Dialysis Unplugged: Reform or Status Quo?

“All empires lose power. But their achievements - and their sins - long survive them.” Ed Smith.

Smith referred in his recent article to the Emperor Akbar of the Mughal empire. Akbar ruled in the 16th century but was only in power for 14 years. But he left a legacy - indeed, 500 years later Time magazine included him as a top 25 political icon. 

Ed Smith's point was that Akbar was a man of ideas. He was creative, open, and tolerant. He encouraged innovation. He was a benevolent emperor.

If one thinks about great empires in nephrology it is impossible to escape thinking of DaVita and Fresenius. They are overwhelmingly dominant in dialysis today. One hundred years from now what will these organizations be remembered for? An investment vehicle for Warren Buffet (as in DaVita) or as great patient centric organizations? What legacy will they leave?

Both DaVita and Fresenius are key members of Kidney Care Partners (KCP). KCP's vision is focused on "ensuring that high-quality, life-sustaining kidney care remains accessible to all patients and to providing prevention and education resources that help patients live a full and productive life." 

The question is what are KCP's (and Fresenius's and DaVita's) real motives? Reform or maintaining the status quo?

Here is a quote from the KCP Chairman Ron Kuerbitz: "Any attempt by Congress to disrupt implementation of ESRD payment reforms would be harmful to the community and to vulnerable patients." 

No, Mr. Kuerbitz, you neither represent "the community" nor "vunerable patients". You represent the dialysis industry. 

We need reform. We need to encourage innovation in the ESRD payment system that continues to link pay with performance -  improvement in important patient outcomes like death, hospitalization, quality of life, and a patient's ability to work, that is rewarded by increased payment. That is what we need.