March 7, 2022

During National Kidney Month DVAC Highlights the Dangers of Healthcare Consolidation

WASHINGTON, DC — In recognition of National Kidney Month, the Dialysis Vascular Access Coalition (DVAC) is highlighting the devastating impact of healthcare consolidation and how it affects kidney patients. 


Dr. Dean Preddie, DVAC’s policy chair, penned an op-ed on the disturbing consolidation trend that hurts non-hospital providers and patients. Preddie points out how health system consolidation only widens the health equity gap and leaves dialysis patients with a lower quality of care. 


Health system consolidation spells disaster for ESRD Patients


By Dean C. Preddie, MD


Consolidation in the United States health care market has been increasing steadily for over ten years, and I think it’s safe to forecast given the economic challenges many providers have been faced with during the COVID pandemic, this trend is not likely to end.  


This is devastatingly bad news for End-Stage Renal Disease (ESRD) patients, particularly those being treated with the streamlined services offered by Vascular Access Centers (VAC), as those patients will now face significantly higher risk of infection, hospitalization and/or death. It is imperative that federal policymakers take immediate and aggressive steps to prevent a crippling impact to patients.


According to a Policy Research Perspective paper released by American Medical Association (AMA) in May 2021, 49% of patient care physicians worked in physician-owned practices, down fairly significantly from 54% in the 2018 AMA survey, and reflects the largest two-year change since the AMA survey began in 2012. One can assume that the recent trend of mergers and acquisitions resulting in private practice closures is a significant contributing factor to the data gathered by the AMA.


Experts in our field have been ringing the alarm bells on health care consolidation for years. In order to control costs and increase market share, large hospital systems have been absorbing physician networks and office-based specialists like a wet sponge in the rain, leaving the patient and the taxpayers to foot the bill for the increase in costs. And, worse, leaving some (most especially and disproportionately communities of color) without a place to go to receive life-saving dialysis or ESRD care. 


During this pandemic, if dialysis patients required hospitalization, they had the highest mortality rate of any single category of patients admitted to a healthcare facility. And with more consolidations and fewer VACs available to provide service, dialysis patients are forced to make the impossible decision to either visit the hospital and risk COVID exposure (and the resultant mortality risk) or skip treatment and risk certain death.


The fact is mergers and consolidations rarely lead to better quality care, more accessible options or lower prices. On the contrary, consolidation ultimately results in less committed care, provides fewer options and drives up health care costs. Studies have shown that ESRD patients treated in the office-based setting have 13% fewer hospitalizations and 38% fewer infections. And even if a dialysis or ESRD patient is able to make it to a hospital, it is far more likely that lengthy wait times and inadequate knowledge of medical history would lead to compromised care and ineffective treatment.


And given the data that clearly shows ESRD is far more prevalent in minority (African Americans, Native Americans and Asian Americans) communities, these consolidations would only serve to further the ever-widening health inequity gap.


The fact is that this consolidation trend is a primary factor in driving healthcare costs up at an exponential pace. The truth is that this consolidation trend is further dividing communities along racial lines. And the fact is that this consolidation trend will ultimately result in deaths that could have been avoided. 


If we don’t fix this soon, I assure you that the consequences will be felt for years to come.


Bio: Dean C. Preddie, MD, is an interventional nephrologist specializing in dialysis access management. He is the medical director of American Access Care Physician, PLLC Manhattan in Manhattan, New York, and serves as the policy chair for the Dialysis Vascular Access Coalition.