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 In examining the records of more than a million dialysis patients,
researchers found that compared to patients getting dialysis at
nonprofit facilities, patients treated at for-profit dialysis
centers were less likely to make it onto a kidney transplant list
and less likely to receive a new kidney from either a living or a
deceased donor.
The implication is that for-profit facilities may be biased toward
keeping patients on dialysis.
"In a 17-year-long study we found that U.S. patients with end-stage
kidney disease who receive dialysis in for profit facilities have
lower access to kidney transplantation compared to patients who
receive care in non-profit dialysis facilities," said study coauthor
Rachel Patzer, an associate professor and director of health
services research in the department of surgery & department of
medicine at Emory University School of Medicine. "The current system
has no financial incentive for dialysis providers to educate, to
spend time with and to refer patients for transplant."
As reported in JAMA, Patzer's team analyzed data from the U.S. Renal
Data System and from Dialysis Facility Compare, which provides
information on each facility's profit status and corporate
ownership, and the Dialysis Facility Report, which captures
information on facility-level patient demographics, mortality,
treatment patterns and transplantation rates.
The researchers ultimately focused on nearly 1.5 million patients
diagnosed between 2000 to 2016, 87% of whom received care at
for-profit facilities. During the study period, 121,680 patients
(8.2%) were placed on a waiting list for a deceased-donor
transplant, 49,290 (3.3%) actually received a deceased-donor kidney
transplant, and 23,762 (1.6%) received a living-donor kidney
transplant.
Patients at for-profit facilities were 64% less likely to get on a
transplant waiting list, 56% less likely to get a transplant from a
deceased donor and 48% less likely to receive a kidney transplant
from a living donor.
There may be ways to improve the situation, Patzer said.
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"Incentives must be aligned so that regardless of whether it's a
for-profit or a non-profit facility, the facility is incentivized to
encourage those patients who are eligible for kidney transplant to
pursue it," Patzer said in an email. "The new executive order
announced this summer, called the Kidney Health Initiative, is a
step in the right direction in that it proposes new payment models
to promote access to kidney transplantation, among other
components."
The new study is "very important," said Dr. Martin Wijkstrom, an
assistant professor of transplant surgery at the University of
Pittsburgh Medical School and director of islet cell transplantation
at UPMC. "It may not be the first to point out this disparity but
it's pretty comprehensive."
"It's scary to see such low numbers," Wijkstrom said. "When I was
reading the study, I started thinking how this could be fixed."
What Wijkstrom came up with was this: patients should get counseling
about kidney transplantation before they are referred for dialysis,
preferably when they are getting a procedure to create a "vascular
access route" that will allow the patient to be connected with the
dialysis machine.
"That way you remove the referral from the nephrologist (who is
working for the dialysis facility)," Wijkstrom said. "There's always
going to be conflict of interest in the situation where the
nephrologist there does the referring."
SOURCE: http://bit.ly/2HUtD2D and http://bit.ly/2HWnC5h JAMA, online
September 10, 2019.
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