Dialysis CEO interviews

[Bill Peckham]

http://www.billpeckham.com/from_the_sharp_end_of_the/2008/04/davita-ceo-kent.html

It's interesting to compare this video interview with the CEO of one of the two large for profit dialysis providers (LDO), with the interview in Renal Business Today with the CEO of a small community based nonprofit dialysis provider (SDO).

Thiry (LDO CEO) identifies his job as "creating a successful, sustainable business in order to create a special environment for people to work in; to build a special place to enrich people's lives". Jackson's (SDO CEO) mission is to "improve the kidney health of NKC's community." I'm sure they both try to be good places to work.

[Deanne]

Interesting. It says a lot about where they put their prirorities! As a patient, I know which place I'd rather be. Of course I want the workers to have a good environment, but the LDO CEO sounds like he's forgotten their business is for the patients.

[stauffenberg]

As soon as private enterprise enters the field of providing healthcare, right away 15% of what Medicare pays these providers is lost to service the profits of the people who invest in those companies, so the service to the patients has to suffer.  There was a survey in 1996 to find out why death rates among dialysis patients in the US were so much higher than in the rest of the developed world, where dialysis is always provided by the government healthcare service rather than by for-profit health providers.  The survey showed that the small group of non-private dialysis centers in the US had the same patient death rate of the countries with socialist medicine, and that the problem was caused by the higher death rate at the for-profit centers.

In Japan 9% of dialysis patients die per year; in Canada 13%; but in the US the figure is 24%.  Private enterprise demands a lot of deaths to keep its stockholders rich.

[Bill Peckham]

The profits at the LDOs are almost entirely from private payers - there is a very small margin on Medicare primary dialyzors when you consider all the revenue streams - treatment/medications/labs (should all LDO products be included - disease management, vascular access, etc.?). If you want to you could say that private payer revenue is about 90% profit (depends on charges - see National Renal Alliance lawsuit http://www.billpeckham.com/from_the_sharp_end_of_the/2008/01/law-suit-reveal.html could be as high as 96% profit).

I'm hearing that the DOPPS data shows that the majority of the mortality difference can be seen as flowing from fistula use.

[stauffenberg]

I have been dialyzed in the US, Britain, and Canada, and have done statistical work as a student at a dialysis unit in Germany, and I have never noticed any difference at all in the rate of fistula use in these various countries.  I would be interested if you have any more data on this.

[Bill Peckham]

I have been dialyzed in the US, Britain, and Canada, and have done statistical work as a student at a dialysis unit in Germany, and I have never noticed any difference at all in the rate of fistula use in these various countries.  I would be interested if you have any more data on this.

I was on a panel earlier this month that reacted to a presentation at the NKF Spring meeting, by Lawrence Spergel, MD, Clinical Chair, Fistula First Initiative who was presenting data to refute the idea that Fistula First increased the use of Catheters - which we believe we've seen here in Seattle - but Spergel had compelling data to show that this wasn't the case. Part of his data set was the rates across the DOPPS countries including how long after placement a fistula is first cannulated - I'm looking to see if that data is published yet - you need a registration code to access the presentation from the Spring meeting website but until I find the more recent data here is data from 2005 that shows the same numbers but with less detail (It's a PDF link)
http://www.kidney.org/professionals/KLS/pdf/BestPracticeMar05.pdf

Notice in particular graph 2A and 2B