A prominent U.S. senator is urging federal regulators to disclose the findings of an investigation into the for-profit dialysis industry, which critics argue is dominated by two major companies that threaten the quality of essential kidney care. Senator Richard Blumenthal, a Democrat from Connecticut, expressed his concerns in an interview with CBS News, highlighting what he described as the “hallmarks of unlawful abuse of market power.”
Approximately 75% of all dialysis clinics in the United States, totaling nearly 5,600, are owned by Fresenius and DaVita, according to a CBS News investigation published earlier this year. Blumenthal noted that while the government may perceive a lack of leverage against these dominant firms, it has not fully utilized its antitrust powers to protect patients.
The Federal Trade Commission (FTC) has been investigating whether this market concentration is affecting patient care. Despite this, the results of the probe remain undisclosed. Blumenthal has formally requested the FTC to undertake “appropriate robust enforcement action” to address identified issues and safeguard patients, including veterans, from potential misconduct.
Each year, around 500,000 Americans rely on dialysis to survive while awaiting kidney transplants, the only viable option for those suffering from end-stage kidney disease. Critics contend that the focus on profitability by Fresenius and DaVita has compromised patient care. Tom Mueller, author of “How to Make a Killing: Blood, Death and Dollars in American Medicine,” characterized the situation as “emergency room care done in the mall,” suggesting that patients are not receiving the tailored treatments they require.
Research from Ryan McDevitt, an economist at Duke University, reveals that over the past three decades, the dialysis industry has increasingly moved towards a “duopoly.” McDevitt termed this sector the “most concentrated health care sector across the entire U.S.” His analysis indicates that when independent clinics are acquired by DaVita or Fresenius, transplant referrals decline by about 10%, patient survival rates drop by 2%, hospitalizations rise by 5%, and infection rates increase by approximately 12%.
A review of federal data conducted by CBS News found that one-third of dialysis clinics in the U.S. failed to meet federal standards this year, with nearly 2,500 of the approximately 7,600 clinics nationwide falling short. The average score among these facilities was 60 out of a possible 100.
Both Fresenius and DaVita responded to the findings by emphasizing their commitment to quality care. In separate statements, they highlighted their track records, asserting that the data reflects “exemplary care.” Fresenius claimed that more than 65% of its dialysis centers earned three stars or higher on Medicare’s five-star scale, a figure the company indicated is above the national average for U.S. dialysis providers.
Medicare’s reimbursement limitations have reportedly incentivized these companies to prioritize filling treatment chairs to enhance profit margins. Blumenthal’s concerns extend to the veteran population, with approximately 40,000 veterans relying on dialysis care while awaiting transplants.
In his correspondence with FTC Chairman Andrew Ferguson, Blumenthal described the dialysis industry as “ripe with predatory, monopolistic potential practices.” He called for a thorough investigation to address what he termed an “anti-competitive, anti-consumer situation.”
Fresenius acknowledged the ongoing inquiry and confirmed its full cooperation with the FTC, emphasizing that further comments could not be made at this time. Requests for comment from the FTC and DaVita have yet to elicit a response.
Concerns about the quality of care at dialysis clinics have been substantiated by data from the Centers for Medicare and Medicaid Services (CMS). Since 2013, CMS officials have cited U.S. dialysis centers for over 115,000 deficiencies, which include issues such as inadequate training and unsanitary conditions in the handling of intravenous medications.
While Fresenius insists that it maintains a strong focus on enhancing patient quality of life and clinical outcomes, DaVita has characterized problems within clinics as “rare and isolated.” Both companies are adamant that any mischaracterization of isolated incidents as systemic failures is misleading and detrimental to patient welfare.
As the investigation progresses, the implications for the dialysis industry and the patients it serves remain a pressing concern for lawmakers and advocates alike.
