There have been a slew of publications discussing the safety, efficiencies, and mortalities at dialysis centers over the past few weeks.  Drs.Zhang and Thamer and Mr. Cotter of  the Medical Technology and Practice Patterns Institute (Bethesda, MD) reported in Health Services Research results that compared USRDS (United States Renal Data System) data across 3601 dialysis centers (2004 data). The USRDS data was then matched with cost, census, and facility data. The study did not address the ratios of nurses to technicians or the presence of physicians, which may have an effect upon these results.

These researchers compared the results among five dialysis chains, as well as for free-standing (unaffiliated) facilities.  The study adjusted for factors such as age and other diseases, but still found the mortality risk (18 to 30 month period) was seriously higher for the two largest for-profit chains (Fresenius and DaVita), when compared to the smaller (but, still substantial) non-profit chain (which I presume is Dialysis Clinics, Inc.). (Since the report does not identify the clinics per se, I am not including the actual percentage differences among them, since those numbers provide no true insight.)  In general, however, the results demonstrated a 13% increase in mortality, when patients were dialyzed at the for-profit, compared to the not-for-profit, facilities.

Pro-Publica presented heretofore confidential data from the Centers for Medicare and Medicaid Services (CMS) for US dialysis facilities.  Heretofore, only Northwest Kidney Centers (one of the first non-hospital providers in the US) published its results for it 14 non-profit centers.  The data covers 15 categories- transplants, infection rates (septicemia, access infections), mortality (first year, overall mortality, and both when compared to the expected rate),  hospital admission and days present, as well as dialysis efficiency (Urea Reduction Ratio, URR).  These results amplify the findings reported in the first report.  To use the chart, you must either enter the address of the facility you wish to examine, or you can find facilities near a specific address.

As an example, near our office, there are four facilities, with a total of 75 dialysis stations.  All had a reasonable mortality rate (below the national average), one had higher than average hospitalization rates and stays, septicemia and access infections were higher than average for two of the facilities, and the URR ranged from 92 to 100%.

Given the change (and incentive system) in dialysis reimbursement rates (discussed earlier here), we can only hope that these numbers will improve.

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