Dialysis: DaVita versus Fresenius - who's better?

At dinner, a friend recently the posed the question: what's the fundamental difference between Fresenius and DaVita? Who is better? The difference, he said, was that DaVita is a dialysis services company whereas Fresenius is a technology company tethered to a dialysis services operation. The goal of DaVita is to maximize profits through more efficient delivery of services to dialysis patients, while Fresenius has a focus on making money in both services and technology. Unlike DaVita, Fresenius spends some of it's money - not enough - on innovating in technology: on machines, dialyzors, and the like. DaVita spends it's money - not enough - on innovating in more efficient care delivery. When DaVita looks at reducing mortality in dialysis patients they look at the quality of how dialysis is delivered and outcomes, when Fresenius looks at improving outcomes it looks at technology.

Here, I am going to juxtapose two quotes to reinforce this point.

First, a blog piece from Allen Nissenson, Chief Medical Officer at DaVita:

"DaVita is entering the world of international dialysis in a big way. We are partnering with doctors in Singapore, India, China, Malaysia, Saudi Arabia, Germany and other countries. As we embark on this exciting adventure, we again are faced with the nagging perception that dialysis outcomes in the United States are worse than those in other parts of the world......So what are the lessons for U.S. nephrologists and for DaVita as it embarks on its international journey? It seems clear that in the United States, there is no substitute for nephrologists spending time with dialysis patients. The dramatic trend—driven by current reimbursement and increasing time demands—toward monthly nephrologist visits, with additional visits made by other caregivers, arguably is contributing to the problem. While mortality has slowly, steadily improved, none of us can be happy with the current high mortality rate. Recommitting to engaging with our patients is one step that may help."

Now a quote from Fresenius's web-site:

"Fresenius Medical Care is highly innovative and fosters a corporate culture of innovation. We strive to continuously develop and refine dialysis therapies and products as an integral part of our growth strategy. The principal focus of all our activities is to improve the quality of life for our patients by making advances in therapy and technology. Innovations from research and development are the key. In combination with a tailored therapy that considers the specific needs of the individual patient we want to further optimize dialysis therapies. Our commitment to research and development places the very best equipment at patients' disposable today and helps to shape the standards of tomorrow. Before starting any product development we ask: What can we do better?"

An example of this innovation from Fresenius published Nov 21 in Blood Purification is a new high-cut off dialyzor - named the "EMiC2 dialyzer" that enhances removal of middle molecules without an increase in albumin loss. On the other hand, one could quibble with Fresenius's so-call focus on technology. Their debacle on Grauloflo, covered by Renalweb, isn't exactly Fresenius's finest hour.

DaVita has been recognized for innovation: it was recently named by Fortune magazine as #1 rated in the field of Health Care Medical Facilities for innovation, long-term investment and quality of products and services. But, if one looks at USRDS data comparing DaVita to either Fresenius or DCI, the two other large dialysis organizations (LDO's) there is no meaningful difference in outcomes.

The biggest problem is that both take 15 to 20% of it's profits and return them to share-holders.