Much has been made in the press recently about the agreement between Eastern Maine Medical Center and DaVita to transfer ownership of the three regional dialysis centers to DaVita. Open discussion about this agreement and the involved parties is of paramount importance and will allow those most affected by this agreement — the patients, their families and the staff at these centers — to have an accurate picture of what they can expect in the coming months.
I have, unfortunately, been disappointed by what has been left out of the discussion thus far.
The reports and comments have focused on how big a company DaVita is and any negative press the company has had in the past. Recently, an opinion piece in the BDN asked questions about local oversight, local care by local people and where the money will go.
The operation will continue to be licensed and inspected by the state of Maine, as it is now, and directed by the same physicians the patients know now. The physicians’ compensation arrangement with DaVita will be the same as it has been with EMMC and ensures that physicians are guiding the course of care, and no one else.
As for keeping local dollars local, the largest portion of any health care budget is wages for the staff providing the care, all of whom are local people. In addition, water, power, rent and other operational costs will also be going to Maine organizations. While these discussions have their place, in my opinion they do nothing to educate the most affected individuals about what they can expect.
As a physician, my primary focus is always the welfare of my patients. The leadership at DaVita has been very open about their practices and welcomed questions about patient care. More than a half dozen of their team, including the regional nephrologist from Connecticut, made the trip to Bangor to answer all of our questions and concerns.
In the world of dialysis, we use various factors such as anemia management, dialysis access type and efficiency of dialysis as metrics to gauge quality of care. The facts are that DaVita consistently has some of the best outcomes in the nation. Their fistula rates — a best practice quality standard for dialysis care — are consistently higher than other providers. This has been shown to decrease infections and hospitalizations and reduce mortality.
I feel these facts should be given more emphasis when we talk about the proposed agreement. While the physicians, RNs and dialysis technicians will remain largely unchanged (most of the staff are planning on working for DaVita) the support that DaVita will be able to provide for other staff — such as dieticians, social workers, home dialysis services — will be augmented. From my perspective as a physician, bringing DaVita to our community is of benefit to my patients. This is a positive development.
During this entire process EMMC has welcomed our input as nephrologists and has worked to find the best fit with regards to a partner in this agreement. I think the public has a right to know that EMMC did its due diligence and had multiple national providers of dialysis present their vision for the dialysis program.
The decision to divest the dialysis program was not taken lightly. The process of replacing the work of the human kidney through man-made means is incredibly complicated and highly regulated. Due to the increasingly complex and ever-evolving nature of the rules and regulations surrounding dialysis, the hospital concluded — finally, and with the support of our independent nephrology group — that patient care would be best served by going with a national company, with dialysis as its only focus.
Questions about the proposed agreement are both welcome and expected, as change always brings about uncertainty. While there will be some changes to the program during this transition, much will remain familiar. Again, because the staff, physicians and locations will remain largely unchanged, this should ease some of the natural anxiety.
I am confident that partnering with DaVita will allow our dialysis program to grow and adapt to the ever-changing landscape of dialysis and continue to provide outstanding patient care.
Michael McGoldrick, MD practices nephrology in Bangor.
After a lot of great, compassionate care, my mother and grandfater died at EMMC. Both death certificates listed kidney failure as their cause of death. My sister graduated from Nursing School at EMMC. It has always been a good hospital that cares for the community in good times and in bad. By selling their dialysis units to a mega for-profit dialysis provider (seriously, their business model has been taught at Stanford) you are taking avay patient centered care and sliding down the slippery slope of for-profit healthcare where the patient is simply an opportunity for profit.
There are great disparitis in how dialysis is billed, and Davita does not publish thier billing rates. It is like doing business with a shady used car dealer – you are sold a lot of goods but you never know what you are going to get in the end. Are you on Medicare? Do you have insurance? Those will be the first questions asked. How will taking you as a patient increase the shareholders profit. Don’t be fooled. It is the economy we are in dark days. A dialysis center can refuse to treat you if you can’t pay your bill. Then you’ll end up in the EMMC Emergency Room anyway. This is all about MONEY. Not patient care.
Tell me Dr. McGoldrick – will the standards and practices of a national for-profit dialysis chain be the guide for your facility? Will you accept all patients? Or will there be special services for those with private insurance? (HIPPERS) Will you and your staff be a part of the DaVita Village? The Village that encompasses all employees of DaVita but not the patients?
I suggest that EVRYONE look at the Pro-Publica Dialysis Facility Database and look at the for-profit facilities versus the non-profit. (DCI in Belfast is a not for profit facility)http://www.propublica.org/series/dialysis
Good luck with your future business arrangement Dr. McGoldrick. I hope that your new incentives and possible stock options help you sleep at night when it is all said and done.
I am one of those people who believe that community healthcare should put patient health as the end profit, not Warren Buffet, Kent Thiery and other DaVita investors.
Anna, you hit the nail on the head. Please come to the Town Hall meeting regarding the sale of EMMC dialysis. Place, date and time to be announced soon.
are there any mobile dialysis units in maine? it would be much better for the bedridden in nursing homes to have dialysis done in-house.
i see on davita website they offer home dialysis. will this be available in bangor area? it would save a lot of money in transport costs for nursing home pts.
Davita will also purchase the home dialysis services of EMMC if this sale is approved by the State Certificate of Need officials.
There is more worry that just uncertainty with the sale of EMMC dialysis to Davita. No mention is made in this Op Ed about dialysis clinic dismissals, sometimes without notice or cause. Nothing is mentioned about the harm to patients, like the harm to the 5 patients I have spoken with. There are hundreds more. Retaliation against patients if they have a complaint and blackballing dismissed patients from treatment are not mentioned. No one mentions the fact that Davita practices routine re-use of single use dialyzers, an unsafe practice that can cause many complications to the patient. Blood clots, and infections are just two of those complications. Fresenius, another huge for profit dialysis company, has made the decision to do away with the practice of reuse because of the complications it causes patients. The fact that the CEO of Davita is the 46th highest paid CEO in the US is not mentioned. That kind of profit is not made by “keeping the money in Maine”. DAvita proudly said in their informational meeting in Bangor (May 25) that they are a “one stop shopping” service(think the “Walmart” of dialysis). They will encourage their patients to buy all of their pharamaceuticals from their own mail order pharmacies, and deliver meds to the patient’s bedside, sucking money away from local pharmacies. They will likely use their own labs for lab studies. They will most likely purchase and use their own medical products. Sure, they will pay utilities in Bangor (unless EMMC pays …..the physical property will not be sold to Davita….just the management of the dialysis patient services). Except for salaries, Davita’s focus is profit and to pay their stock holders, not to enrich Maine, Bangor or local businesses. These are my thoughts and opinions on the DAvita sale, and they come after hours on the phone with a national Dialysis patient advocate. She has taken on the task of placing dismissed dialysis patients into different dialysis services and reviewing State surveys of Davita clinics nationwide. She has boxes full of documents regarding dialysis clinics.
Dialysis patients cannot live without dialysis,,,they would die. She is truly a life saver because she gets dismissed patients into services elsewhere. She will come to Maine soon to educate Mainers about Davita.
EMMC already has a fine dialysis service. Maine and our area does not need a huge for profit Fortune 500 company here. It will not help patients and it may harm them. Patients are the NUMBER ONE priority. Let’s keep the control and policy of our dialysis clincs local. It is my goal in the near future to give these patients a voice in this huge decision that may affect them. And who will be more affected by this sale than the patients? This decision was made behind closed doors….. totally without patient engagement.
You can read more about the Business of DaVita here:
http://www.nytimes.com/2011/07/26/health/26dialysis.html?_r=1&pagewanted=allLawsuit Says Drugs Were Wasted to Buoy Profit
One of the nation’s largest providers of kidney dialysis deliberately wasted medicine in order to reap hundreds of millions of dollars in extra payments from Medicare, a former clinic nurse and a doctor are charging in a whistle-blower lawsuit.
And here:
DaVita, doctors group probed for possible kickback
A federal grand jury in Denver is investigating the relationship between DaVita Inc. and one of the city’s largest kidney doctors’ offices to determine whether the dialysis company essentially paid a kickback to guarantee a steady stream of patients.
In 2008, DaVita, the nation’s largest dialysis provider, sold half-ownership in seven dialysis clinics to Denver Nephrology for $1.89 million. Those clinics generated estimated annual revenues of more than $28 million, according to documents obtained by The Denver Post.
http://www.denverpost.com/news/ci_19252778
I worked in dialysis for over twenty years and had to deal with numberous buy-outs over the years. When a unit is sold nothing good comes from it other than the doctor making money from selling their patients. Staffing always suffers, supplies become bargain basement quality and the patients will suffer. Good luck to all.