’s used in an intensive care unit for people with acute kidney failure. The filter also eliminates fluids and water from the body. It’s also used in dialysis for patients who suffer from blood pressure problems. The filter also prevents the buildup of dangerous levels of waste products. It’s a 12-to-24-hour process.
Peritoneal dialysis is associated with an increased risk of infection in the abdominal cavity. Conditions in the peritoneum can cause peritonitis, a severe disease that enlarges the abdominal wall. In addition, the patient’s heart rate can fluctuate when removing fluid and waste products.
Aside from the risks involved, hemodialysis and peritoneal dialysis involve other challenges. For example, a person on dialysis can experience pain, nausea, itchy skin, and depression. In addition, people on dialysis often suffer from kidney-related amyloidosis, which develops when blood proteins deposit on the joints. The condition is more common among people with a long history of hemodialysis.
The government’s payment policies for dialysis have created financial incentives for corporate dialysis. For example, CMS pays one-quarter of the clinics in the U.S. more than 13 percent of their gross revenue. But these rates haven’t adjusted for inflation.