Davita is bad!!!

[bluedove57]

I'm in North Carolina visiting my daughter and am using one of Davita's clinics. It is yukkkk!!!  The chairs are all busted and taped together. The nurses are nice but couldn't care less about the patients. They wanted to give me Epo when my clinic specificly told them I didn't need it. They were told I can ride at 85 with my blood pressure and I fiind out I'm not feeling good because I'm riding at 75. The nurse said he was aware of my pressure but watching it. That could so easily clot my access. I asked for some saline to bring my pressure up so only then they gave me some. A half hour before my treatment was over I told them I had a slight cramp in my back if they could give me 100cc saline but instead they took me off. They didn't want me to have a bad weekend. I have 4 treatments left and get worried they will kill me or just pretend I'm not there. I didn't reach my clearance because they took me off early. I think they wanted to get out of there so the hell with me. I may be a guest visiting but I still have a condition that has to be monitored.  for Davita. I feel for anyone that has to use Davita as their clinic all the time.

[goofynina]

Epoman would have a field day with this one, lol,  What is scary is that you just described the unit that i used to go to when i was on hemo, yes it is Davita too.   

[Zach]

Ask for copies for each of your treatment runs.  They even may be computerized, so no funny business, like changing numbers.   

[bluedove57]

Tomorrow I go back to Davita for another treatment. Makes me a little nervous being I just had a weekend. I have to watch everything they do. Am I the only one that seems to think they are a weird bunch of techs and nurses? Are all Davita clinics so careless?

[joseph_towey]

I dialyize at a Davita clinic in Birmingham, AL and can't complain. Of course, I've only been on hemodialysis for two months now but the staff is friendly and has been extremely accomodating during this time. I have noticed, however, that the clinic is a bit understaffed and therefore I have had to do a good bit of waiting around for a chair...and I guess there tv's could use some work as well.

[bolta72]

I have been going to Davita on Cape Cod Mass for 9 months now and have no problem. The nurses are great and the techs are very good. The unit could use some new chairs and Tv's. I think it depends on which unit you go to.

[Jaybird]

It all depends on the unit. My unit in Atlanta looked like a warehouse with chairs in it when I first started going. Since then its had a complete renovation. But I don't go anymore because I am a home patient now.

-Jaybird

[kitkatz]

It all depends on the unit. My unit in Atlanta looked like a warehouse with chairs in it when I first started going. Since then its had a complete renovation. But I don't go anymore because I am a home patient now.

-Jaybird

Funny thing. I read that line whore house, not warehouse, and did a double take!

[goofynina]

It all depends on the unit. My unit in Atlanta looked like a warehouse with chairs in it when I first started going. Since then its had a complete renovation. But I don't go anymore because I am a home patient now.

-Jaybird

Funny thing. I read that line whore house, not warehouse, and did a double take!

Yep, Vegas will do that to you girlfriend  

[mdorn]

I hope you made it through your visit OK. I dialize at a Davita clinic in Durham, NC. Mine is very clean with working chairs and TV's. The techs care about you (out of 3 Doctors that take turns, only 1 gives you the impression that he cares) and the Nurses are excellent.

Marv

[gr8fulrn]

Im glad everyone thinks the nurses and staff are good. But I also want to tell you that the companies no matter who they are are not being cheap. The average patient has either medicare or medicaid. The average reimbursement is anywhere from $120-140 per tx from these government agencies. So to start you need a dialyzer which is depending on the contract rate approx. $20. Then the blood tubing approx $10. Then the labor of your nurses, techs, sec., machine maintenance guys, dietitians and SW. anywhere from $60-70 per tx. Then that doesn't include the supply cost of about $15/tx. thats the gauze, bandage, tape, syringes, lidocaine, heparin, Tylenol, b/p meds etc.... Then there is the cost of medical directors, building maintenance, utilities and lease. So if you think about it the gov. doesn't even pay for a treatment the dialysis companies eat the cost. Thats why they hire managers to keep these costs down. It is a very stressful job for a manager. And if they didn't keep the cost down to try and profit a few cents per tx then there wouldn't be companies here to dialyze the pts. they would be forced out of business.

[Rerun]

Im glad everyone thinks the nurses and staff are good. But I also want to tell you that the companies no matter who they are are not being cheap. The average patient has either medicare or medicaid. The average reimbursement is anywhere from $120-140 per tx from these government agencies. So to start you need a dialyzer which is depending on the contract rate approx. $20. Then the blood tubing approx $10. Then the labor of your nurses, techs, sec., machine maintenance guys, dietitians and SW. anywhere from $60-70 per tx. Then that doesn't include the supply cost of about $15/tx. thats the gauze, bandage, tape, syringes, lidocaine, heparin, Tylenol, b/p meds etc.... Then there is the cost of medical directors, building maintenance, utilities and lease. So if you think about it the gov. doesn't even pay for a treatment the dialysis companies eat the cost. Thats why they hire managers to keep these costs down. It is a very stressful job for a manager. And if they didn't keep the cost down to try and profit a few cents per tx then there wouldn't be companies here to dialyze the pts. they would be forced out of business.

WTF??     What country are you in??  DaVita or "Total Renal Care" as the statement says charges me $3,000 a time.  That includes EPO and Zemplar.  Do the math.....$36,000 a month.  M O N T H!   That is what they charge.  My insurance pays $5,000/mo and I don't know what Medicare pays.  We are ALL on medicare.  If you are a dialysis patient and have been for more than 3 months you ARE on medicare.  Don't tell me they are scraping by.  AND if I'm the only one paying the bills then why can't I have the SHIFT I want and the CHAIR I want??

[okarol]

Davita in the business news:

DaVita 1st-qtr profit rises 33 pct

Mon Apr 30, 3:49 AM ET

NEW YORK (Reuters) - DaVita Inc. (NYSE:DVA - news), the biggest provider of dialysis in the United States, said on Monday its first-quarter profit rose 33.2 percent, helped by an increase in the number of treatments at its facilities.

First-quarter profit increased to $76.6 million, or 72 cents per share from $57.5 million, or 55 cents per share, a year earlier.

Wall Street analysts had on average forecast 72 cents per share, according to Reuters Estimates.

Looking ahead, the company said it expects operating income in 2007 to be between $740 million and $780 million, compared with its earlier forecast of $700 million to $760 million.

Net operating revenue increased about 10 percent to $1.28 billion in the first quarter.

Total treatments for the quarter were 3.7 million, compared with 3.5 million in the year-ago quarter. Non-acquired treatment growth in the quarter was 4 percent.

Operating cash flow for the year is expected to be in the range of $460 million to $510 million.

----------------

My Comment: It appears they are profitting more than just a few cents...

[Mongo]

WTF?? What country are you in?? DaVita or "Total Renal Care" as the statement says charges me $3,000 a time. That includes EPO and Zemplar. Do the math.....$36,000 a month. M O N T H! That is what they charge. My insurance pays $5,000/mo and I don't know what Medicare pays. We are ALL on medicare. If you are a dialysis patient and have been for more than 3 months you ARE on medicare. Don't tell me they are scraping by. AND if I'm the only one paying the bills then why can't I have the SHIFT I want and the CHAIR I want??

There is a huge difference between what is CHARGED and what DaVita is PAID. It sounds like you are Medicare primary with a supplement or secondary insurance.

The COB (coordination of benefit) period for patients that have commercial insurance is 30 months. During those 30 months, the commercial insurance is primary and the medicare is secondary. Beginning the 31st month, Medicare becomes primary and the commercial insurance secondary.

The truth is, for every MEDICARE PRIMARY patient that DaVita treats, they lose $15-20 per treatment. It is through efficient management and patients with commercial insurance that DaVita remains in the black.

Mongo

[Mongo]

Davita in the business news:

DaVita 1st-qtr profit rises 33 pct

Mon Apr 30, 3:49 AM ET

NEW YORK (Reuters) - DaVita Inc. (NYSE:DVA - news), the biggest provider of dialysis in the United States, said on Monday its first-quarter profit rose 33.2 percent, helped by an increase in the number of treatments at its facilities.

First-quarter profit increased to $76.6 million, or 72 cents per share from $57.5 million, or 55 cents per share, a year earlier.

Wall Street analysts had on average forecast 72 cents per share, according to Reuters Estimates.

Looking ahead, the company said it expects operating income in 2007 to be between $740 million and $780 million, compared with its earlier forecast of $700 million to $760 million.

Net operating revenue increased about 10 percent to $1.28 billion in the first quarter.

Total treatments for the quarter were 3.7 million, compared with 3.5 million in the year-ago quarter. Non-acquired treatment growth in the quarter was 4 percent.

Operating cash flow for the year is expected to be in the range of $460 million to $510 million.

----------------

My Comment: It appears they are profitting more than just a few cents...

The key here is "per share".

DaVita is a for-profit, publicly traded company. There is board of directors that is elected by stockholders and they are responsible for keeping the stockholders happy. For profit healthcare companies have a difficult task...providing excellent care for their patients while keeping their stockholders pleased with their investment.

I have yet to see a company balance clinical outcomes and business better than DaVita.

Mongo

[gr8fulrn]

I agree davita does a good job. I feel sorry for people that are in a bad clinic. That is not Davita. That is a poor manager and a poor ROD that is afraid to improve their clinic because they dont want to go out of their "budget". I feel its better to keep a nice clinic and happy patients I care about my patients and if I didnt I wouldnt be here.  I just also know how business is run and thats out of my control... So why dog it. Im thankful for being there for my patients and giving them the quality of life they deserve. I dont care who pays the bill or if they profit.  I just care that I can see all my patients everyday and know I do the best I can for them. I take it personally if a patient expires, I mourn for their families and always reflect back if I did everything I could to enhance their lifes. My patients become my family and dont even think about money when it comes to them. All my discussions with dialysis pts has been about life and quality of it. I have never had a pt tell me there were unhappy that Davita is making a profit. Who gives a care... Im just thankful for everyday I can help someone be a more productive human being. Maybe if you were paying out of pocket for your treatments you could feel angry. But since the fed gov. is footing the bill . what is the big deal??? what would happen to you if the gov decided to cut dialysis?? I dont even want to think about that. I know alot of countries that would let people die. If anyone ever knew what it was like to be a pt. in another country believe me you would be very thankful to be an american. Do you ever wonder why we have so many illegals on diaysis? Its because their country dont give a care. They want to live just like we all do. They are not complaining.

[glitter]

Maybe if you were paying out of pocket for your treatments you could feel angry. But since the fed gov. is footing the bill . what is the big deal??? what would happen to you if the gov decided to cut dialysis?? I don't even want to think about that. I know a lot of countries that would let people die. If anyone ever knew what it was like to be a pt. in another country believe me you would be very thankful to be an American. Do you ever wonder why we have so many illegals on dialysis? Its because their country don't give a care. They want to live just like we all do. They are not complaining.

Until you walk in the footsteps of a patient- you will never really understand their point of view...just because they get better care then a third world country does not make it okay for the crap they do put up with. What about the countries like the UK or Australia or Ireland or Germany where the care is not only as good as a America, but some will say better?  The Federal Government does not foot the entire bill either- we still pay for private insurance. and we pay for Medicare. and we pay deductibles. and co-payments. Saying we should be grateful our dialysis patient are treated better here then in Mexico is absurd.

[BigSky]

There is a huge difference between what is CHARGED and what DaVita is PAID. It sounds like you are Medicare primary with a supplement or secondary insurance.

The COB (coordination of benefit) period for patients that have commercial insurance is 30 months. During those 30 months, the commercial insurance is primary and the medicare is secondary. Beginning the 31st month, Medicare becomes primary and the commercial insurance secondary.

The truth is, for every MEDICARE PRIMARY patient that DaVita treats, they lose $15-20 per treatment. It is through efficient management and patients with commercial insurance that DaVita remains in the black.

Mongo

While I have never dealt with Davita I do have my reservations about them, especially since they have been trying to undercut the nursing laws in this state for years.

They lose $15-$20 per treatment?  BS!!    Far too much companies like this come up with some overinflated price as to what they charge for services and then try to pass this bs over about losing money on treatments.

$76.6 MILLION PROFIT in one quarter.  If that pace is kept up, that is over $300 million in PROFITS in one year, not gross income but PURE PROFIT!  Losing money my a**

Efficient management?  That may be, but no company, and I mean no company is that efficient they can claim they are losing money on their mainstay business while ranking in millions in PROFITS, not sales, but PROFITS!  It is IMPOSSIBLE to lose money on patient treatment yet rank in millions of dollars in profits off that same treatment of those same patients.

But by all means, Davita wants to make such claims, open their books.  Lets see just what they are paying on an individual basis for all supplies, workers, equipment etc. etc.  Then lets see just what they are fudging on and including in that amount, such as overpaid CEO's etc, etc,.  We all know its not the people who are actually doing the work that are making the money since Davita is famous for pushing to have nursing laws changed so that lower paid techs can do the job.

[Bill Peckham]

Maybe if you were paying out of pocket for your treatments you could feel angry. But since the fed gov. is footing the bill . what is the big deal??? what would happen to you if the gov decided to cut dialysis?? I don't even want to think about that. I know a lot of countries that would let people die. If anyone ever knew what it was like to be a pt. in another country believe me you would be very thankful to be an American. Do you ever wonder why we have so many illegals on dialysis? Its because their country don't give a care. They want to live just like we all do. They are not complaining.

Until you walk in the footsteps of a patient- you will never really understand their point of view...just because they get better care then a third world country does not make it okay for the crap they do put up with. What about the countries like the UK or Australia or Ireland or Germany where the care is not only as good as a America, but some will say better?  The Federal Government does not foot the entire bill either- we still pay for private insurance. and we pay for Medicare. and we pay deductibles. and co-payments. Saying we should be grateful our dialysis patient are treated better here then in Mexico is absurd.

I'll say better. Apples to apples the US mortality rate is 20% higher than it would be if it met European standards of care.

[Bill Peckham]

Davita in the business news:

DaVita 1st-qtr profit rises 33 pct

Mon Apr 30, 3:49 AM ET

NEW YORK (Reuters) - DaVita Inc. (NYSE:DVA - news), the biggest provider of dialysis in the United States, said on Monday its first-quarter profit rose 33.2 percent, helped by an increase in the number of treatments at its facilities.

First-quarter profit increased to $76.6 million, or 72 cents per share from $57.5 million, or 55 cents per share, a year earlier.

Wall Street analysts had on average forecast 72 cents per share, according to Reuters Estimates.

Looking ahead, the company said it expects operating income in 2007 to be between $740 million and $780 million, compared with its earlier forecast of $700 million to $760 million.

Net operating revenue increased about 10 percent to $1.28 billion in the first quarter.

Total treatments for the quarter were 3.7 million, compared with 3.5 million in the year-ago quarter. Non-acquired treatment growth in the quarter was 4 percent.

Operating cash flow for the year is expected to be in the range of $460 million to $510 million.

----------------

My Comment: It appears they are profitting more than just a few cents...

The key here is "per share".

DaVita is a for-profit, publicly traded company. There is board of directors that is elected by stockholders and they are responsible for keeping the stockholders happy. For profit healthcare companies have a difficult task...providing excellent care for their patients while keeping their stockholders pleased with their investment.

I have yet to see a company balance clinical outcomes and business better than DaVita.

Mongo

How many companies have you looked at?

If you just believe Davita's own PR you might think so but their PR is wrong, some would say an outright lie. http://biz.yahoo.com/prnews/070514/sfm026.html is a recent example.

They're touting their internal 2006 data as compared with CMS publicaly available 2004 data. If you look at just the publicaly available 2004 data from CMS/USRDS you see Davita is trailing the industry - 38% to 40%.

By the way - the Northwest Kidney Centers? 68% fistula rate.

[Hawkeye]

Ok here is how I see it.  The for profit companies like DaVita and Fresenius are reporting losses, but the losses only exist in what they think they should be making per treatment. I know that for example Fresenius has a $20.10 budget for each treatment for dialysis supplies.  This is gauze, tape, bandaids....everything except medications with the exception of Heparin and Sterile Water.  I don't know of any clinic that achieves this target unless they are A. Getting suplies from an outside vendor and not putting it on there reports, B.  Have a very small patient population where it is easy to control supplies and their use.  On average most clinics lose around $1.00 per treatment.  Then there is understaffing, so instead of paying regular time to several staffers they are paying overtime to a few staffers.  So there is indeed a loss seen on the clinical level.  Where they make up the lost profits is in the medications.  Epogen is a great example of this.  Each vial of Epogen is required to hold X amount of fluid.  To insure that the vial contains at least that much through out the packaging process the vials always have overfill or extra Epogen in them.  You don't pay for that overfill only the labeled amount.  You just combine up that overfill and save tons of money.  I'm sure it was most likely Okarol who posted an article that explains this and gives the exact dollar amount of profit from this practice.  It also shows the loss that would occur if there was no overfill.  The bottom line is yes the companies do have loss, but they make it up other ways to gain a profit.

[Black]

I'll say better. Apples to apples the US mortality rate is 20% higher than it would be if it met European standards of care.

What are the European standards for deciding who gets dialysis and who doesn't?

[Bill Peckham]

I'll say better. Apples to apples the US mortality rate is 20% higher than it would be if it met European standards of care.

What are the European standards for deciding who gets dialysis and who doesn't?

They're about the same. Remember for the purpose of mortality comparisons the US does not include those who pass in the first three months so if you're thinking of palitive dialysis care then it is not a factor.

What you would look at is the The Dialysis Outcomes and Practice Patterns Study (DOPPS). Here is a starting point http://www.nature.com/ki/journal/v57/n74s/full/4491626a.html

"First, although the overall mortality rate is exceedingly high among dialysis patients, outcomes vary substantially across facilities and countries 1,2,3,4. For example, a fivefold variation in crude mortality was reported across facilities in the United States and adjusted mortality indicators show comparable variability 1,2. Also, the reported 5-year mortality rates for end-stage renal disease (ESRD) patients in Europe and Japan are 20–35% lower than those reported for patients in the United States, even with adjustment for age, sex, and diabetic status 3. The observed variation in mortality across centers and countries raises the strong possibility that differing treatment practices may contribute to the variation in outcomes. Second, dialysis outcomes can be modified by changes in dialysis practice. For example, several studies have shown that improved patient survival is associated with higher dialysis doses and use of different types of dialysis membranes 4,5,6. Finally, observational studies have proven to be an efficient means for discovering associations between treatment patterns and outcomes 4,5,7,8,9. Findings from large, well-designed, nationally representative observational studies have prompted changes in the national practice of dialysis and provided the impetus for important clinical trials 10,11."

References

   1. McClellan, WM, Flanders, WD, Gutman, RA: Variable mortality rates among dialysis treatment centers. Ann Intern Med 1992 117:332–336,
   2. Hulbert-Shearon, TE, Loos, E, Ashby, VB, Port, FK, Wolfe, RA: USRDS 1999 Unit-Specific Reports for Dialysis Patients: A Summary. 1999 University of Michigan, Ann Arbor,
   3. Held, PJ, Brunner, F, Odaka, M, Garcia, JR, Port, FK, Gaylin, DS: Five-year survival for end-stage renal disease patients in the United States, Europe, and Japan, 1982–87. Am J Kidney Dis 1990 15:451–457,
   4. Owen, WF, Lew, NL, Liu, Y, Lowrie, EG, Lazarus, JM: The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med 1993 329:1001–1006,
   5. Held, PJ, Port, FK, Wolfe, RA, Stannard, DC, Carroll, CE, Daugiridas, JT, Greer, JW, Hakim, RM: The dose of hemodialysis and patient mortality. Kidney Int 1996 50:550–556,
   6. Hakim, RM, Held, PJ, Stannard, DC, Wolfe, RA, Port, FK, Daugirdas, JT, Agodoa, L: Effect of the dialysis membrane on mortality of chronic hemodialysis patients. Kidney Int 1996 50:566–570,
   7. Churchill, DN, Taylor, DW, Cook, RJ, Laplante, P, Barre, P, Cartier, P, Fay, WP, Goldstein, MB, Jindal, K, Mandin, H, McKenzie, JK, Muirhead, N, Parfrey, PS, Posen, GA, Slaughter, D, Ulan, RA, Werb, R: Canadian hemodialysis morbidity study. Am J Kidney Dis 1992 19:214–234,
   8. Greenfield, S, Sullivan, L, Sillman, RA, Dukes, K, Kaplan, SH: Principles and practice of case mix adjustment: applications to end-stage renal disease. Am J Kidney Dis 1994 24:298–307,
   9. Held, PJ, Wolfe, RA, Gaylin, DS, Port, FK, Levin, NW, Turenne, MN: Analysis of the association of dialyzer reuse practices and patient outcomes. Am J Kidney Dis 1994 23:692–708,
  10. National Kidney Foundation: Dialysis Outcomes Quality Initiative Clinical Practice Guidelines. Am J Kidney Dis 1997 30(Suppl):S1–S240# ,
  11. Eknoyan, G, Levey, AS, Beck, GJ, Agadoa, LY, Daugirdas, JT, Kusek, JW, Levin, NW, Schulman, G: The Hemodialysis (HEMO) Study: Rationale for selection of interventions. Semin Dial 1996 9:24–33,

[gr8fulrn]

In Japan CAPD is you only option. If you fail at that then you have to do hemo. And thats only if there is a machine. Same in Europe. Its not like here where every corner is  a clinic.Thats why they have less mortality rates. The pts dont have a choice like they do in the USA.  NOT ALL pts can do CAPD or home hemo but I bet 50% could but wont. So whats up with that??? Americans dont want responsibility for their own care. If that was the case they would do it.  Then they wouldnt have nothing to complain about.... I personally would do CAPD to preserve my residual renal function as long as I could and to have a more normal way of life and to continue to work and be productive.  I think the US is lacking in education for our patients. I do a real good job in educating and trying to get people to do self care, but I hear every excuse in the book why they cant. I think the US needs to start everyone out one CAPD unless of course they are elderly and alone, or in a SNF.  My CAPD pts are happy, travel, work, and feel normal. Sometimes I think its easier to blame then take responsibility.  Cant blame dialysis companies for poor pt outcomes like potassium, albumin, phosporus and KT/V. Those on the pts non compliance with diet and signing off and refusing to get a fistula.

[Rerun]

In Japan CAPD is you only option. If you fail at that then you have to do hemo. And thats only if there is a machine. Same in Europe. Its not like here where every corner is  a clinic.Thats why they have less mortality rates. The pts dont have a choice like they do in the USA.  NOT ALL pts can do CAPD or home hemo but I bet 50% could but wont. So whats up with that??? Americans dont want responsibility for their own care. If that was the case they would do it.  Then they wouldnt have nothing to complain about.... I personally would do CAPD to preserve my residual renal function as long as I could and to have a more normal way of life and to continue to work and be productive.  I think the US is lacking in education for our patients. I do a real good job in educating and trying to get people to do self care, but I hear every excuse in the book why they cant. I think the US needs to start everyone out one CAPD unless of course they are elderly and alone, or in a SNF.  My CAPD pts are happy, travel, work, and feel normal. Sometimes I think its easier to blame then take responsibility.  Cant blame dialysis companies for poor pt outcomes like potassium, albumin, phosporus and KT/V. Those on the pts non compliance with diet and signing off and refusing to get a fistula.

Hmmmm I'd like to argue with you but I think you are right.  I don't want to do Home Hemo because I don't want the responsibility and the mess.  You have to do your own machine maintenance etc...  I would do CAPD but I have too much scar tissue.  And I am alone so I go in center and complain at their incompetence.  But yeah you nailed it.