A prominent U.S. senator has urged federal regulators to disclose the findings of an investigation into the dialysis industry, which critics argue is dominated by a “duopoly” that threatens the quality of essential kidney care. According to a CBS News investigation earlier this year, two companies, Fresenius and DaVita, control nearly 75% of all dialysis clinics in the United States, totaling approximately 5,600 facilities.
Senator Richard Blumenthal, a Democrat from Connecticut, expressed his concerns regarding potential abuses of market power during an interview. He noted, “The government may feel it has no leverage against two companies that provide for almost all the dialysis treatment in the country. But it has failed to use more leverage, including its antitrust powers against those companies.”
The Federal Trade Commission (FTC) has been investigating whether the market control exerted by these companies affects patient care. Despite this, results from the probe have not been made public. Blumenthal emphasized the importance of holding these companies accountable, stating he has requested that the FTC take “appropriate robust enforcement action” to address identified issues and protect patients, including veterans, from potential misconduct.
Approximately 500,000 Americans rely on dialysis to survive while awaiting kidney transplants, the only solution for most individuals suffering from end-stage kidney disease. Critics assert that the leading companies in the sector have prioritized profits over patient care. Tom Mueller, author of “How to Make a Killing: Blood, Death and Dollars in American Medicine,” highlighted the issue, stating, “This is emergency room care done in the mall. People are not given the tailored treatment that they need.”
Concerns about the concentration of power in the dialysis sector are echoed by economist Ryan McDevitt from Duke University. He remarked earlier this year that over the past three decades, the industry has slowly transitioned towards a “duopoly,” making it the most concentrated healthcare sector in the country. The CBS News review of federal data revealed that nearly one-third of dialysis clinics failed to meet federal standards in 2023, with about 2,500 of the roughly 7,600 clinics nationwide cited for deficiencies.
Both Fresenius and DaVita defended their performance in statements to CBS News, arguing that their track records reflect “exemplary care.” Nonetheless, McDevitt pointed out that Medicare’s reimbursement limits per patient have led these companies to focus on maximizing patient numbers to enhance profit margins. In 2022, DaVita provided over 29 million dialysis treatments, generating an average revenue of $391 per session, contributing to a combined revenue of $33.7 billion for both companies.
Research conducted by McDevitt has shown that when independent clinics are acquired by these corporations, their transplant referrals decrease by approximately 10%, patient survival rates drop by 2%, hospitalizations rise by 5%, and infection rates increase by around 12%. The two companies have contested these claims, with Fresenius asserting its commitment to “improving quality of life” for patients.
Despite ongoing concerns, the Center for Medicare and Medicaid Services (CMS) has routinely monitored dialysis clinics since 2013, uncovering over 115,000 deficiencies ranging from poor hygiene practices to inadequate training in handling medications. Fresenius highlighted that more than 65% of its clinics received three stars or higher on Medicare’s five-star rating scale, a figure the company claims exceeds the national average.
DaVita emphasized that issues reported in clinics are “rare and isolated,” arguing that these do not represent systemic failures in care delivery. In a statement, the company acknowledged, “We take every concern seriously, and if we make an error, we work immediately to resolve it.”
Blumenthal pointed out that a significant number of veterans, approximately 40,000, also rely on these for-profit clinics for their dialysis needs. In his correspondence to FTC Chairman Andrew Ferguson, he urged the agency to take decisive action to protect these vulnerable patients from misconduct, characterizing the industry as “ripe with predatory, monopolistic potential practices.”
In response to inquiries regarding the ongoing investigation, Fresenius stated, “We are aware of the inquiry and are fully cooperating with the FTC. As this is an ongoing investigation, we cannot comment any further.” The FTC and DaVita did not immediately provide comments regarding the investigation.
As this situation continues to develop, the spotlight remains on the dialysis industry, with advocates calling for increased transparency and accountability to ensure the provision of quality care for all patients reliant on these vital services.
