Dialysis care battle is getting heated

Dialysis care battle is getting heated
BRIAN NEWSOME
2009-10-18 17:02:46

Dialysis giant DaVita Inc. has raised the stakes in a bad-blooded competition over chronically ill kidney patients, luring a prominent out-of-town doctor to start a practice in Colorado Springs and oversee one of its centers.

Comings and goings in the medical specialties are not unusual for a major city, but the business of kidney care has been especially competitive in Colorado Springs in the past year with allegations of dirty business practices and lawsuits to air them.

Into the fray comes Dr. Robert Provenzano, DaVita’s vice president of medical affairs and past president of the Renal Physicians Association. He was hired last week as medical director of DaVita Pikes Peak Dialysis Center, and he recently started a practice in northeast Colorado Springs. He received his Colorado license from the Medical Board of Examiners on Sept. 22, and he’s applied for privileges to treat patients at Penrose-St. Francis Health Services and Memorial Health System.

Provenzano, who has spent his life in Detroit, said he decided to come to Colorado Springs because there’s a need for more doctors to treat chronic kidney disease here, and he was ready for a change in his life. He said he has not come here to compete with Pikes Peak Nephrology Associates, the region’s largest nephrology practice that had a falling out with DaVita.

“I don’t view any conflict or competition at all,” he said. “It’s a win-win for everybody.”

Those doctors are skeptical. Dr. Stephen Fox, at PPNA, says there are plenty of doctors to meet the demand. “We are very concerned that these doctors, and DaVita don’t have the best interest of our community at heart.”

For years, DaVita provided almost all of the region’s dialysis services while PPNA treated almost all of the region’s patients. Doctors at PPNA also served as DaVita’s medical directors.

That relationship soured when Liberty, a competitor, designed to open centers in Colorado Springs. The doctors welcomed having two choices, and DaVita responded by serving them arbitration papers alleging improper business practices.

The doctors countersued DaVita, accusing it of abusing the legal system for business purposes.

Liberty has since lured patients and employees from DaVita. The latest blow came last month, when DaVita lost a contract with Memorial Health System to provide inpatient dialysis services to Liberty. DaVita made $891,000 from that contract in 2009, according to Memorial.

DaVita continues to hold its inpatient contract with Penrose-St. Francis Health Services.

Provenzano is an accomplished doctor for DaVita to have in its corner. In addition to leaving behind patients, he vacated posts at St. John Hospital and Medical Center as chief of nephrology, hypertension & transplantation, director of nephrology research and director of acute dialysis services. He has also held teaching post at Wayne State University Medical School.

Provenzano plans to bring additional Detroit doctors to help with his practice, Colorado Springs Nephrology Associates, next to St. Francis Medical Center. He said his son, Dr. Chris Provenzano, and partner Dr. Keith Bellovich will join him full time. Two other Michigan doctors, Quresh Khairullah and Jukaku S.M. Tayeb, will split their time between Detroit and Colorado Springs, Provenzano said.

None of his four partners have obtained medical licenses in Colorado.

The patients at the center of it all are people whose kidneys no longer function properly. Dialysis is artificially filtering the blood. Although there are some forms of dialysis that can be done at home, most people go to centers three times a week for the treatment.

Federal law prohibits physicians and dialysis centers from exclusive relationships or payment arrangements for patient referrals, but a physician is unlikely to be a director of a center he or she doesn’t have a good opinion of.
PPNA says the addition of three full-time nephrologists is too many for Colorado Springs, but Provenzano says the market here is “immature” and that there are populations here at high-risk of chronic kidney disease in coming years.

There’s no magic number, said Edward Golub, senior director of marketing for Merritt Hawkins & Associates, a physician recruiting firm. The closest number is a ratio study done in 1980 that found a need for one nephrologist for every 100,000 people, he said, which would mean about six for El Paso County. There would be twice that many here with Provenzano’s new practice.

But community needs vary widely. A retirement community, for example, would need far more geriatricians than a same-sized community of mostly young families.

Numbers notwithstanding, Provenzano believes he’ll bring a valuable service to Colorado Springs. He built his Detroit practice around the concept of seeing fewer patients to give them more time. Several patients have the physicians’ cell phone numbers, he said. Donna Reesman is director of clinical services for Provenzano’s Detroit practice, St. Clair Specialty Physicians, which he will continue to oversee as an administrator. She’s known him for 20 years and said he has a reputation as a “forward thinker.”

http://www.gazette.com/articles/davita-64006-colorado-kidney.html