Troubling Article - NY needs the LDOs?

Bill_Peckham · December 29, 2006, 4:36pm

This New York Times article has a number of statements that I would take issue with but this sentence was a surprise:

Newly released patient data show that people who receive their dialysis from a national chain generally fare better than those treated by an independent provider.
Really? The Large Dialysis Organizations (LDO) are the answer? Reading through the article it seems this conclusion flows from looking at the data reported on Dialysis Facility Compare web site.

Other quotes that make me cringe:

“Survival for them is an ordeal, at best.”

"For all but a few, holding a job is out of the question. "

And then there is this:
“Four of the five largest chains had adjusted death rates 7 percent to 10 percent lower than the independents had as a group in 2004”

This statement needs further explanation – the published peer reviewed studies that I have seen show a slight survival advantage by dialyzing through a non-profit (aka independent) provider.

Maybe I’ll give this article a good Fisking because it really should be debunked point by point. My dog is still on vacation in Idaho so I think I’ll go through this point by point.

“National chains customarily provide technicians and other staff members with months of initial training and occasional re-training, instruction that can boost the quality of care and that independent companies, with their tighter operating margins, have a hard time affording, experts say.”

This article has to have been fed to the “National Paper of Record” by some hack hired by one of the for profits – one I’d guess that rhymes with “don’t believe ya”

system · December 29, 2006, 5:46pm

I too was thinking this article is way off base. The only thing I can figure is they were comparing the chains to the small for profit dialysis centers. I don’t think they could have been comparing them to the non-profits as the non-profit is our area of New York are very good.

Marty

Gus · December 29, 2006, 6:02pm

I probably believe it, large dialysis chains such as those of non-profit like Satellite Dialysis and others do have better results. The reason for that is that they have the resources to fulfill their patient’s needs.

Small independent dialysis groups really barely meets patients needs tend to stuggle a bit harder .

Bill_Peckham · December 30, 2006, 6:38pm

Here is part 1 of my 4 part Fisking of the New York Times article. Text in italics are from the article. Regular text are my comments

[I]Tens of thousands of people across the country, their kidneys ruined by Type 2 diabetes, have been forced into the grim routine of dialysis care, and in New York, those patients routinely receive some of the worst treatment, government records show.

At New York dialysis centers, those being treated are more likely to suffer from anemia and are less likely to have enough impurities and excess fluid removed from their blood, allowing more damage to their bodies, according to the records.[/I]

Tens of thousands? Try hundreds of thousands. This is their lead? They first try to establish a nominal connection to diabetes and then point to how people universally, across the country are forced into a grim routine of dialysis care apparently without exception other than it is worse in New York (it is never clear if they mean the City or the State or both). The government records reporting anemia and kt/v must be a reference to CMS web site Dialysis Facility Compare.

Experts say the disparity is caused in part by the fact that New York is dominated by small dialysis providers, many of them run by people with little background in medicine who entered the business to meet the surging demand.

Experts? How about a name. Who exactly is running which clinics? All clinics must have a Medical Director, who would certainly have a background in medicine, don’t they run the clinics? So it is the owner or CEO of the clinic that doesn’t have a medical background? Is Davita CEO Thiry a Nephrologist?

[I]Many of the smaller centers provide good care, experts say, but a lot also lack the money and staff training to compete on a quality-of-care basis with the national dialysis chains that dominate the market across the rest of the country. Newly released patient data show that people who receive their dialysis from a national chain generally fare better than those treated by an independent provider.

Many, a lot[/I] - in journalism I believe these are called weasel words (no offense to weasels) because their presence makes it impossible to fact check the statement. This paragraph seems to say that the national chains dominate the market because of their quality of care, this is not what happened. The newly released patient data is again a reference to the annual update to the Dialysis Facility Compare (DFC) web site which now reports data through the 2005 calendar year.

The article never directly references the DFC and never looks at how the DFC data is generated. Also because the DFC data is old the article reports the state of the renal industry as it existed in 2004 & 2005. In this article FMC & RCG and Davita & Gambro have yet to merge which is confusing.

But the chains are largely blocked from operating in New York by a state law that effectively bars publicly traded companies from owning health care facilities in the state. “With the need for dialysis on the rise, the department is questioning whether it makes sense not to allow these large corporations to participate,” said Jeffrey W. Hammond, a Department of Health spokesman.

Ah, so now we come to the point of the article. And the first quote. So, there are state regulations baring the two large for profit dialysis providers from building or expanding their hegemony to New York the State. Now this is a fair question - are non-profit and small dialysis systems in the interest of the residents of the Empire State? Should the Rubin Center need to compete with Davita or FMC? But the article never clearly states that question instead we are suppose to conclude that government data is showing that New Yorkers are getting shoddy care because of antiquated rules and regulations.
[I]
In 1980, fewer than 50,000 people in the United States needed dialysis to do the work of their kidneys; today, there are more than 350,000, including roughly 24,000 in New York. In 1980, diabetes was the primary cause of kidney failure for fewer than 6,000 dialysis patients; today, the figure is about 150,000.

Survival for them is an ordeal, at best.[/I]

A difficult or painful experience, especially one that severely tests character or endurance? Yes, I suppose three day a week, three hour treatments are an ordeal for many. But that is not renal care at its best. That is not even average renal care. Marty is dialysis an ordeal for your father? This would have been a much more interesting article if the writer had described optimal or even good dialysis care. What strategies have people found, people right there in New York, to lessen the “dialysis ordeal”? How have people changed the ordeal into a burden into an inconvenience?

Again the writer adds the diabetes dimension. In fact having diabetes and needing dialysis is harder than just needing dialysis. However, based on the rest of the article I think highlighting the diabetes link is a way to tie this article into an admirable ongoing diabetes focus at the NY Times and is, no doubt, how this story was pitched to the writer. It is curious that the article’s lead speaks of tens of thousands across the country only to point out here that it’s actually hundreds of thousands - not even mentioning the millions predialyzors with some degree of diminished kidney function.

At a typical dialysis center, patients come in three times a week, typically for four hours at a time. They sit in rows of recliners, dozing, watching television — anything to take their minds off the machines, needles and tubes that siphon blood from their bodies, clean it of impurities like urea, and pump it back in. It is surprisingly quiet; patients are so beset by side effects like fatigue, cramps or thirst, that mere conversation seems like an effort. For all but a few, holding a job is out of the question. Most will never be healthy enough to qualify for a transplant that would free them of this burden, and there are far too few donated kidneys, anyway.

This is a typical dialysis unit? Mere conversation is too great an effort? I assume the reporter is saying the people are at the unit for four hours, hooked up to the machine for just three of those hours judging by the state of the unit’s dialyzors. And it is interesting that the impurity mentioned is the harmless little molecule urea. What about phosphorus and potassium? What would have been interesting would be for the reporter to say how many dialysis units he visited and where exactly?

How about stopping by this one http://www.lowermanhattandialysis.com/ ? I assume it is about a $10 cab ride from the Times office but really you wouldn’t even have to leave the comfort of the cubical, just browse the web site. A 12.8% mortality rate and the web site helpfully notes “All patients accepted - We do not exclude patients for poor health. “ I for one would be very interested in reading about what a day in the life is like for the average dialyzor at the Lower Manhattan Dialysis center. Even better of course would be if the reporter went out to the Rubin Center and talked to the people running that program. Having never spoken to them myself I can not say what their reaction to this article is but I would give their reaction a lot of weight.

Bill_Peckham · December 30, 2006, 6:40pm

New drugs and dialysis techniques have improved their chances of survival since the 1980s, despite the fact that patients today are older, heavier and sicker. Even so, the average dialysis patient spends 15 days a year hospitalized, and the death rate is about one in five each year. “I want to say it’s a rough life, but it hardly is a life,” said Denise Bembury, a dialysis patient who lives in Brooklyn. “I wouldn’t put this on anybody.”

How about saying what the mortality rate has done over time, the improvement depending on which years exactly you start and end the analysis - the 80s? - is from 24 to 22%. The real question is why has there has been so little improvement. This would have been an excellent time for the reporter to report the international comparisons or at the least the wide range of outcomes evidenced by it would appear units in the reporter’s own area code.

I do not in any way doubt Denise’s experience and perception of dialysis but there are at least thirty percent of dialyzors that are working by the official definition, once you include the active retireds and those busy but not collecting a pay check well over 50% of dialyzors do not match the picture presented. So again the reporter missed an opportunity to looking into what is different about Denise’s care from the people at a unit with better reported outcomes? What about Denise’s care would change if one of the LDOs were allowed to buy her unit?

Across the country, five companies own or operate almost two-thirds of the 4,800 dialysis units. Two of them, Fresenius Medical Care and DaVita, have more than half the market. But in New York, the big five run about 20 percent of the roughly 250 centers, by far their lowest share in any state. The State Department of Health has helped the national chains work around the law that bars publicly traded companies from owning health facilities. This has allowed them to open some centers here, but the companies say the approval process remains long and difficult, dampening their interest.

The “big five”? Interesting that the reporter is downplaying the fact that there is really just the big two. I’ll have to wait for Nephrology News & Issues annual run down of the top 10 dialysis providers to be sure but I don’t think any other provider has more than 10% of the market, while the big two have over half - I thought closer to two thirds just between them.

The ownership restriction, in place for at least 50 years, state officials said, was enacted when there was no such thing as a dialysis center, and was intended to ensure that hospitals are responsive to local concerns, not to far-flung shareholders. Though the Health Department talks of changing the law, no one has made it a priority, and not even the large chains have pushed the issue in Albany.

So the question seems to be are dialyzors better served by units responsive to local concerns, not far flung shareholders? Again this seems to be the true issue that should be addressed directly.

Recent reports on the quality of dialysis care by the federal Centers for Medicare and Medicaid illustrate New York’s cause for concern. The centers examined a sampling of Medicare patients’ dialysis records in each of 18 regions, one of them New York State.

Now we get to the source of concern the data reported on DFC. The 18 regions are the Renal Networks, DFC reports unit results as compared to national numbers and as compared to the unit’s network numbers.

Medicare pays for almost 90 percent of dialysis in this country, and in the reports, for 2003 and 2004, New York ranked worst in all three of the most commonly used quality measures. Those measures are how likely patients are to have enough excess fluid like water removed from their blood during dialysis, how likely they are to have enough impurities like urea removed, and how likely they are to be anemic or severely anemic because of the treatment.

Not quite. Medicare is the primary payer, paying 80% of allowed charges, for 75% of all dialyzors. Medicaid is primary for about 10% and secondary for about 50% of the Medicare primary dialyzors, while the VA covers about 5% (but they may not be included in the numerator being used depending on the source) and there are some State programs. And while all these Public (i.e. Government) payments cover 90% of all treatments they only amount to about 50% of industry revenue. And … okay never mind Medicare pays for 90% of dialysis in this country. But back to those measures.

If you go to the Dialysis Facility Compare web site you can look at the data for New York. DFC breaks New York into Upstate and NY City & Vicinity. According to DFC Upstate has 70 units; 92% meet anemia targets, against a 92% national average; 93% meet URR targets against 92% nationally. It gets confusing when you get to the mortality measure because the site reports 6 units with better than expected mortality outcomes against 27 worse than expected mortality outcomes, with 216 units reporting.

The DFC section on NY City & Vicinity reports the same mortality breakdown so I think that represents the network breakdown, which would be all of New York - upstate and city. All of this is to point out the data is confusing and contradictory but since the reporter seems to be reporting off a data summary - it would be useful to know who prepared that data summary.

This would again be a good time to investigate what works. What are the six units with better than expected outcomes doing different? Why are there no consequences or intervention at units that report worse than expected outcomes? What is the solution to those low measures? More dialysis is something that is proven to work but the only solution the article seems to suggest is that NY needs LDOs because LDOs report better numbers.

Assuming this is true we should be provided the source and it should be explained how exactly this data is collected. One would assume that the LDOs are better at being measured because they have the staff to focus on the task e.g. making sure all the boxes are checked - tingling in the feet that’s Renal Neuropathy - to get full comorbidity “credit”.

Those scores have improved in New York over the last decade, but not as quickly as they have nationwide, and New York’s numbers were actually worse in 2004 than in 2003. The federal agency does limited comparisons of individual dialysis centers, which show that nationally, 4 percent of them have unusually poor patient survival rates, defined as at least 20 percent below average. In New York, 12 percent do. Federal officials caution against putting much stock in any one center’s numbers, but they say the regional picture clearly shows a problem.

Again this seems to be referring to the DFC web site data for NY State aka the Network: 12% of 216 is about 26 which is close to the 27 the DFC reports; 12% of the article’s 250 number would be 30 units with worse than expected mortality rates which isn‘t reported anywhere I can find, just as the 250 unit number does not appear to be from public information.

This would be another point where it would have been helpful if the article had said where the data is coming from and report if there have been any audits of the data collection process. Also since this is public data why not compare units that are doing well with ones raising red flags. What is being done, what should be done and what was the experience of dialyzors at independent units that were sold to LDOs?

The federal data do not draw any conclusions about the cause of the disparity. But experts said they believed the quality of care was affected by the high number of smaller, less experienced providers in the New York market. In fact, in New York City, one-fifth of the centers operating earlier this year had existed for less than five years.

What experts? One fifth of the centers had not been operating five years ago - is that higher than nationally? Is that number directly related to the increase in the number of people who need dialysis? What was the alternative? Existing units could have grown larger; instead of having a unit closer to home dialyzors would have had to go farther to large units. That would be better? Dialysis has been around for over 40 years in NY were some of those new units replacing out dated facilities? Isn’t that a good thing?

Bill_Peckham · December 30, 2006, 6:41pm

A recent report by the United States Renal Data System Coordinating Center, a quasi-governmental agency that compiles the records of most dialysis patients, shows that patients at the major chains were less likely to die than those treated by smaller companies. According to the center, the numbers were adjusted to account for differences that might affect patients’ risk, like age and sex, whether they had an underlying disease like diabetes and how long they had been on dialysis. The independents were defined as not being part of a major chain or a hospital.

Again this is confusing because I think the previous data in this article is from the DFC web site run by CMS and now the article points to a USRDS report. The USRDS has a different standard of chain dialysis - I think the Rubin center would not be a smaller center in the eyes of the USRDS but would be allowed under the NY State law this article seems to suggest is the barrier to care. The other issue left undressed is are the large corporate providers better at filling out comorbidity forms? This should be a testable hypothesis, if this is the case smaller providers should get more diligent about checking boxes on admission forms and this mortality difference should narrow.

This would have been a good time to report the overall morality advantage shown in the USRDS data (was it statistically significant?) and exactly how many of NY State’s dialysis providers fall into the USRDS’s “Independents” category, less than the 80% not owned by the LDOs. Now would be a good time to report on alternatives to either some defective mom and pop dialysis unit or dialysis through the LDOs e.g. the Rubin Center, Beth Israel.

Four of the five largest chains had adjusted death rates 7 percent to 10 percent lower than the independents had as a group in 2004, and one chain had higher rates, according to the center’s most recent annual report. Since then, two major chains, including the one with the highest death rate, have left the business, and two new ones have been formed.

Was this piece of obfuscation really necessary? Some of the units have changed owners but was this more then changing the name on the door? The two “new” “big five” providers were just units spun off from the big news of the last two years the merger of Davita/Gambro and FMC/RCG. This bit of verbal misdirection makes me question the entire slant of the article. If the real question is “Does locally based healthcare have a value greater then then efficiencies gained through corporate healthcare?” then let’s address that issue directly. I would welcome that discussion (hint: my answer is that we all gain from locally based non-profit healthcare) or perhaps we the question is “Should there be small, local for profit healthcare providers?” I admit to having less strong feeling on this issue but it seems to me the only way corporate for profit healthcare could work is if there is competition. Taking either question I don’t see the clear benefit offered by LDOs.

Patients at the small companies were much more prone to infections that led to hospitalization or death. The small companies also lagged in nondialysis care that dialysis centers usually take over, like ensuring that patients get vaccinations for influenza, pneumonia and hepatitis B. Their diabetic patients were less likely to have tests that monitor blood sugar control.

I am in favor of making Dialysis Facility Reports public information and then we could see the unit by unit incidence of infection and hospitalizations. It isn’t too surprising that for profits are sure to provide every billable service but I can think of a few other solutions to service under utilization then turning healthcare over to corporations.

Some independent operators say that large companies can “cherry pick” healthier clients. But the government’s figures show that the national chains’ patients are actually sicker when they begin dialysis — more anemic, more overweight, and with more advanced kidney disease.

Sicker or better at filling out forms? Is this data subject to audit? If the LDOs truly have sicker dialyzors at the initiation of treatment isn’t that a failure of their CKD outreach? Are the small providers cherry picking? This is an odd assertion to make without showing some evidence of skepticism. A lack of skepticism is really the flaw throughout this article.

Researchers and state and federal officials say they have known, or at least suspected, for years that patients fare better at the major chains, but they cannot be sure why. One factor believed to play a role is that the average Medicare reimbursement rate for a dialysis session, $140 to $150, has changed little since the 1970s, making it difficult for the smaller operators who cannot realize economies of scale. Tight operating margins have left fewer small providers nationwide, although their numbers have grown in New York, where the chains have not been able to operate freely.

Really these people all suspect this but they can’t be bothered to state this publicly and defend their point of view? Is the only solution to vertically integrate the provision of dialysis so that we can achieve optimal economic efficiencies? Is the primary goal of this country’s commitment to people with CKD5 economic efficiency? Of course not. Can the difference in operating margins also be explained in the way Private payers are billed? Can a corporate provider of dialysis pass economic efficiencies on to dialyzors e.g. through improved care or longer runs, while at the same time enjoying recognition for their stocks performance?

Dr. Allan J. Collins, director of the United States Renal Data System Coordinating Center, said: “We do know that the large organizations have an enormous advantage in resources because they can demand discounts from suppliers on drugs and equipment, and that can translate to better staffing, better training. The chains also tend to be more systematic and standardized in their procedures.”

Finally another direct quote but the quote does not support the idea that these efficiencies are the end of the story. That huge advantage in resources (interesting again no mention of LDOs practice of private payer revenue maximization, only their advantage in purchasing power) does not necessarily translate to dialyzor care. Better training? Now would be a good time to provide a few specific examples of how training differs. It seems to me this quote from Dr. Collins is innocuous and was thrown in so that someone could be quoted directly while keeping the sweeping and damming statements anonymous.

Michael Paget, executive director of the National Renal Administrators Association, which represents large and small dialysis companies, said he was not familiar with the Coordinating Center’s research that indicates one group performs better than the other. The center first included those comparisons in a report last year, and first included the mortality and hospitalization breakdowns this year. “I don’t think you can generalize about the independents, and there are many that do an excellent job,” outperforming even the best of the major chains, he said. But he acknowledged that bigger companies probably had an edge in training.

Is the reason he was unfamiliar with the data because it is hard to find or is it being ignored? Again the only specific mentioned is training but it really sounds like the reporter forced the admission out of him. Also we again have a quote, only the second expert, and only towards the end of the article and it specifically says you shouldn’t draw too many conclusions from the data the reporter is drawing conclusions from.

Bill_Peckham · December 30, 2006, 6:42pm

[I]The federal government and most states, including New York, do not set training or educational standards for dialysis technicians, the workhorses of a dialysis center. (Federal rules require only that the centers have full-time or part-time doctors, social workers and nurses on staff.)

National chains customarily provide technicians and other staff members with months of initial training and occasional re-training, instruction that can boost the quality of care and that independent companies, with their tighter operating margins, have a hard time affording, experts say.[/I]

Another anonymous expert, who does not seem to be familiar with the conditions of coverage. So it seems the conclusion we meant to draw seems to be that in the absence of training standards we should encourage LDOs in our communities because their economies of scale allow more money to be spent on training. So we, through Medicare, get more for our money when dialysis is provided by a LDO. And we to draw this conclusion based on anonymous sources and contradictory, unverified and ambiguous data. Um, I pass.

[I]Ms. Bembury, 44, uses an independent center, Nephrocare, a three-year-old unit on Atlantic Avenue, in the Weeksville section of Brooklyn. She goes there, she said, because her doctors referred her there. Like many patients, she has no idea how it compares with other centers, or how to find out.

Until earlier this year, she was a social worker and an avid cook. Now, she is on disability, and her companion of more than 30 years prepares meals. They have six children, and she wonders how the four youngest, all teenagers, will manage. “I’m thirsty all the time, and tired,” she said.[/I]

Again this sounds like a situation that is sub optimal but there is no discussion at all about solutions other then the provision of dialysis through LDO.

Nephrocare was one of a few dozen centers in New York with an abnormally high death rate in 2004, though not in 2005, and in both years, it had an unusually high number of patients with uncontrolled anemia, Medicare records show. An administrator at Nephrocare said that none of the owners or staff would be interviewed, and several other large, independent centers around the city gave the same response.

It is unfortunate that actual providers would not speak on the record. It may be that there is a problem at Nephrocare but if that is the only example the reporter can come up with then the article should be about Nephrocare. I’m curious which other providers said they would not be interviewed. I find it surprising since nonprofit organizations have a duty to report to their communities, and I would think that the 6 units that are reporting better then expected mortality would be delighted to shine a light on their performance.

There are no rules as to who can own or manage a dialysis center. Doctors control some. Others are run by people with no background in health care. State officials say they conduct a “character and competence” review, and look at owners’ finances.

Run by and owned by are two very different things. Does the reporter really mean to say that some units are run by people with no background in healthcare? Is he talking about Nephrocare? Why not say who owns and who operates Nephrocare since that seems to be his example. And what is meant by “run by”? The CEO or the Nurse manager or the Medical Director or some other administrator? What sort of qualifications are in place in other states? What is NY missing?

[I]Under Medicare rules, states must inspect most centers every three years, though troubled centers are visited more often. Even when there are persistent problems, regulators would rather coax a center into improving than shut it, even temporarily, because the dialysis supply barely keeps up with demand.

State officials said they could recall only one center being forced to close this decade, and Medicare gave that order, not the state. The experience was painful, they said, as patients had trouble finding other centers nearby with spaces, or stations, available.

“We had 403 people who had to find other stations in New York City,” said Mr. Hammond, the department spokesman, “and that is not something we encourage or want to happen.”[/I]

I’m confused is a lack of surveys now the problem? I thought the issue was the lack of training standards? Or was it the small economies of the independent providers? Is now the problem that there are rules to be followed and standards to meet but because of spotty Medicare/State oversight there is no consequence to providing shoddy, substandard care? That does sound like a problem. Too bad there is no space left to report on what could be done.

The Times could have done alot better.

system · December 31, 2006, 10:44am

Bill,

I thought that article to be more false than true. It just seems like someone is trying to make a case for NY to make it easier for the large dialysis corporations to enter NY state. I thought many of their points were either just misleading or just plain false. I also have heard from staff at the centers which were once private owned and sold to Fresenius that the dialysis standards went down not up. In summary I think the article was written with very little research done, if any, to support the statements.

Marty

Gus · December 31, 2006, 3:30pm

The easiest and most effective way to find out is to go to each of the dialysis centers in NYC and look at the faces and wellbeeing of the patients dialyzing there. Sit down in the waiting room for awhile and observe carefully…

Beth_Witten_MSW_ACSW · January 3, 2007, 10:34am

Just received this rebuttal to the NY Times article from a friend and thought everyone would be interested in reading it.

Op/Ed Submission (New York Times) by Wayne Evancoe 12/28/2006

In Response to “Dialysis in N.Y. lags as Diabetes Ruins Kidneys” article
(12/28/2006 NY Times front page by Richard Perez-Pena)

In his article, Mr. Perez-Pena appears to be asserting, that patients receive better care at large, for-profit national chain dialysis providers, as compared to smaller, independent, not-for-profit dialysis centers. As a CEO of the Rubin Dialysis Center, an independent, not-for-profit dialysis system in New York’s Capital Region, I disagree. I can assure you that we have provided innovative, high quality dialysis care to thousands of patients for more than 20 years.

There are always going to be dialysis providers, large and small, who have quality of care issues. However, other studies have shown that independent providers provide dialysis care as good as or better that the national chains. A 2002 Study published by the Journal of the American Medical Association concluded that, “Hemodialysis care in private not-for-profit centers is associated with a lower risk of mortality compared with private for-profit centers.” (JAMA, vol.288 No.19, 11/20/2002) For example, many independent dialysis providers have better staffing ratios than many for-profit chains. That can impact care delivery.

In addition, our center encourages patients to consider innovative home-based dialysis therapies that have helped to improve our dialysis patients’ quality of life. Since 1998, our center has been using the Internet to monitor dialysis patients trained to perform their own treatments in their home while they sleep. The clinical and quality of life results have been excellent compared to the regimen of three times per week in-center dialysis.

Now we also offer short daily and peritoneal dialysis therapies. These types of treatment allow patients to be more in control of their care and maintain their own life schedules at home. Our not-for-profit center holds educational activities, provides emergency funds when required, and even offers simple things like extra blankets, coffee or tea, wireless Internet access, etc, while patients are on treatment.

While Mr. Perez-Pena describes the dialysis routine as “grim,” many of our patients are thankful that such life-sustaining treatment allows them to continue to work or volunteer part-time and participate in the lives of their children and grandchildren – many even in the comfort of their own homes.

The Center for Medicaid and Medicare Services (CMS), the federal regulatory agency that oversees dialysis care, sets out very specific Conditions of Coverage that specify what qualifications the dialysis provider’s governing body, management team, and Medical Director must possess as well as clinical staff experience. Further, the New York State Department of Health performs unannounced on-site visits and surveys to ensure that a dialysis provider is complying with those rules.

I acknowledge that independent, not-for-profit dialysis centers are at an economic disadvantage, as compared to the large for-profits. The shortage of qualified nurses and the demand of higher wages have a significant impact on independent, not-for-profit dialysis centers. The large chains can manufacture supplies and buy their drugs at much lower prices than independents can.

Currently, New York law (Article 28 and Certificate of Need review) prohibits publicly traded or foreign owned companies, like the national dialysis chains, from owning health facilities in New York. Mr. Perez-Pena’s implied solution for improving care --opening up New York to the for-profit national chains-- is not the answer. This action would not guarantee improved care; it would only make the national chains richer and would likely result in the closing of many quality independent dialysis centers.

Without independent dialysis centers, both patients and their insurance companies would have less choice, the positive push to expand “at-home dialysis” therapies may suffer, and when only a couple of giant chains then exist, there would be no looking back then or reinstituting treatment choice. Let’s take all factors into any global analysis of quality.

Wayne A. Evancoe, CEO/Renal Administrator
Hortense and Louis Rubin Dialysis Center, Inc.
1850 Peoples Avenue
Troy, New York 12180
(518)271-0702

bobeleanor · January 3, 2007, 10:50am

Did any body other than the man from the rubin center write to the Times? I did, how about it, Bill, Gus , Country Girl Or Beth or Dori?
bobelenor

Gus · January 3, 2007, 2:37pm

[quote=Beth Witten MSW ACSW;11818]Just received this rebuttal to the NY Times article from a friend and thought everyone would be interested in reading it.