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The State of Dialysis Care in the United States


ProPublica senior editor Robin Fields has conducted an investigation into the state of the United State’s system of dialysis care and has found it greatly flawed.

Fields investigative research into the system created in 1972 by Congress to assist renal failure patients who needed dialysis for survival is published today in the online journal ProPublica.

Fields notes initially the program helped about 11,000 Americans for a modest initial price tag of $135 million, covering not only their dialysis and transplants, but all their medical needs. Now almost 40 years later the program cost taxpayers more than $20 billion a year to care for almost 400,000 who need dialysis. This is approximately $77,000 per patient.

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Over the course of more than a year, Fields and ProPublica reviewed thousands of inspection reports and interviewed more than 100 patients, advocates, doctors, policy makers, researchers and industry experts to get a grasp on American dialysis.

A summary of their findings is more grime than not:

  1. the dialysis patient pool is growing by 3% a year
  2. the kidney program is approximately 6% of the Medicare budget
  3. 1 out of 4 dialysis patients die within a year
  4. examination of inspection records for more than 1,500 clinics in California, New York, North Carolina, Ohio, Pennsylvania and Texas from 2002 to 2009 revealed filthy or unsafe conditions in almost half the dialysis units
  5. Clinics are supposed to be inspected once every three years, but as of October, almost one in 10 hadn't had a top-to-bottom check in at least five years, as shown by data from the Centers for Medicare and Medicaid Services.

Fields notes, "The government's payment policies for dialysis have created financial incentives that, in some ways, have worked against better patient care, while enabling for-profit corporations to dominate the business." Today, more than 80% of the nation's 5000 clinics are for-profit and almost two thirds of all clinics are operated by two chains. And Fields goes on to explain how the business models have changed to work to the for-profits' advantage now.

The investigation includes a graphic that explains how dialysis works.

In Dialysis, Life-Saving Care at Great Risk and Cost”; Robin Fields; ProPublica, November 9, 2010