Change in state rules sparks competition to build
Recent changes to state rules have prompted a rush to build new kidney dialysis clinics across Eastern Washington.
One company will get the nod this spring to build another facility in Spokane with five stations that clean the blood of people with renal failure. There also are proposals to put 20 new dialysis units in the Tri-Cities and 17 more in Wenatchee. A new clinic has opened in Colville, and others are being considered in Whitman, Adams and Lincoln counties.
New clinic plans are applauded by patients and their doctors. Dialysis is a life-saving treatment that often requires patients to visit a clinic three times a week for hours at a time.
Having more clinics to choose from, especially for patients in small towns, bolsters safety and convenience.
Spokane nephrologist Dr. Henry Mroch remembered a patient from Tekoa who missed dialysis for eight days as last year’s record snowstorms closed highways. “We became very worried,” Mroch said.
Such stories underscore the necessity of more dialysis clinics in rural Eastern Washington as the number of people with kidney disease climbs.
Driving the increase is an aging population with higher rates of obesity, diabetes and hypertension.
There are about 335,000 dialysis patients in the United States. In Washington state there are 5,467, according to the Northwest Renal Network. Some experts say there will be a 60 percent increase in kidney disease within 10 years.
In 2007, the state changed the system it uses to approve applications for new dialysis clinics. Previously, state regulators issued a Certificate of Need on a regional basis. The new rules look at the need within a county’s boundaries.
Mroch said most kidney doctors are proponents of competition and remain concerned that even with the changes to the state’s Certificate of Need program, competition continues to be limited.
He pointed to North Idaho, where dialysis providers do not have to meet needs-based criteria to build a clinic.
Sacred Heart Medical Center established dialysis services in Spokane decades ago. Then in the late 1990s, Fresenius, the world’s largest dialysis company, won difficult approval from state health regulators to turn Spokane into a competitive dialysis market when the need for more kidney services outpaced the supply of dialysis stations.
A few years after Fresenius opened its clinics in Spokane, Sacred Heart sold its dialysis clinics to Renal Care Group.
Several years ago Fresenius bought Renal Care Group. As a condition of the sale, regulators required Fresenius to divest itself of the clinics it had built. DSI, another big dialysis operator, bought those.
Jean Stevens, a Fresenius regional vice president based in Portland, said the company has found a competitive business model for Eastern Washington that works. The company is competing with the nation’s second-largest dialysis company, DaVita, to build a clinic in Spokane. DaVita wants to build its first Spokane clinic north of downtown along Indiana Avenue.
Fresenius wants to build its fourth Spokane County clinic in Deer Park.
Only one will get approval.
Providence Sacred Heart and Deaconess medical centers have their own inpatient dialysis units.
While large companies have come to dominate dialysis services in many parts of Washington, Seattle’s dialysis patients continue to be served by Northwest Kidney Centers in Seattle, a nonprofit that has been caring for kidney failure patients for 48 years.
The changes instituted in 2007 may be most pronounced in the Tri-Cities, where two counties and three cities come together at the confluence of the Snake and Columbia rivers. State regulators, using the new county-based needs methodology, determined Benton County is an underserved dialysis area even though neighboring Franklin County has underused kidney clinics.
Fresenius and DaVita are competing for the right to build.
There are also two competing applications in Wenatchee. DaVita and Central Washington Hospital are attempting to gain the approval, said Bart Eggen, executive manager of Washington’s facilities and services licensing unit within the Department of Health.
“The state does recognize the good of competition,” Eggen said, “but we try to temper that to ensure existing providers can be protected and flourish.
“In the end we hope these changes will provide better access for patients and improved service.”
He said dialysis treatments enjoy an unusual reimbursement model. Medicare covers about 70 percent of patients, regardless of age. It’s an unusual arrangement for the government program that acts as insurance for Americans older than 65 years.
“What it means is that there are very few dialysis patients who are uninsured,” Eggen said.
While the Medicare arrangement is unusual, the complaints about the program’s reimbursements are not.
“There’s no doubt that Medicare reimbursements are insufficient,” Stevens said. “Like hospitals and other providers, we depend upon private-pay insurers to make it all work.”
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