Death Rates Higher at For-Profit Dialysis Centers: Study

[Hellllllo Nurse, BSN, RN]

Death Rates Higher at For-Profit Dialysis Centers: Study

Research suggests non-profit centers could save 2,500 lives a year

By Adam Marcus

HealthScoutNews Reporter

TUESDAY, Nov. 19 (HealthScoutNews) -- If you need kidney dialysis, you might want to choose where you go for the blood-cleaning treatment very carefully.

A new study has found that Americans who have dialysis done at private, for-profit centers face an 8 percent higher risk of death than those who seek the treatment at private, non-profit clinics.

The research also suggests that 2,500 deaths a year, and possibly many more, could be prevented by switching kidney patients to the non-profit dialysis centers. For-profit dialysis units typically have smaller staffs with less well-trained nurses and technicians than their non-profit alternatives. Patients also generally attend for-profit clinics for shorter periods, which has been associated with higher mortality rates.

The argument for profiteering dialysis facilities is that market competition will lead to cost savings without sacrificing patient safety. However, Dr. P.J. Devereaux, a Canadian cardiologist and co-author of the new study, says that's not happening.

"What our research keeps showing is that, instead of creating efficiencies, people are cutting the quality of care," he says.

Devereaux and his colleagues report their findings in tomorrow's Journal of the American Medical Association .

Medicare had nearly 286,000 dialysis patients in 2001, up from 142,000 a decade ago, according to the Centers for Medicare and Medicaid Services. Of those, 258,000 received treatment at outpatient clinics and about 28,000 had the procedure done at home.

The government insurance program had approved more than 67,000 dialysis facilities as of last year, of which roughly 75 percent were for-profit.

Devereaux and his colleagues, including doctors in the United States, reviewed eight earlier studies of freestanding dialysis centers, using data collected from 1973 though 1997. Each study covered an average of more than 1,300 clinics, and six of the eight found a statistically meaningful increase in death rates at for-profit centers.

One study seemed to give an advantage to for-profit clinics. However, it was drowned out by the others, leaving an average death rate 8 percent higher than in the non-profit centers.

That figure may underestimate the true effect, Devereaux adds, because the most rigorous study -- with the best adjustments for age, sex and severity of illness leading to kidney failure -- had the biggest gap, of 18 percent.

Devereaux says the results should be a signal to Canadian policy makers, who are now debating the feasibility of profit-driven dialysis centers in that country.

Michael Paget, executive director of the National Renal Administrators Association, a trade group representing about 700 dialysis center managers, would not comment on the latest findings.

However, Paget says, "I don't see how [profit motive] makes any difference for how they operate."

The Centers for Medicare and Medicaid Services, a division of the Department of Health and Human Services, did not have anyone immediately available to comment on the study.

What To Do

To learn more about kidney dialysis, try the National Kidney Foundation or the National Institutes of Health .

SOURCES: P.J. Devereaux, M.D. clinical scholar, McMaster University, Ontario, Canada; Michael Paget, executive director, National Renal Administrators Association, Prescott, Ariz.; Centers for Medicare and Medicaid Services; Nov. 20, 2002, Journal of the American Medical Association

Copyright © 2002 ScoutNews, LLC. All rights reserved.

http://www.hon.ch/News/HSN/510352.html

[jnette, ASN, EMT-I]

I can certainly understand this... not rocket science when it comes to the $$, right?

Thanx, Hellllo. :)

[elkpark]

The argument for profiteering dialysis facilities is that market competition will lead to cost savings without sacrificing patient safety. However, Dr. P.J. Devereaux, a Canadian cardiologist and co-author of the new study, says that's not happening.

I'm sure that, if/when the studies are done, the same results will be found in other types of for-profit healthcare operations ... The primary objective in for-profit facilities, by law, is to generate as large a profit as possible for the shareholders, not to make sure that you and I get the healthcare services we need or that the services they provide are the highest quality possible. I'm not saying that's "evil" or anything, it's just a fact of life in the business world.

I work for my state as a surveyor/inspector, and my observation of the for-profit facilities I have surveyed is that they are focused on doing as little as possible without actually getting in trouble with the state or the feds ... They cut every corner they can think of, and squeeze every nickel until it screams. The attitude from management always seems to be, what is the bare minimum we can do and still meet the state requirements? I know that people have lots of different opinions on this issue, but that's not a philosophy I'm comfortable with ...

[Farkinott, RN]

My experience of ANY private healthcare providing facility is the same. Maximum profit, minimal care.

[GTS]

I work for my state as a surveyor/inspector, and my observation of the for-profit facilities I have surveyed is that they are focused on doing as little as possible without actually getting in trouble with the state or the feds ... They cut every corner they can think of, and squeeze every nickel until it screams. The attitude from management always seems to be, what is the bare minimum we can do and still meet the state requirements? I know that people have lots of different opinions on this issue, but that's not a philosophy I'm comfortable with ...

I couldn't agree more with the exception of a few rare cases. I love the "squeeze every nickel until it screams" part. As true and sad as it is, the visual I got really made me laugh. I work on the technical side of things and that really hits us hard sometimes. They want to spend the bare minimum to get things fixed but get angry with us when it breaks down again. They don't understand that by just spending the extra buck, not only will it lower future repair costs and down time, but it will go lengths to helping us achieve our ultimate goal.... patient safety. Well, at least I know it's my goal. And I find it really agrevating when a safety issue is brought up and all the higher ups act so concerned and get the "we need to do something about this" attitude. Then when it comes time to foot the bill they don't want to spend the money to do it right and safe. "Cost effective" and "cheap" have two entirely different meanings. I can tell you which one I would go with if the decision were mine.

Okay... I'm done with my rant now. Sorry, I couldn't help myself. :)

[Sheri257]

Wow Christina, thanks for the article.

Looks like I'll be working for non-profits, if possible.

[elkpark]

Wow Christina, thanks for the article.

Looks like I'll be working for non-profits, if possible.

It is possible -- I've been an RN for ~20 years now, with a hard-'n-fast rule against working for for-profit employers, and I haven't had to go hungry yet! :chuckle