DaVita Medical Insights

The Impact of Consolidation in the Dialysis Industry

Consolidation has been occurring in many sectors of the U.S. economy, including healthcare. In the dialysis industry, this is due in part to inadequate government funding, as shown in the independent analyses of the Medicare Payment Advisory Committee (MedPac). In most facilities, approximately 90 percent of patients are reimbursed through a government program, and with the demands to continuously improve quality outcomes, small and independent dialysis providers are increasingly unable to survive.

Despite the toll this is taking on small dialysis providers, many believe there are positive aspects in this consolidation, including creating economies of scale where resources are scarce, enabling the ability to analyze and help improve outcomes on a large population basis and driving investments in innovative approaches to improving care delivery and patient outcomes. There is no part of the healthcare industry where consolidation has occurred more quickly or dramatically than in the dialysis sector, where DaVita is one of the two major dialysis providers that oversee the care of over two-thirds of all U.S. dialysis patients. A recent article in the Clinical Journal of the American Society of Nephrology by Erickson and colleagues explored whether access to care or patient choice was impacted by this consolidation, which is a concern expressed by some, but without evidence to support the concern. The authors found that “a decade of consolidation in the United States dialysis industry did not (on average) limit patient choice or result in more concentrated local markets.”

During this time of consolidation, DaVita has made considerable investments in innovation to improve care delivery, ensure access to quality care and uphold patient choice. These investments include medication management programs, initiatives that deliver care coordination and integrated care management, and removing barriers to care for patients seeking vascular access procedures, all of which can help providers deliver patient-centric, high-quality care.

Consolidation, if done carefully and with patient outcomes in mind, can be an important driver of a better quality of life for patients with ESRD!

To read the article abstract, click here.

Allen R. Nissenson, MD, FACP, FASN, FNKF

Allen R. Nissenson, MD, FACP, FASN, FNKF

Prolific author and renowned authority on kidney disease, Allen R. Nissenson, MD, is chief medical officer at DaVita Kidney Care and emeritus professor of medicine at the David Geffen School of Medicine at UCLA, where he has served as director of the dialysis program and associate dean. Dr. Nissenson is also co-chair of the Kidney Care Partners Quality Initiative. Dr. Nissenson served as a Robert Wood Johnson Health Policy Fellow of the Institute of Medicine from 1994–1995 and worked in the office of the late Senator Paul Wellstone. He is a former president of the Renal Physicians Association (RPA), served on the RPA Board of Directors as a special advisor to the president and is a former president of the Southern California End-Stage Renal Disease Network. He is the author of more than 700 scientific papers and the editor of two dialysis textbooks, one in its fourth edition and the other just released in its 5th edition. Dr. Nissenson earned his medical degree from Northwestern University Medical School and is the recipient of various awards, including the AAKP Medal of Excellence award, the Lifetime Achievement Award in Hemodialysis and the National Kidney Foundation “Man of the Year” award.