NYC Hospitals’ Dialysis Plan Is Under New Scrutiny

Thu, 02/13/2014 - 8:56am
Nina Bernstein

For 400,000 people across the country with failed kidneys, dialysis care is a matter of life and death. It is also a lucrative business, in part because Medicare pays for such treatment regardless of age.

But as for-profit clinics and chains have grown to control about 85 percent of the dialysis market over the last decade, researchers have documented starkly higher mortality rates in centers owned by for-profits compared with nonprofits.

Now the New York State Public Health and Health Planning Council is set to vote Thursday on a deal to turn over dialysis at four of New York City’s public hospitals to a for-profit franchise called Big Apple Dialysis despite government data showing the company’s centers did not perform as well as the hospitals themselves.

The deal was approved more than a year ago by the city’s Health and Hospital Corporation, the public hospital agency, which says the terms of the contract ensure that quality will remain high, and that shifting dialysis patients to Big Apple, part of a company called Atlantic Dialysis, will save the financially troubled hospital system $150 million over the next nine years. Atlantic, based in Queens, has agreed to pay the city $1.6 million in annual rent and $1.1 million to buy equipment at the 57 dialysis stations that now treat about 1,000 patients at the four city hospitals — Harlem Hospital, Kings County Hospital, Lincoln Hospital Center and Metropolitan Hospital.

But the contract, which hinges on the planning council approving the company for a “certificate of need,” is now under new critical scrutiny. The New York State Nurses Association and patient advocates are pointing to government data on death rates, adjusted by Medicare for patient mix and severity of illness, that show Atlantic’s operations performed 3 percent worse than the national norm between 2009 and 2012, while the four hospitals, over all, performed 17 percent better than average.

“We believe that selling patients into the commercial dialysis market is in direct conflict with H.H.C.’s public service mission and governing statute,” Carl Ginsburg, a spokesman for the nurse’s union, told the planning council committee that considered the matter on Jan. 30. He urged that the committee give the new city administration a chance to review it.

Late on Wednesday, that request was echoed in a letter emailed to the planning council by the City Council speaker, Melissa Mark-Viverito, the chairman of the Council Health Committee and members representing the affected districts.

Both sides agree that part of the expected savings for the hospitals, and for the 20 percent profit margin that the company projects on annual revenue of $15 million, is based on replacing nurses with lower-paid technicians, and increasing the patient capacity of each dialysis unit. Such measures are out of the public hospitals’ reach, officials say, for lack of capital to add about 60 dialysis stations and because they must pay higher fringe benefits.

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