Have we lost our way?

Recent coverage by the lay press of renal providers fighting over patients in Colorado sends a bad message about a therapy that already has a less-than-stellar image in the eyes of the public. We spend $16 billion each year in taxpayer dollars (including mine and yours) to treat 350,000 patients, and we can't seem to shake a mortality rate that is over 20%. A transplant is the gift of life. Dialysis? It's something most people avoid at all costs (and perhaps one of the reasons why those with late-stage CKD, despite warnings from their nephrologists, are in denial until the trip to the emergency room). Fighting for patients over money--that adds to the ESRD Program's dark reputation.

Indeed, if these turf wars were based on improving patient outcomes--rather than enticing patients with bigger TVs or better massage chairs--we would all feel better about it. But they're not.

The fact of the matter is that most providers have always looked at the renal industry as a form of buying and selling patients. In the mid- to late 1990s, when we saw a Blitz-Krieg of acquisitions and consolidations among mid-sized providers, patients were been traded for company stock and medical director contracts. The dialysis chains with commercial patients were--and still are--the most lucrative for buyers.  Before considering an acquisition, one of the first things providers would review is the percentage of commercial patients, because they generated the most revenue.

Little has changed since then. And now, patients are getting the message. "With everything that is going on, you feel like you are becoming sort of a dialysis dollar," said 53-year-old dialysis patient Julie Estes of Colorado Springs, in an interview with the Denver Post. She is one of the patients caught up in a tug-of-war between DaVita Inc. and Liberty Dialysis over where she should be treated.

These dogfights over patients are not just occurring in Colorado. With certificate of need requirement a thing of the past in most states, renal providers are building clinics around the corner from competitors to entice patients. Physicians are in the driver's seat, because they control they influence patients on where they go.

But is there anything in that sales pitch about patient care or better outcomes? Does the clinic offer an in-center nocturnal dialysis program? Are there any fitness classes? Do you have a night shift to accommodate me so I can tell my boss I can handle a different shift that pays me more--and keeps me off disability?  Do you offer self-care? Can I sit down with my doctor, nurse, or dietitian for more than a few minutes each month and have a real discussion about how I can improve my health status?

Those are good reasons to change renal providers. Is my doctor suggesting I go to a different renal provider because he is looking out for my best interests--or his own? The debate in Colorado make it unclear.

The renal community has many dedicated, hard working professionals who truly do care about delivering quality care. But it's also a business. A provider that opens up a new clinic needs physicians to direct patients to their chairs. That is a business relationship that needs to be nurtured and maintained if that provider wants to be and remain profitable. But health care isn't like selling energy, automobiles, or advertising. It's about treating human beings and finding ways to make them feel better. This is supposed to be the priority.

Have we lost our way? Julie Esters is suggesting that we have. Maybe it is time to put down the lawyer's pens, the non-compete contracts, and the P&L statements, and pick up the stethoscope.