It was recently reported in National News that for-profit dialysis units run a 20% higher risk of mortality compared to non-profit units. I am looking for opinions as to why this occurs. I would assume that many non-profits would include critical care units in hospitals, and should logically have higher mortality.
Of course the prevalence of re-use in for-profit most likely tilts towards higher death rates. Your input is deeply appreciated.

m micone,

I think your theory is flawed for a couple of reasons :

1. I may be wrong but I don't think the mortality of a critical care patient gets attributed to either group. For most things, "acutes" are an entity all by themselves.

2. It is the for-profits that have abandoned reuse not the other way around. The two largest for-profits can buy dialyzers from themselves as well as other supplies cheaper than doing reuse, many of the smaller non=profits continue doing reuse in order to survive.

Chuck

I wonder if one could make the correlation to treatment length? Do non-profits typically run their patients longer? Just a thought.

Bill,

Very good point! I don't recall ever seeing statistics for that.

We're non-profit and the treatment times are set by the physicians. At our largest facility, every patient runs a minumum of 4 hours, at all of the other facilities there are many patients who only run 3 - 3.5 hours, again, this is by physician order not company policy.

Chuck

I am part owner and operator of a for-profit facility that does reuse. I have to take exception to your theory that facilities that reuse their dialyzers have higher mortality rates. Our average reuse runs around 29-30. Our mortality rate, as reported by CMS, is 34% lower than expected. The report goes on further to state that only 8% of the facilities in the United States (for-profit and not for profit combined) have mortality rates as low as ours.

It is my belief that some for-profit facilities have cut their staffing so low that they are not able to keep good tabs on their patients' levels of wellness. They don't have the time to educate the patients, as they should. That's one theory.

Another theory is that most for-profit facilities are located in urban (metropolitan) areas. Typically, these patients are more resistant to education, generally making life choices that are not in their best interests.

Another theory is that the numbers may have been manipulated in the study in order to reach a chosen outcome.

Frankly, some of the worst care that I've ever seen has been in hospital based facilities. I've seen some pretty poor care in for-profits, as well. But, the simple fact is that the type of management, regardless of for or non-profit status, is the key to whether a facility will have a high or low mortality rate. ESRD patients are standing on the edge of a cliff. The ESRD care provider is hanging onto the patient's belt, keeping them from going over the edge. If you are not diligent in your care, patients will slip over the edge.

Going back to the staffing-management issue, I would throw one more theory in your direction, which is staff turn over. High staff turnover never allows a facility to build an "expert" staff. Inexperienced staff is deadly to ESRD patients. A poor manager will have continual staff turnover. I'd bet if you looked at this one single issue, the mystery of why facilities have higher mortality rates would be solved.

Respectfully,

Joe Atkins, CEO
Shelby County Kidney Center
Sidney, Ohio

I think Joe you have some good points regarding staff. In my limited experience with only a few centers there does seem to be a trend that the staff who work for non-profits or profits not owned by the big chains seem to be happier with their jobs. Most of the staff I talk with who have worked for the chains then switched to a non-profit or privately owned always say they like working at these places better.