Dialysis facility joint ventures: do resource utilization and health outcomes vary by ownership status of dialysis facilities?
Abstract: Dialysis facility joint ventures (JVs) allow a nephrologist or group of nephrologists to partner with a dialysis company to share in the management, profits, and losses of an outpatient dialysis facility. Proponents of JVs argue that these arrangements align the interests of nephrologists and dialysis companies to drive improved clinical outcomes and increased patient satisfaction. Others have cautioned that JVs create financial conflicts of interest for participating nephrologists that may inappropriately influence decisions about patient care. However, there have been no published studies on the effects of JV ownership of dialysis facilities on patient care or clinical outcomes. The primary barrier to such research has been that virtually no information about JVs—including which dialysis facilities are operated as JVs or even the total number of dialysis facility JVs that exist in the US—is made publicly available by dialysis companies or regulatory agencies. Using a novel dataset of dialysis facility ownership information we obtained via a Freedom of Information Act request to the Centers for Medicare and Medicaid Services and clinical, administrative, and institutional data collected by the United States Renal Data System, this study will be the first to explore associations between physician ownership of dialysis facilities and a range of utilization and outcome measures, including standardized hospitalization and mortality rates, transplant rates, and utilization of erythropoiesis-stimulating agents.