With permission, here's Consoli's original, unedited op-ed.
What Does Our Community Want?
Very soon Danbury Hospital will decide what kind of care the 125 patients with End Stage Renal Disease will receive at the Nelson F. Gelfman Dialysis Unit. The Hospital wants to divest its dialysis services to a national for- profit chain - DaVita Inc. Patients in the Danbury area have been getting high quality hemodialysis for the past 30 years from the physicians and staff at Danbury Hospital. There is no guarantee that the current dialysis staff will be part of the new “dialysis family”. We need to know what this choice could mean for our community, dialysis patients and their families.
The New England Journal of Medicine reports that, in the United States, the care of patients with kidney failure is a $15.6 billion dollar industry. More than 200,000 dialysis patients each year receive care in hospital based or free standing centers.
While Medicare pays for almost all dialysis, it now pays only a “fixed” or “bundled” amount. That amount has not been increased since 1973. However dialysis centers were allowed to bill Medicare for three drugs routinely administered to dialysis patients: Venofer, an iron supplement, Zemplar, a vitamin D analog and Epogen, a glycoprotein hormone. Billing for these medications made dialysis very lucrative for large national chains for more than a decade but the goal of profits took a toll on the quality of care patients received according to many studies.
• JAMA reports in 2007 that Epogen for dialysis-related anemia is the single largest Medicare drug expenditure and U.S. taxpayers foot the bill.
• Patients in large for-profit dialysis chains were consistently administered the highest doses of Epogen regardless of anemia status according to a study reported in the Journal of the American Medical Association in 2007.
• The 2006 Renal Data System figures showed that 60 percent of DaVita patients had red blood cell levels that the Food and Drug Administration considered risky.
• According to a 2007 American Medical Association study, for-profit clinics used $1700 more of Epogen on each patient each year than not-for –profit centers did.
• A 1999 study by the New England Journal of Medicine of 3569 patients treated in both non-profit and for-profit centers showed that for-profit centers had a 20 percent higher mortality rate and a 26 percent lower rate of referral for renal transplants.
• Most importantly, study after study shows that for-profit centers provide better care when there is competition for patients with nearby not-for-profit facilities and hospital based centers. Danbury Hospital needs to continue to provide that competition.
Under the new Medicare “fixed” reimbursement system for dialysis both hospital based and for-profit centers would receive the same payment per treatment. We believe that under this scenario the for-profit facilities may use less labor and equipment per treatment as cost saving measures. Karen Kitzky, a 58 year old DaVita patient in Colorado Springs, on dialysis for 16 years, switched to another provider because she felt the DaVita was understaffed. “I didn’t feel safe enough to go to sleep”, she said.
In addition, DaVita, Inc. is currently under investigation by the U.S. Department of Justice in New York, Missouri, Colorado and Texas for a variety of allegations including the overuse of Epogen; its financial relationships with pharmaceutical companies and physicians; submission of fraudulent Medicare claims; and improper billing.
Dialysis in Danbury doesn’t belong in the medical marketplace. It should not be outsourced like the laundry and dietary departments. We believe our community hospital needs the right balance between patient care and profits, because we aspire to offer “A Higher Level of Care”. We believe that standard of care should be our “true north”.
We are disappointed that the President and CEO of Danbury Hospital, Dr. John Murphy, would not postpone the proposed changes to the dialysis unit and would not meet with us to discuss alternatives. We know our community expects a higher level of care, lower mortality rates and higher referrals for renal transplants.
Our community values high quality care above high dialysis profits. We hope the Nelson F. Gelfman Dialysis Unit will continue to provide Danbury area residents with life-saving hemodialysis. Finally, we hope readers of the News Times agree with us and will contact Dr. John Murphy and ask him to continue our long-standing, Community Hospital not-for-profit dialysis unit.