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Behind the Huge Variations in Dialysis Patient Mortality

Cheryl Clark, for HealthLeaders Media, October 21, 2010

The way the Uncle Sam treats end-stage renal disease (ESRD) is—as close as anything else—socialized medicine.  

The federal government picks up the tab for dialysis, medications, hospitalization, lab, and physicians' supplies for at least 453,000 patients who lack private insurance, at an average cost of between $57,639 and $77,506 per patient per year as of 2008, according to the U.S. Renal Data System.

In 2008, ESRD costs were $26.8 billion, 5.9% of the total Medicare budget and a 13.2% increase over 2007.

Despite all this spending, however, the disease is plagued by enormously high death rates that average one in five patients undergoing dialysis a year.  In other words, for every 10 patients who get dialysis on January 1, only eight will still be alive on Dec. 31.  

To confound the issue further, the risk of dying varies greatly among the 5,000 dialysis centers around the country.

You would think Uncle Sam would want to count on good quality care for his money no matter where the care was provided. But that is not the case.

In some centers, risk-adjusted mortality rate is as low as 10%, while in others it is as high as 30% annually.  That means that in some centers, nine people walk out after a year, whereas in other centers, only seven.

That's a lot of deaths, despite an awful lot of money being spent, and without any good explanation for the wide variation, says Kamyar Kalantar-Zadeh, MD, PhD, a researcher and Director of Off-Campus Dialysis Expansion Program and Epidemiology at the UCLA David Geffen School of Medicine. Something else is obviously going on.

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