I just read the January issue of Nephrology News and Issues, which incuded Fresenius Medical's new "anti-dialyzer reuse" add. The two page add shows a full page photo of a young boy blowing his nose on a kleenex. The obvious insinuation is that dialyzers, like the kleenex, should be thrown away, not reused.

I've been disgusted and angry with companies before, but, with the exception of Amgen's high cost of Epogen, nothing has made me angrier. Clearly, Fresenius Medical began their organization by being the kings of the concept of dialyzer reprocessing. It is Fresenius Medical that profited from dialyzer reuse, which gave them the capital to become the largest provider of dialysis, world wide. I might add that it was Fresenius Medical that faired the worse during the Senate Subcommittee on Agings Hearings that investigated the "poor care" being rendered to ESRD patients throughout the United States. Why did they fair the worse? Because their pateints apparently had a lot to complain about.

Now, after creating a reimbursement environment that is dependent upon dialyzer reuse in order for a facility to survive (particularly independent facilities) the king of dialyzer reprocessing is passing itself off as the new white knights of single use only dialysis. Now, like a reformed prostitute, Fresenius is preaching the benefits of non-reuse, even going as far to publish research with questionable results, designed to scare the entire industry by telling them that dialyzer reuse increases pateint mortality. In the meantime, other, more credible research from the University of Minn. Twin Cities, shows the exact opposite results.

The bottom line is that Fresenius Medical Care produces and sells their dialyzers to their own clinics. We should all be so lucky to own the company that provides all of our disposables, including the dialyzer. This is strictly nothing more than a marketing ploy to take over the entire ESRD industry, something that Fresenius has been trying to accomplish, for years.

There is a sad truth in the ESRD industry, which is that Fresenius Medical Care, by being the original kings of dialyzer reprocessing, are responsible for creating our present low levels of reimbursement for ESRD care. This fiscal nightmare has been compounded by the high cost of Epogen, as well as the new reimbursement environment recently created by the Medicare Moderization Act (as it pertains to ESRD reimbursement).

The truth is that FMC is not publishing their mortality. In fact, they have done everything they can to interfere with the mortality data reported at CMS's Dialysis Facility Compare web site. I will offer the following challenges to FMC:

1) If you really believe that non-reuse leads to a lower mortality, let's compare the overall mortality of FMC with our facility, Shelby County Kidney Center. Accoring to CMS, only 8% of the dialysis faclities in the United States have a mortality rate as low as ours. And, we reuse our dialyzers. Furthermore, our rates of infection, as well as rates of admission are remarkably lower than the national average. I publish my CMS quality data on the Internet for all to see. Is FMC willing to do the same?

2) If FMC truly believes that reprocessing of dialyzers is "bad" for the patient, why don't they produce a quality high flux dialyzer at a cost that reflects what Medicare is willing to pay for a dialysis treatment? It would take a dialyzer cost of about $5 per dialyzer, before independent facilities would be able to afford it. Otherwise, they would have to lay off staff in order to afford a new dialyzer for each treatment.

To sum this up, dialyzer reuse exists because of a Medicare reimbursement environment that was created by FMC's original policy to reprocess their dialyzers. Once Medicare was able to evaluate FMC's profit margin, seeing that they were the largest provider, this led CMS (previously HCFA) to keep chipping away at ESRD reimbusement, which is a composite rate frozen in the 1980's. Thank you very much FMC.

It's clear that with the present level of reimbursement, indedendent facliites, who have become dependent upon reuse to survive, would fold if forced to stop reprocessing of dialyzers. FMC is acutely aware of this, which is why they have begun their present anti-dialyzer reprocessing campain. They are not being driven by good patient care, but only by greed and the desire to crush independent providers, as well as any chain that reprocesses their dialyzers.

We do reprocess the dialyzers in our faclity. The result is that our quality numbers are higher that the grand majority of the dialysis providers in the United States. Our Kt/V's are higher, our mortality is lower and our morbidity rates are lower.

The real truth behind what drives the quailty of care in any dialysis faclity lies with the quality of the dialysis team taking care of the patients. It means that the facility hires quality staff in numbers that provide a safe patient to staff ratio. It means that social worker and dietary staff are made available to meet the patients' needs. It means that the nephrologist comes by more than once a month to see the patient. These are the real things that help you assure quality patient care.

Sincerely,

Joe Atkins, CEO
Shelby County Kidney Center
Sidney, Ohio

I think one thing should be noted in your bashing of Fresenius. Fresenius is not the "king of dialyzer reprocessing." That would be National Medical Care, which Fresenius bought. Soon after the takeover by Fresenius, the talk began about non-reuse. If you are going to talk about someone, at least get the facts straight.

Joe,

I won't even begin to think I know all of the history of Fresenius, etc. What I do know, is that as an independent, non profit unit, as the one I work for, we have to worry daily about costs. Now bear in mind that I am merely a pct, and the only example I have of our cost cutting is the numerous changes in product we go through to try to save a dime. It's a case of "try this...it's cheaper" and this happens all the time. Big business gets wonderful price reductions in the cost of their stock because of the huge orders they place. We have to pay more because of our lack of volume. Being non profit, we are already behind the eight ball because of medicare/medicaide reimbursements...which I know I don't have to tell any of you about. We're being crusified. And if the patient cannot pay??? Well...we are treating them anyway. Profit units have the luxury of choosing who they treat and don't treat. We treat anyone who lines up at our door. It would be nice if we got reimbursed for that in a fair and efficient manner...and it would be nice if our costs for supplies was fair. I guess the bottom line is that Big business is big business. Be it Fresenius, Gambro, Davita...whoever. The little guys will always be fighting to stay afloat. It's not fair...but it's fact.

Dawn,
I work for Fresenius and I am sure we do get better prices because of the volume we buy, that point I won't argue. What I do take issue with is your statment about "choosing" our patients. We also treat "anyone who lines up at our door". We do not turn away patients. Period. We have our share of indigent patients as well.

Mike

Rather than bashing Fresenius, which does indeed have its share of problems, I agree that we should be looking out for what is best for our patients. I work in a hospital based facility that decided to go to non re-use several years ago for numerous reasons. The first was that we were constantly training re-use technicians because of our rapid growth. Once trained, if a PCT position became available anyone working for the hospital had 1st dibs - and any type of dialysis experience was a plus. Other factors included the cost of chemicals, heparin, re-use supplies etc. We did a thorough cost analysis and found that non-re-use was the way for us
to go.

But all that aside, we also have some of the best outcomes in the state and nation. I don't think it has anything to do with whether we re-use or not. I think it is the quality of our staff and the care they give. Keeping quality staff can be a problem I know with the low reimbursement rates. I would ask all who read this post how many really write our congress person or representatives and stay active in the political arena? I think we all get a little disgusted with the way things are done in Washington DC, but if we care about the patients we serve, we owe it to them to continue the fight for quality care at reasonable reimbursement rates.

FMC/NMC may have started the decline (or freeze) of ESRD reimbursement by introducing and supporting re-use, but we must make the "powers that be" understand that our patients are now more ill and need more care than they did years ago. Since the time of the so called "death committee" we have begun taking older and sicker patients than would have been taken in those years. The types of patients that we treat now have multiple co-morbid conditions that complicate their dialysis care.

As with any other commercial advertising, if you don't like it - buy somewhere else. But the fact is (as I see it), FMC does have more cost effective dialyzers that give excellent results.

And now I'll get off my soapbox...

Seems to me that the "Long Term Goal" for ending re-use in the Fresenius clinics is being overlooked.
Can somone honestly say there is data to support the fact that continued exposure to low levels of disinfectants is A-okay for a "long term" dialysis patient?

Studies done in the 80's compared formaledehyde exposure to cigarettes. There was a way to determine overall dose to patient. But for obvious reasons, testing was never performed. Testing would have taken into account rebound from potting compound.

DialysisJoe,

As with any process one starts at a certain point and usually tries to improve on the process.

I believe that's what Fresenius did. Fresenius has never made money selling it's dialyzer to itself. LOL

And now as Davita has purchased Gambro and the subsquent merger requires Davita to use Gambro products I believe we'll see Davita go to non re-use.

The dangers of new dialyzers will never be greater than giving a patient someone else's dialyzer.

I don't believe I've ever seen first use syndrome with the new dialyzers.

I've worked in many units in my travels in ten states in the last 4 years. Non re-use is just better, cheaper, cleaner etc.