Who is the largest dialysis provider

Figure 3 presents the number of dialysis clinics owned by the major providers of dialysis services in the United States as of January , with market share concentrated among two largest providers.

DaVita is one of the largest providers of kidney dialysis services and related lab services in the United States. In , the company was renamed DaVita. DaVita Kidney Care provides dialysis and related lab services. DaVita owns or manages approximately 2, outpatient dialysis facilities in the United States and provides acute inpatient dialysis services at approximately hospitals. Based on the number of patients served, DaVita has approximately 37 percent market share within the United States.

In , DaVita added facilities to its portfolio through acquisitions and de novo projects. In addition to providing dialysis services, Fresenius Medical Care also develops and manufactures a full range of dialysis equipment used at dialysis clinics. Fresenius Medical Care owns or manages approximately 3, outpatient dialysis centers worldwide, which serve approximately , dialysis patients.

Based on the number of patients served, Fresenius Medical Care has approximately 38 percent market share in the United States. ARA owns and operates more than dialysis clinics in partnership with approximately nephrologist partners treating approximately 16, patients in 27 states and the District of Columbia.

ARA has grown through a combination of de novo clinic openings as well as through acquisitions, and the company opened 13 or more de novo clinics each year from to Outside of the publicly traded operators discussed above, there are few other major dialysis providers in the United States.

The remainder of the market consists of providers operating less than dialysis outpatient facilities. Figures 6 and 7 outline two key financial trends of the three publicly traded dialysis providers in the United States. In , Medicare was expanded to include coverage for patients with chronic kidney failure, for all patients regardless of age.

The payments are administered through two plans, Medicare Part A hospital insurance and Medicare Part B medical insurance. Most patients in need of dialysis care will qualify for and have both Medicare plans.

For most patients with private health insurance, the private payor is the primary payor during the first 30 months of dialysis treatment. After the month period, known as the coordination period, Medicare becomes the primary payor. The reimbursement rates vary considerably between private payors and governmental payors. While this study was specific to DaVita, the delta between governmental and private reimbursement rates exists throughout the industry and has led to regulatory and political backlash for dialysis clinics discussed further in later sections.

Related, the shift from fee-for-service to value-based care that is taking place throughout the healthcare system is impacting the dialysis industry as well. While there is currently a small quality adjustment to the fee-for-service rate received by dialysis clinics from governmental payors, new payment models have been promoted by CMS in recent years, and the Trump Administration has introduced new regulations which aim to move more dialysis into the home setting and reduce the costs associated with providing dialysis services to ESRD patients.

A recent proposal associated with the 21st Century Cures Act would enable ESRD patients to enroll in Medicare Advantage plans beginning in , reflecting the continued growth in Medicare Advantage and managed care in general. Fresenius accounted for 72 percent of ESCO facilities in the first two waves of participation, and DaVita represented 16 percent of participating facilities.

While overall results from the ESCOs were mixed and some providers reported positive outcomes according to Lewin Group, Fresenius has publicly discussed on several investor calls that issues regarding alignment with providers and benchmark setting have contributed to results that were below its expectations. Fresenius also indicated that the problems it experienced with its ESCOs would inform its decision regarding whether, and how much, to participate in voluntary models included in the Advancing American Kidney Health Initiative.

DaVita has publicly discussed certain reservations it holds about the models as well. The initiative outlines several goals, including improving access to kidneys for transplant, shifting more patients to home-based dialysis treatments, encouraging the development of artificial kidney devices, and changing reimbursement for kidney disease treatment. In particular, the initiative created five new payment models, one of which is mandatory and four of which are voluntary.

The mandatory payment model is the ESRD Treatment Choices model, and makes mandatory adjustments to reimbursement to participating providers for home-based dialysis and dialysis services.

The mandatory model is intended to increase home-based treatment and encourage providers to educate patients on their treatment options. By comparison, that is the largest rate of growth in the last three years among the 10 largest providers: these dialysis companies added 17, patients from and 19, patients from In , a shortage of dialysate for peritoneal dialysis patients led to a significant drop in the number of new patients on the therapy.

There was an uptick in the number of PD patients in see Figures 2 , That continued growth was seen this year as well, with almost 2, patients added between Growth in the number of home hemodialysis patients slowed significantly this year after steady increases of patients per year since This year, growth was limited among the top 10 providers to less than patients. Overall, the 50, patients on home therapies in represents That has changed little over the last four years, as providers continue to place the majority of new patients into outpatient centers.

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