History of Dialysis "Business" shows why advancement is stagnant

[kickingandscreaming]

Interesting article provides a lot of context.
Here's one of many "money" quotes:

With their ownership stakes in brick-and-mortar facilities and facing a stagnant Medicare reimbursement rate, nephrologists embraced cost-containment in unexpected ways.  A ‘one-size-fits-all’ mentality became the norm for dialysis care. Virtually no one foresaw that most nephrologists would utilize the cheapest, fast, and often iatrogenic dialysis treatment for nearly all their patients.  Kt/V (or urea kinetic modeling) was widely embraced as the gold standard of care, providing patients with minimal hemodialysis treatments based on two outcomes:  ‘not dead’ and ‘not in the hospital.’  Two hemodialysis treatment shifts were made to fit into one 8-hour staff shift.  Only a small percentage of clinics provided treatment times that began after 5 pm. 

Ownership stakes in brick-and-mortar dialysis facilities by nephrologists also effectively killed the development of breakthrough technologies for dialysis.   Advances in dialysis care had to fit within the brick-and-mortar facility model, both physically and financially. While smaller, portable, wearable, and easy-to-operate dialysis devices would have greatly benefitted working-age patients, these technology breakthroughs would have been financially devastating for nephrologist owners and the dialysis corporations. Stagnant technology sustained the wealth generation pathway for nephrologists for decades.  Promising technology, such as the small, portable REDY machine that utilized sorbent technology developed by NASA, disappeared from the U.S. market.    Hemodiafiltration, an advanced renal replacement therapy that appears to offer many advantages over standard dialysis treatments, is widely utilized in Europe and Japan.  It is virtually unknown in the U.S.   Few would foresee that many nephrologists would not refer patients for home training or for transplantation in order to keep chairs filled in their dialysis facilities.

There's lots more at: http://www.renalweb.com/writings/StagnantDialysis.htm

[Athena]

An extremely valuable article K&S and something every patient should read and try to fully comprehend.

The constant question on my mind is why aren't any good lawyers & journalists in the medical field looking at this? Sounds like it's a very lucrative sordid little industry that needs to be exposed at last.

[Simon Dog]

Medicare supports the mediocrity.  The standards state that all patients should receive "adequate" dialysis; not the "best possible" dialysis.

It's hard to prove that the cost cutting in the business (specifically the 3x/week in center protocol) is substandard or actionable when it is explicitly established by the feds as an acceptable treatment level.

Fortunately, the system does not seem to be too fussy about how many home treatments patients do.

[kickingandscreaming]

Don't you just love the standards that they set for success?  "Not dead" and "Not hospitalized."  Wow!  Such aspirations!

The field will never advance as long as there is this conflict of interest at the heart of it.  There is no incentive for advancing things as that might kill the golden goose.  Or the cash cows that we patients unwittingly are.  It's quite a racket.

I'm deeply conflicted.  On the one hand, I'm grateful that there is a system in place that allows me to prolong my life (if I choose to) and that I don't have to cough up the huge sums of money involved.  On the other hand I see how rife with corruption it is.  Of course, our entire western medical model is totally money-driven these days.  Not just nephrology.

[Simon Dog]

Its a mixed bag.  Some countries have better systems (I've read that a neph is always on duty in Italian dialysis clinics), however, the US is pretty good at making sure everyone who need it gets some (note I said some, not optimal) dialysis.   In some other countries, it's cash up front or no hose (this is, however, true for transplants in the US).

[Athena]

If everyone in our society were asked whether they would accept having the bare essential minimum of medical treatment that will just keep them alive but not working (which most dialysis patients are unable to do as stated in this article), then the answer would be a strong NO.

As a non-dialysis CKD patient, I already have logged my answer into the system for all to see.

Having the very best of available medical treatment is a given in just about every other disease category known to man. Kidney patients are no different in wanting the very best treatment that is possible.

[Michael Murphy]

One of the reasons for the slow development of better treatment options is that the keystone development requirements have not occurred until recently.  Enhanced filteres have made implantable artificial kidneys possible.  New methods of collagen frame work makes cloning a viable option.  New nanotube methodology means even better filters.  We are on the cusp of major changes. 

[Athena]

One of the reasons for the slow development of better treatment options is that the keystone development requirements have not occurred until recently.  Enhanced filteres have made implantable artificial kidneys possible.  New methods of collagen frame work makes cloning a viable option.  New nanotube methodology means even better filters.  We are on the cusp of major changes.

I hope so Michael - we need a new breakthrough in kidney disease treatment in particular! For too long, renal medicine has lagged behind all the other medical disciplines. They all work together synergistically - but until some brilliant minds put their new knowledge to some renal good use, we'll only keep hearing about how they beating the odds against certain types of cancers, how spinal cord injury patients are regaining feeling in their legs, how HIV is about to be cured, etc.

[plugger]

I like my doctors to be doctors and my bean-counters to be bean-counters.  Now with this clear violation of the Stark Law we have doctor/bean-counters who have an interest in continuing assembly-line medicine - get them in and out as fast as you can, use the cheapest labor, and keep high patient/staff ratios.  However the dialysis companies managed to get an exemption from this truly great law.