A prominent U.S. senator is urging federal regulators to disclose findings from an ongoing investigation into the for-profit dialysis industry. Critics argue that a “duopoly” formed by two companies has negatively affected the quality of essential kidney care for patients in need. According to a CBS News investigation, Fresenius and DaVita control nearly 75% of the more than 5,600 dialysis clinics operating across the United States.
Senator Richard Blumenthal, a Democrat from Connecticut, expressed his concerns regarding the potential abuse of market power in a recent interview. He stated, “The government may feel it has no leverage against two companies that provide for almost all the dialysis treatment in the country. But it has failed to use more leverage, including its antitrust powers against those companies.”
The Federal Trade Commission (FTC) has been investigating whether the market dominance of these two companies has impacted patient care. As of now, the results of this inquiry remain undisclosed. Blumenthal has requested that the FTC take necessary enforcement actions to address any identified issues and safeguard the interests of patients, including veterans, who rely on these services.
Approximately 500,000 Americans depend on dialysis to survive while awaiting kidney transplants, which are often the only viable solution for those suffering from end-stage kidney disease. The clinics provide essential blood filtering services, yet critics argue that the focus on profit by the leading companies compromises the quality of care.
Tom Mueller, author of “How to Make a Killing: Blood, Death and Dollars in American Medicine,” highlighted this concern, stating, “This is emergency room care done in the mall. People are not given the tailored treatment that they need.”
Economist Ryan McDevitt from Duke University noted that the industry has been trending towards a duopoly for over three decades. He characterized the dialysis sector as “the most concentrated health care sector across the entire U.S.”
Recent data reviewed by CBS News revealed troubling statistics: nearly one-third of dialysis clinics did not meet federal standards this year, with almost 2,500 of the approximately 7,600 clinics failing to comply. The average compliance score was a mere 60 out of a possible 100.
In response to the criticisms, both Fresenius and DaVita have emphasized their commitment to providing high-quality care. Fresenius stated that its performance reflects a track record of “exemplary care,” while DaVita highlighted its “dedicated clinicians” who deliver individualized care in a complex environment.
Critics argue that Medicare’s reimbursement limitations have incentivized these companies to prioritize patient volume over individual care quality. For instance, last year, DaVita delivered more than 29 million dialysis treatments, generating approximately $391 in revenue per session. Together, both companies reported a total revenue of $33.7 billion.
Research conducted by McDevitt indicates that when independent clinics are acquired by either DaVita or Fresenius, there is a notable decline in transplant referrals by about 10%, a 2% decrease in patient survival rates, a 5% increase in hospitalizations, and a rise in infection rates by approximately 12%.
The scrutiny of the dialysis industry is not new. Health surveyors from the Center for Medicare and Medicaid Services (CMS) have identified over 115,000 deficiencies in U.S. dialysis centers since 2013, citing issues such as inadequate hand hygiene and unsanitary conditions during IV medication handling.
Fresenius reported that over 65% of its dialysis centers received three stars or higher on Medicare’s five-star scale, surpassing the national average for all U.S. dialysis providers. In contrast, DaVita claimed that reported problems in clinics are “rare and isolated,” emphasizing that such instances do not represent the overall quality of care provided.
Senator Blumenthal pointed out that veterans are among those increasingly relying on for-profit clinics, with roughly 40,000 veterans depending on dialysis services. He has urged FTC Chairman Andrew Ferguson to take decisive action to protect patients from potential misconduct by these companies.
In his correspondence with Ferguson, Blumenthal asserted that the dialysis industry is “ripe with predatory, monopolistic potential practices.” He called for an investigation that aligns with the FTC’s mandate to address anti-competitive behavior.
Fresenius has acknowledged the ongoing inquiry and stated that it is fully cooperating with the FTC. As the investigation continues, both the FTC and DaVita have yet to respond to requests for further comment.
