At the Intersection of Health, Health Care and Policy Cite this article as: William Cabin, David U. Himmelstein and Steffie Woolhandler For-Profit Dialysis: The Authors Reply Health Affairs, 33, no.11 (2014):2083 doi: 10.1377/hlthaff.2014.1101
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Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2014 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on June 18, 2015 at UNIVERSITY OF BATH
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doi:
10.1377/hlthaff.2014.1101
For-Profit Dialysis: The Authors Reply Our August 2014 article cited a meticulous meta-analysis of virtually all dialysis mortality studies that found higher death rates at for-profit facilities. 1 Allen Nissenson—an executive whose dialysis firm recently settled federal kickback charges for $389 million2—seeks to overturn that conclusion based on two cherry-picked studies that used idiosyncratic multivariate analyses to adjust away the observed differences. Moreover, convincing research has uncovered mechanisms behind forprofit dialysis firms’ bad outcomes. These firms systematically overdosed patients on erythropoietin even after its dangers were known, 3 which increased profits but also deaths. Forprofit facilities were also less likely to refer patients for transplants4 (you lose customers that way). And they shied away from peritoneal dialysis for children, 5 which is the preferred— but less profitable—modality. The overwhelming weight of evidence indicts for-profit dialysis care. Similarly damning evidence warns that profit-seeking incentives kill
thousands of hospital patients each year and, as our study found, condemn hundreds of thousands of vulnerable home care patients to inferior care at inflated prices. William Cabin, David U. Himmelstein, and Steffie Woolhandler City University of New York NEW YORK , NEW YORK NOTES 1 Devereaux PJ, Schünemann HJ, Ravindran N, Bhandari M, Garg AX, Choi PT, et al. Comparison of mortality between private for-profit and private not-for-profit hemodialysis centers: a systematic review and meta-analysis. JAMA. 2002;288(19): 2449–57. 2 Kutscher B. DaVita nearing $389M settlement agreement with feds over doc kickbacks. Modern Healthcare [serial on the Internet]. 2014 Feb 13 [cited 2014 Aug 20]. Available from: http:// www.modernhealthcare.com/article/20140213/ NEWS/302139974 3 Ishida JH, McCulloch CE, Dudley A, Grimes BA, Johansen KL. Dialysis facility profit status and compliance with a black box warning. JAMA Intern Med. 2013;173(12):1152–3. 4 Garg PP, Frick KD, Diener-West M, Powe NR. Effect of the ownership of dialysis facilities on patients’ survival and referral for transplantation. N Engl J Med. 1999;341(22):1653–60. 5 Furth SL, Hwang W, Neu AM, Fivush BA, Powe NR. For-profit versus not-for-profit dialysis care for children with end stage renal disease. Pediatrics. 1999;104(3 Pt 1):519–24.
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Health Affa irs
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The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/33/11/2083.full.html
For Reprints, Links & Permissions: http://healthaffairs.org/1340_reprints.php E-mail Alerts : http://content.healthaffairs.org/subscriptions/etoc.dtl To Subscribe: http://content.healthaffairs.org/subscriptions/online.shtml
Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2014 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on June 18, 2015 at UNIVERSITY OF BATH
Letters There is a limit of 300 words for letters to the editor. Health Affairs reserves the right to edit all letters for clarity, length, and tone. Letters can be submitted by e-mail, [email protected], or the Health Affairs website, http:// www.healthaffairs.org.
doi:
10.1377/hlthaff.2014.1101
For-Profit Dialysis: The Authors Reply Our August 2014 article cited a meticulous meta-analysis of virtually all dialysis mortality studies that found higher death rates at for-profit facilities. 1 Allen Nissenson—an executive whose dialysis firm recently settled federal kickback charges for $389 million2—seeks to overturn that conclusion based on two cherry-picked studies that used idiosyncratic multivariate analyses to adjust away the observed differences. Moreover, convincing research has uncovered mechanisms behind forprofit dialysis firms’ bad outcomes. These firms systematically overdosed patients on erythropoietin even after its dangers were known, 3 which increased profits but also deaths. Forprofit facilities were also less likely to refer patients for transplants4 (you lose customers that way). And they shied away from peritoneal dialysis for children, 5 which is the preferred— but less profitable—modality. The overwhelming weight of evidence indicts for-profit dialysis care. Similarly damning evidence warns that profit-seeking incentives kill
thousands of hospital patients each year and, as our study found, condemn hundreds of thousands of vulnerable home care patients to inferior care at inflated prices. William Cabin, David U. Himmelstein, and Steffie Woolhandler City University of New York NEW YORK , NEW YORK NOTES 1 Devereaux PJ, Schünemann HJ, Ravindran N, Bhandari M, Garg AX, Choi PT, et al. Comparison of mortality between private for-profit and private not-for-profit hemodialysis centers: a systematic review and meta-analysis. JAMA. 2002;288(19): 2449–57. 2 Kutscher B. DaVita nearing $389M settlement agreement with feds over doc kickbacks. Modern Healthcare [serial on the Internet]. 2014 Feb 13 [cited 2014 Aug 20]. Available from: http:// www.modernhealthcare.com/article/20140213/ NEWS/302139974 3 Ishida JH, McCulloch CE, Dudley A, Grimes BA, Johansen KL. Dialysis facility profit status and compliance with a black box warning. JAMA Intern Med. 2013;173(12):1152–3. 4 Garg PP, Frick KD, Diener-West M, Powe NR. Effect of the ownership of dialysis facilities on patients’ survival and referral for transplantation. N Engl J Med. 1999;341(22):1653–60. 5 Furth SL, Hwang W, Neu AM, Fivush BA, Powe NR. For-profit versus not-for-profit dialysis care for children with end stage renal disease. Pediatrics. 1999;104(3 Pt 1):519–24.
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