Kidney Failure and the Federal Government (1991) / Chapter Skim
Currently Skimming:
Structure of the Provider Community
Structure of the Provider Community
Pages 110-132
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From page 110... ...
Structural change in the provider community is analyzed in terms of: · overall growth in treatment capacity, especially in relation to the increase in patient population; · growth of hospital-based versus independent facilities; · growth of for-profit versus not-for-profit facilities; and · growth of large versus small facilities. The policy implications of these structural changes for access, patient choice, and quality of care are then briefly discussed with the committee's statements and recommendations.
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From page 111... ...
· The total number of Medicare-certified renal dialysis treatment providers grew from 1,004 in 1980 to 1,740 in 1988, with independent facilities contributing to over 90 percent of this growth. · In 1988, approximately 62 percent of all renal dialysis facilities were independent units, compared to about 40 percent in 1980.
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From page 112... ...
Outpatient Dialysis Facilities Since the ESRD program began in 1973, the total number of Medicarecertified renal treatment providers has grown from 606 to 1,819 in 1988, primarily in dialysis facilities. From 1980 to 1988, such facilities grew from 1,004 units to 1,740, an average annual growth rate of 7.1 percent (Table 6- 1)
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From page 113... ...
Actual treatments per year per unit capacity 52,364 to 105,958, an average annual growth rate of 9.2 percent,4 and the number of outpatient hemodialysis treatments grew correspondingly at 9.7 percent annually (Table 6-11. Thus, total capacity of all renal treatment providers, measured by the aggregate number of hemodialysis stations, grew somewhat slower than the patient population and the number of dialysis treatments provided between 1980 and 1988.
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From page 114... ...
Kidney Transplant Centers There were 167 renal transplant centers when the Medicare ESRD program was established in 1973. Each year the number decreased slightly until the early 1980s when the trend reversed, and the number of renal transplant centers grew at 4.2 percent annually from 151 in 1980 to 219 in 1989.
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From page 115... ...
Second, the proportion of black children treated in pediatric facilities is higher than in the adult facilities, and black patients receive transplants at lower rates than do whites. The number of pediatric ESRD patients is increasing (see Chapter 5)
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From page 116... ...
Outpatient dialysis providers can be categorized along three dimensions: hospital-based or independent; for-profit or not-for-profit; and size as measured by number of stations. Hospital-Based Versus Independent Providers9 Hospital-Based Providers The growth of hospital-based outpatient dialysis facilities can be examined in terms of increases in the numbers of facilities, dialysis stations, and patients, and their "market share" relative to that of independent facilities.
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From page 117... ...
By the end of 1988, about 62 percent of all dialysis facilities were independent, compared to approximately 40 percent in 1980. During this time, the independent facilities accounted for 92 percent of the increase in all outpatient dialysis facilities.
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From page 118... ...
_~ llospital-based units O 1 1 1 1 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 1988 Year FIGURE 6-1 Outpatient Dialysis Units, 1980-88: Independent Versus Hospital Based SOURCE: HCFA, 1980-88. Dialysis Stations The total number of stations in independent facilities also grew significantly from 6,111 dialysis stations in 1980 to 15,518 stations in 1988, at an average annual growth rate of 12.4 percent (Table 6-3 and Figure 6-21.
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From page 119... ...
number of facilities grew significantly. Since the growth in the number of independent facilities and stations was comparable to the increase in demand for patient treatments from 1980 to 1988, on a national level the independent facilities experienced no significant utilization rate increase.~° Not-For-Profit Versus For-Profit Providers In 1988, about 52 percent of all outpatient dialysis facilities were proprietary (Table 6-4)
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From page 120... ...
Independent not-for-profit facilities grew at a faster pace, from 79 units in 1980 to 185 units in 1988, an average annual growth rate of 11.2 percent (Table 6-5~. Dialysis Stations The total number of stations in not-for-profit facilities grew slowly from 7,230 in 1980 to 9,726 in 1988, an average annual growth rate of 3.8 percent.
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From page 121... ...
121 Do Do on Do ._ C)
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From page 122... ...
The not-for-profit sector accounted for 42.7 percent of the treatment capacity in 1988 but 48.5 percent of the total patient population. For-Profit Providers For-profit providers have been a major source of growth in outpatient dialysis since 1980 with increases in the numbers of facilities, dialysis stations, and patients receiving treatment.
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From page 123... ...
1 4000 1 2000 CO .O 10000 CC
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From page 124... ...
However, the medium-size and large facilities accounted for the growth of hospital-based renal treatment facilities during the 1980s. Although independent facilities are predominantly medium or large in size, they increased during the 1980s in all three size categories.
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From page 125... ...
125 ca - o + o C~ C)
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From page 126... ...
As previously noted, independent dialysis facilities, especially the forprofit ones, have grown far more rapidly than hospital-based units during the past decade. This growth of proprietary independent facilities has been accompanied by an increase of multiunit "chains." The project staff estimate that by 1988 more than half of all 912 for-profit renal dialysis facilities were affiliated with a chain.
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From page 127... ...
127 Do oo 1 or Do ._ V)
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From page 128... ...
128 oo oo o oo ._ V: Ct ~s Ct V)
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From page 129... ...
Vivra and REN, in 1989, became the first publicly traded all-dialysis service corporations. Additionally, there are a number of smaller chains, including Greenfield Health Systems Corporation, Detroit, Michigan; Renal Treatment Centers Corporation, Philadelphia, Pennsylvania; Satellite Dialysis, San Francisco, California; Northwest Kidney Center, Seattle, Washington; Salick Health Care, Los Angeles, California; Kidney Care, Jackson, Mississippi; Clinishare, Los Angeles, California; Neomedica Dialysis Centers, Inc., Chicago, Illinois; Home Intensive Care, N
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From page 130... ...
CONCLUSIONS Renal dialysis facilities have increased substantially in number since the ESRD program started in 1973. This increase has paralleled the growth of the patient population, although certain geographic areas still lack adequate treatment capacity to meet increasing demand.
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From page 131... ...
9. The distinction between hospital-based and independent outpatient dialysis providers is based on HCFA's categorization of renal treatment facilities.
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From page 132... ...
1980-88. Annual Facility Surveys.
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