PD vs. In-center Hemodialysis

Why don’t more clinics offer PD and instead choose only to offer in-center hemodialysis?

I think most units are just trying to hit the mainstream, fill up their chairs.
It seems like more companies that operate more than one unit are sharing a pd nurse who travels.
I also think many doctors are uncomfortable with pd patients because they may not have as much experience with pd. Therefore they don’t promote the therapy or may be unwilling to initiate a program if they don’t have senior leadership.

So what happens when the chairs are all full and the doctor has patients waiting in the wings to start? There are always more patients waiting. If these clinics don’t have PD (or home hemo) training programs, they have to send patients that would have come to their clinics elsewhere. This means that their clinic tens of thousands of dollars every year for every patient sent away. Instead, if these clinics had PD (or home hemo) training programs and screened every patient for it, they could send those patients home that were willing and able to do home dialysis and keep in-center chairs for patients that actually needed more intensive nursing care. This would be a much better allocation of scarce resources. This would mean that in-center programs would have sicker patients which might require changes in patient/nurse ratios. However, money saved through the home dialysis program would make this more possible to afford. It would also mean that healthier patients would be able to live fuller lives…dialyzing to live, not living to dialyze…possibly work and keep private health insurance coverage longer.