Community Dialysis Houses in the U.S.?

Been some years since I’ve dropped by! Always found this site very useful when I had technical questions - and the people were always friendly and helpful. Yes I’m back despite finding the format new and scary! (I’ll probably get used to it)

Anyway, lately I’ve been posting a bit on X. I ran into a person who posts by the name @DailyHemo (very impressive individual by the way). This person informed me about these Community Dialysis Houses in Australia? New Zealand? (I would put up a link or two, but I can’t since I haven’t posted for awhile - but if you google ‘Community Dialysis House Youtube The Kidney Society’ videos should come up)

My question is what obstacles might be in the way of getting something like that started here in the U.S.? The first obstacle that comes to mind is I know with the nephs exemption to the Stark Law and their financial interests in some clinics, they might be disinclined to recommend them. And I could see companies like DaVita and Fresenius hating the competition - and trying to kill them. Is there anything else that might be a worry?

I have a crazy idea about how to start one here in Denver. Crazy you say? Much like the crazy idea my friends and I had back in 2007 - we thought we could get a state bill passed for the certification of techs. Oh wait, we did it!

This 2008 newspaper article was about the establishment of the first dialysis community home in the U.S. on Maui in Hana. People on dialysis living in that area had to drive a long way on a winding, dangerous, and sometimes impassable road to the closest dialysis clinic. The community home passed CMS inspection that found it in compliance with federal regulations. It’s my understanding that patients could come to the clinic and use the machines that were purchased through donations to run their own treatment themselves or with help from a care partner. I went to Maui in 2011 and rode with family on that highway to Hana and I can confirm that it was beautiful but somewhat overwhelming knowing that dialysis patients had been having to drive that road three times a week in all kinds of weather. I uploaded a picture I took of the house that had been converted with donations to allow patients to dialyze in their own community. I believe it had to meet the Medicare regulations for physician and other staff. I think one issue that might prevent setting up community homes across the U.S. is that each one would have to meet regulations to protect the health and safety of patients dialyzing there and they would have to still comply with regulations that require patients, including those trained to do home dialysis–to have access to an MD, RN, dietitian and social worker.

Thanks! Could be biting off a lot with this one.