A prominent U.S. senator is urging federal regulators to disclose findings from an investigation into the for-profit dialysis industry. Critics have raised concerns that a “duopoly” formed by two major companies is negatively impacting the quality of essential kidney care. According to a comprehensive report by CBS News earlier in the year, these two companies control nearly 75% of all dialysis clinics in the United States, amounting to approximately 5,600 facilities.
Senator Richard Blumenthal, a Democrat from Connecticut, expressed his worries about what he describes as the “hallmarks of unlawful abuse of market power.” In his interview with CBS News, he emphasized that the federal government might feel powerless against these dominant providers but has not fully utilized its antitrust powers to address the situation. “It has failed to use more leverage, including its antitrust powers against those companies,” Blumenthal stated.
The Federal Trade Commission (FTC) has been examining whether the market control held by these companies has adversely affected patient care. However, the senator noted that the agency has yet to make any findings public. Blumenthal has formally requested that the FTC “take appropriate robust enforcement action to remediate issues it has identified and protect patients, including veterans, from misconduct by these companies.”
Approximately 500,000 Americans rely on dialysis to survive while awaiting kidney transplants, which are the only viable solution for those suffering from end-stage kidney disease. The dialysis centers provide critical treatment, yet critics argue that the leading companies in the sector, namely Fresenius and DaVita, have shifted their focus toward profit maximization.
Tom Mueller, author of “How to Make a Killing: Blood, Death and Dollars in American Medicine,” articulated this concern, stating, “This is emergency room care done in the mall. People are not given the tailored treatment that they need.”
Economist Ryan McDevitt from Duke University indicated that the industry has been moving toward a duopoly for three decades, making it one of the most concentrated healthcare sectors in the country. A review of federal data conducted by CBS News revealed that one-third of dialysis clinics did not meet federal standards this year, with nearly 2,500 out of approximately 7,600 clinics failing to achieve acceptable performance. The average score among these facilities was a mere 60 out of a possible 100 points.
Both companies defended their track records when approached by CBS News, asserting that their operations reflect a commitment to “exemplary care.” Blumenthal, however, pointed to critical research suggesting that when independent clinics are acquired by either DaVita or Fresenius, key performance metrics such as transplant referrals and patient survival rates decline. Specifically, McDevitt’s research indicated a drop in transplant referrals by about 10%, a 2% reduction in patient survival rates, a 5% increase in hospitalizations, and a 12% rise in infection rates over the past two decades.
Fresenius responded to these allegations by stating that it maintains a steadfast commitment to enhancing quality of life and clinical outcomes for its patients. DaVita echoed this sentiment, asserting that its clinical teams provide high-quality, individualized care even within a complex regulatory environment.
Routine monitoring of dialysis clinics by the Center for Medicare and Medicaid Services (CMS) has revealed concerning deficiencies. Since 2013, U.S. dialysis centers have been cited for over 115,000 violations, including poor hand hygiene, unsanitary conditions in IV medication handling, and inadequate staff training. Both Fresenius and DaVita reported that they have taken these findings seriously, with Fresenius noting that over 65% of its centers received three stars or higher on Medicare’s five-star scale.
In a recent letter to FTC Chairman Andrew Ferguson, Blumenthal highlighted the growing reliance of veterans on for-profit dialysis clinics, stating that approximately 40,000 veterans depend on these services while they await kidney transplants. He urged the FTC to take decisive enforcement actions to protect these vulnerable patient populations from potential misconduct.
Fresenius confirmed its awareness of the ongoing inquiry and stated it is fully cooperating with the FTC. However, the company declined to provide further comment due to the investigation’s active status. DaVita and the FTC did not immediately respond to requests for further information.
The senator’s push for accountability reflects a growing concern about the potential for monopolistic practices within the dialysis industry, as patients continue to seek reliable and high-quality care.
