Am I being feint with my praise? I don’t think so.
The following statement worries me: “"DaVita and the industry are working with CMS to improve quality for our patients in several aspects," said DaVita Group Vice President LeAnne Zumwalt. "We look forward to partnering with CMS on the development and implementation of the expanded QIP in 2014 and beyond." QIP takes two clinical areas into account. The first is anemia management, and the second is Urea Reduction Ratio (URR).
Neither anemia nor URR as surrogate endpoints correlate with hard outcomes, such as death or cardiovascular complications. For example, raising the hemoglobin (Hb) concentration with epoetin-alfa (the Normal Hematocrit study) does not result in improved outcomes; on the contrary, there is a 30% higher rate of death or heart attacks. Likewise, as reported in the HEMO study raising the URR (or a related parameter KT/V) does not improve outcomes.
The big picture is that we still haven’t figured out for sure what interventions work in dialysis patients. We need a better mouse-trap, not metrics to see how well the current mouse-trap is working.
DaVita, as a profitable dialysis company (profits have doubled from last year), needs to invest serious money in trials to figure out the one thing that matters the most to dialysis patients: living longer and more fullfilling lives.
With approximately 1,777 dialysis facilities, serving approximately 138,000 patients, revenues of $1.86 billion and a gross margin of nearly 18%, DaVita is a powerful presence. It has ambitions to be even larger and control more of the health care spend of it's dialysis patients. However, DaVita's financial statements indicate a zero dollar R&D expense, even though I am sure that they do spend some money on clinical research. Who can blame them for running a commercially profitable and efficient enterprise? However, it is a fair criticism that they are not spending money on research figuring out how to improve clinically meaningful outcomes in dialysis patients (and here I am referring to large well designed RCTs).
What we need from DaVita, as one of the largest dialysis organizations (LDO's) around, is to get off the side-lines and invest in trials in their patients. Obsessing about QIP formulated outcomes like anemia and dialysis adequacy is failing to see the forest from the trees.