U.S. dialysis provider DaVita backed a federal kidney care plan announced Oct. 20 but objected to what it saw as criticism of innovation and scale in the dialysis market.
The U.S. Department of Health and Human Services (HHS) estimates that 37 million U.S. adults have chronic kidney disease and 87% are unaware of it. Its Kidney Care National Plan focuses on preventing kidney failure, widening dialysis choices and changing how transplants are managed.
HHS estimates that two companies account for about 74% of the dialysis market. The department also says that, as of 2019, roughly one-third of the U.S. population lived in areas where one of those firms faced no rival dialysis provider. Its fact sheet does not identify the companies.
The department says rules that impede new providers and practices by established firms can raise prices for patients and taxpayers. It also points to a split in the incentives for prevention: patients, payers and providers face costs for screening and early care, while another party may receive the later benefit.
Among the steps HHS is considering are commissioning a systematic evidence review of kidney disease screening in at-risk groups, revisiting dialysis facility requirements and assessing treatment in other settings. Neither its announcement nor its fact sheet sets a deadline for those proposals.
DaVita said most of its patients have care plans that extend beyond dialysis and that its size helps it invest in technology and broader care. The company challenged what it described as a suggestion that kidney care lacks innovation or that scale holds it back. HHS’s fact sheet criticizes market concentration and barriers to entry; it does not say size alone prevents innovation.
DaVita also said it is deploying a clinical innovation at its centers, without identifying it or providing outcome figures.
As an example of the potential of value-based kidney care, DaVita cited the voluntary Kidney Care Choices model. An evaluation by The Lewin Group for the Centers for Medicare & Medicaid Services (CMS) found increased use of home dialysis and more living-donor transplants across the model in its 2023 performance year. It also found $304.8 million in increased net Medicare spending. The findings cover the model overall, rather than DaVita’s patients specifically.
HHS says the plan builds on the 2019 executive order Advancing American Kidney Health. The Kidney Care Choices model is scheduled to run through 2027, and The Lewin Group’s next report will assess its 2024 performance year.
