Investigation Finds U.S. Kidney Dialysis in a Sorry State

By Andrew Moseman | November 10, 2010 1:48 pm

arlificial kidney (dialysis) deviceDialysis can be a life-saver for people with kidney failure, but according to a major investigation, the way we do it and finance it in this country is a total mess.

Writing in The Atlantic, reporter Robin Fields of the nonprofit investigate journalism group ProPublica lays out her long investigation into dialysis. Though the procedure since 1972 has been the only one guaranteed universal coverage to all Americans through Medicare, Fields finds it disturbingly inefficient, with one in four American patient dying within a year of beginning treatment:

Now, almost four decades later, 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 kidney patients would die each year. [The Atlantic]

How did things go so awry? Medicare mandated coverage, the investigation finds, but it did not properly mandate how the clinics spent Medicare’s money.

The article shows the complexity of providing universal care through for-profit businesses, illustrating how perverse incentives in payment policies create a situation in which patient care is measured in quantity rather than quality. Dialysis patients get too many drugs (which nets profits for the clinics that are dispensing them), for instance, but not enough oversight of dialysis procedures by doctors and nurses (which costs companies money). [TIME]

Field’s full piece is available for free at The Atlantic’s website. ProPublica obtained data from the Medicare database that Medicare officials had been holding despite Freedom of Information Act requests, which the ProPublica promised to release shortly. The investigators also turned up a leaked PR document from Kidney Care Partners, an organization of clinics, detailing how it planned to spin the investigation’s findings.

The response has already begun in some corners. Barry Straube, Medicare’s chief medical officer, admits that Medicare has not been up to par in inspecting dialysis clinics. But he contends that the violations of cleanliness and of proper practice that ProPublica found in clinic visits are not indicative of the nation’s clinics as a whole. He says:

“My main quibble with the article is that it sounds like one would not want to have dialysis in the United States. This is a lifesaving treatment that the vast majority of people are being treated very well in very clean facilities that hopefully make very few mistakes.” [NPR]

DaVita, the largest dialysis provider in the United States, has also responded through its chief medical officer, Allen Nissenson.

The U.S. has comparatively higher death rates, Nissenson said, for two reasons: Patients tend to come into the dialysis system already sicker than those in other countries, and the U.S. has higher proportions of blacks and Latinos — populations with a greater incidence of serious kidney disease — than more homogenous countries. [Denver Post]

Related Content:
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DISCOVER: Effective Kidney Transplants Without a Lifetime of Powerful Drugs
DISCOVER: The Downfall of India’s Kidney Kingpin, our in-depth investigation this year into international kidney trading

Image: iStockphoto

CATEGORIZED UNDER: Health & Medicine
  • nick

    Wow, the ‘blame it on the ethnic minorities’ defense angle.

    I wonder, if the higher incidence of serious kidney disease has anything to do with the higher instance of poverty among the minorities cited. If you can’t afford good health care prior to getting the only care freely mandated (which, in this case is an end-effect do-or-die treatment – you don’t need dialysis unless you’re going to die without it), of course you’re going to have a higher incidence of serious disease.

  • Bigby

    And we want to put all healthcare in the hands of the US Government…???

  • amphiox

    re #2:

    Yes, in fact we do. This is what happens when WE DON’T.

  • Daniel J. Andrews

    My thoughts too, amphiox. People can’t afford health care, put off getting tested/seeing a doc till it becomes critical, and then it may be too late.

    I’m so glad I live in Canada. I don’t have to look at my bank account before deciding whether I should get that slight chest pain checked out (ah, it’s probably nothing), or whether or not I should get blood tests checking my cholesterol levels (it’s probably fine—just because all the relatives on my mom’s side died of heart disease/attacks in their mid-50s doesn’t mean I have the same problems).

    I can get these things checked before they become a big problem, as can anyone else in every developed country in the world (except the U.S. for some bizarre reason).

  • Brian Too

    Patients who present at point of care in the U.S. tend to have higher acuities. It has nothing to do with ethnic groups per se. It is an aspect of uninsured and under-insured individuals, avoiding the health care system because they know that payment is going to be a problem.

    So what do they do? They try to self-medicate. They try to outwait the problem. They try herbal remedies. They try free clinics. They try every angle available to them short of the expensive, and usually clinically necessary, visit to the doctor.

  • FacePalm

    How many more decades of For-Profit Healthcare do we have to endure? We tolerate ‘Alternative Medicine’ and legally protect “Faith Healers’ ,imo, because they spare more hope for alot of sick [and uneducated] people than our healthcare system does. I’m 27 years old and I had my first doctor visit last month, excepting public school vaccinations, and this is not uncommon. I’m extremely lucky, I think, that I’m perfectly healthy and disease free despite spending my entire life without medical care: the answer to this was to leave it all in For-Profit and force people to buy coverage…or face fines?!

    When will we [the people] put our feet down and tell the Government to give us what we need instead of stuffing their overflowing pockets at our expense? They are here to guide and aid us, we are not here to be their personal pocket-book.


  • FacePalm

    Oh, btw… not that it’s really relevant but I was doing some temp work two years back and one of the projects I was sent to was a DaVita Dialysis Clinic…. Mold Remediation. We were all told to remove our Tyvek suits before exiting the building at any time because they didn’t want the public to know about it.

    Granted it took 3 months to get the spore count to acceptable levels.. but ffs take better care of your businesses.

  • Deadmanistalking

    My kidneys failed in 2000, they had swollen to over to over 13lbs apiece, consequently BOTH had to be removed after I suffered through 2 strokes due to Congestive Heart Failure. I became a Hemodialysis patient, and recieve treatments at a Fresineous owned/operated Dialysis clinic in Texas; been there now 11 years. I have witnessed 6 people die right there on the floor or in their chairs as well as 3 in the WAITING room area mostly due to flat out NEGLECT.At least 5 different doctors have come and gone since I started, each even less caring even less interested in caring for any of the patients there; on average I have timed their visits with each patient at 10-40 SECONDS, and NEVER more than 2 minutes, even if you have questions and need answers and advice. They arrive, dont even take the time to look at your records to even locate your name, ask what you need, sign their name, indicating they did indeed see you and move on asap in order to collect as much money as possible in the shortest amount of time.The floors are never clean, hair, blood, nasty used tape, wrappers from wipes, diff medicines even food and candy wrappers and mud is everywhere, I find blood and other body fluids dried and stuck on the chair I am assigned to regularly, even wet fresh blood at times on the chairs and all over under them. I have seen needles dislodge, patients crying out for help and are ignored , staff argueing even insulting older patients who are scared out of their minds, alarms are almost always shut off and the techs walk away w/o even looking at the patient.The techs routinely gather and watch TV, Football games especially, while alarms sound 2-3-4 minutes and longer. Patients regularly cramp-up, some so bad they pass out from the staff removing too much fluid too soon. I have had most of these things happen to me as well, including these ignorant untrained techs actually RAMMING in the needles, damaging my access, causing severe bleeding, I have had to be sent home several times because of needles stuck so far into the access and with such force, the needle passes right thru the artery or vein, and comes out on the other side. When this happens, and the needles are pulled back into the vessel into the bloodstream; the hole punctured thru now begins to leak a solid stream of blood into the arm or leg that cannot be stopped, because it is on the underside/inside of the vessel. Its called infiltration, the leaking blood forms an enormous hematome, that sometimes takes weeks to finallystop hurting.I have had this happen several times because the techs become distracted and look away, or are talking and not even paying attention while they are inserting the needles. I have had 3 Fistulas and one graft all destroyed due to the ignorance and incompetence of staffers that just plain do not care about damaging patients access, all in less than 4 years….I am very aware now, and only allow a certain few to actually insert the needles , or I DO IT MYSELF, to prevent damage and save it from the other techs that simply do not care.They want to rush rush rush, and go eat snacks or lunch, they are constantly texting and sending recieving messages and calls, while supposedly providing care for these patients, most of whom are older, easily intimidated and flat out scared to say anything. I have heard staff say to those who do speak out, ‘if you dont like it here, find another clinic, or we will for you’.It literally is a house of horrors-if you have ever seen a person go into arrest because too much fluid is being removed way too fast, you KNOW what I mean,I myself have literally passed out twice in the early days, and was spotted and saved by a Nurse, not a tech, the techs were all gathered talking about something and did not even notice, or respond to the blaring alarms from the machine as my blood pressure hit 65 over 40 !! Today during dialysis a new patient began to feel dizzy and sick, he began to vomit, the techs were nearby but none wanted to assist him while he was throwing up;seconds later he blacked out because his blood pressure just caved, alarms are going off everywhere, and he lost consciousness; fell out of his chair to the hard floor, his head made an awful sound as it hit and both needles were pulled right out of his arm causing blood to gush onto him the floor, until the tech treating/watching him got a pair of surgical gloves on and finally got to him and plugged the 2 holes up with her fingers. EMS is at this clinic at least 4 times a month sometimes even more often due to episodes like this as well as strokes and people suffering Congestive Heart failures while waiting for treatment. Then theres the issue of pain meds , some of the staff at times have taken the liquid pain killer applied by injection, for themselves to use; Lidocain – that is used to lessen the burn that is caused by the insertion of these very large dialysis needles, and replaced the Lidocain by injecting saline back into the bottle. I myself have also smelled liquor, tequilla to be specific and whiskey many times on the breath of 2 people, one of whom is a REGISTERED NURSE while on duty, and administering care and giving various medications to patients they are alcoholics! Working while drunk/drinking??? I can go on, but I must say right here, I am also only alive right now because of a small group of dedicated nurses and techs also employed at this clinic. I am grateful to them , and I have told them so many times, including the surgeons and doctors and their support teams that spent 13+ hours in the OR keeping me alive while they removed the enormous kidneys and literally saving my life.They have kept me alive , taken very good care of me, even taught me most of what they know, so that I can keep myself alive as well; they are “old school” caregivers who listen, care and are dedicated to help and to save people to sick or otherwise unable to care for themselves. I would have been dead a long time ago if it werent for these dedicated few.I have reported these problems and many more not mentioned here to Fresineous regional and national managers, anonymously of course, and sent copies to the JP in my county, written several blogs and even sent this and more info to National Kidney Foundation and even BBB , but to my knowledge nothing has ever been done; nothing has changed, it is still the same extremely risky roll of the dice each time you sit down for treatment.


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