What davita has to say

[cschwab]

With all the articles we have posted about  for-profit medicine, we thought we ought to give time to what the davita has to say about this.

The following is what they gave us through contract lobbyists to answer our questions about their business:
http://dialysisethics2.org/open_images/flyers/Davita_answer.pdf

The above did bring up a couple of more questions that haven't been answered:

1) DaVita serves a large portion of the minority population.  We recall the Afro-American dialysis population has a lower mortality rate than the Caucasian dialysis population.  Shouldn't this cause DaVita's mortality rate to be better than DCI's?  Why the discrepancy?  

2) We did see the improvement in lab results for phosphorous.  Is this due more to the use of binders, or is it more time on dialysis?  I do seem to recall phosphorous can be an indicator of middle molecule clearance and more time on dialysis - however it can also be cleared out with the use of binders.

[cschwab]

The davita reps also replied to questions about reuse and patient/staff ratios, but haven't replied to follow-up questions:

davita on patient/staff ratios:
"CO does not have state-specific staffing ratios.  There are only a handful of States that do (not the majority).  Per DaVita

[cschwab]

A final comment on reuse:
As for the above studies, we can question the legitimacy of each others information but the bottom line is incidents like the following wouldn't occur if reuse was abandoned:

"There is no doubt about what happened to Betty Allen and DaVita's role in it. Her death certificate says she died after "exposure to Renalin during hemodialysis," giving DaVita's Muskegon address. Medical notes from DaVita and Spectrum repeatedly refer to her accidental infusion with Renalin during dialysis, as does the autopsy report."  Muskegon Chronicle

[cschwab]

We also still have other questions we feel davita hasn't properly answered:

1) We would like to know why patients come into dialysis with kidney disease, yet pass away with heart problems?

2) Is it possible for techs to come in with more medical background?

3) What information do those on dialysis receive about reuse?

4) After showing the davita reps the following graph, we are still wondering why there is a disparity between hospitalization and mortality rates between davita, fresenius, and DCI?



5) What are daVita's best practices and what are they like at DCI and other countries?

6) From '91 to '01 the USRDS shows the number of patients doubling, costs tripled, yet the death rate was up 123%.  We were wondering where the money went?

[cschwab]

And a question for Medicare: why can't they pay for 85% of dialyzors getting at least 4 hours of treatment 3 times a week?  -as they do in Germany and Japan.

"In Japan and Germany, one of the pay for performance targets for dialysis is that 85% of dialyzors must be getting at least 4 hours of treatment 3x/week (this would translate to 2 hours x 6 days a week). I think that would be an excellent goal worth working toward here, particularly in light of the DOPPS (Dialysis Outcomes & Practice Patterns Study) data among 22,000 or so dialyzors that found a 30% drop in the risk of death for folks who got at LEAST 4 hours of treatment. IMHO, there is no excuse for anyone to be getting less than this, regardless of body size. It is not possible to get too much dialysis (though it is possible to remove too much water and leave people feeling wretched--this is actually quite common)."  http://forums.homedialysis.org/showthread.php/2667-Dialysis-Industry-May-Expand-as-Study-Sways-Medicare

[angieskidney]

This is a very informative thread!

[cschwab]

Thanks Angie!  I did have another question for the feds besides the Medicare question above: could the Congressional Budget Office (those Navy Seals of accountants) tell us where the money is going in dialysis?

I've wondered that ever since I saw the following stats from the USRDS:

From

[cschwab]

I went to church today and talked to my Pastor about what we are seeing in dialysis and how answers seem hard to come by.  Guess what!  Not only is he very interested in this, but there is also have a Healthcare Action Committee!  I plan on talking to the committee and seeing if they could help in getting some answers.

[angieskidney]

Thanks Angie!  I did have another question for the feds besides the Medicare question above: could the Congressional Budget Office (those Navy Seals of accountants) tell us where the money is going in dialysis?

I've wondered that ever since I saw the following stats from the USRDS:

From

[cschwab]

We are considering things.  One thing is trying to reason with them a bit more,  see how that goes.  There is always hope.

[cschwab]

Think this sums up some questions:

U.S. vs Italy





Costs and deaths

[angieskidney]

Wow this is an informative post! Especially the graphics.

[cschwab]

They say a picture is worth a thousand words!  It was nice to see a dip in the mortality these last years, but looking where Italy is at shows we still have a long ways to go here.