Much has been made in the press recently about the agreement between Eastern Maine Medical Center and DaVita to transfer ownership of the three regional dialysis centers to DaVita. Open discussion about this agreement and the involved parties is of paramount importance and will allow those most affected by this agreement — the patients, their families and the staff at these centers — to have an accurate picture of what they can expect in the coming months.
I have, unfortunately, been disappointed by what has been left out of the discussion thus far.
The reports and comments have focused on how big a company DaVita is and any negative press the company has had in the past. Recently, an opinion piece in the BDN asked questions about local oversight, local care by local people and where the money will go.
The operation will continue to be licensed and inspected by the state of Maine, as it is now, and directed by the same physicians the patients know now. The physicians’ compensation arrangement with DaVita will be the same as it has been with EMMC and ensures that physicians are guiding the course of care, and no one else.
As for keeping local dollars local, the largest portion of any health care budget is wages for the staff providing the care, all of whom are local people. In addition, water, power, rent and other operational costs will also be going to Maine organizations. While these discussions have their place, in my opinion they do nothing to educate the most affected individuals about what they can expect.
As a physician, my primary focus is always the welfare of my patients. The leadership at DaVita has been very open about their practices and welcomed questions about patient care. More than a half dozen of their team, including the regional nephrologist from Connecticut, made the trip to Bangor to answer all of our questions and concerns.
In the world of dialysis, we use various factors such as anemia management, dialysis access type and efficiency of dialysis as metrics to gauge quality of care. The facts are that DaVita consistently has some of the best outcomes in the nation. Their fistula rates — a best practice quality standard for dialysis care — are consistently higher than other providers. This has been shown to decrease infections and hospitalizations and reduce mortality.
I feel these facts should be given more emphasis when we talk about the proposed agreement. While the physicians, RNs and dialysis technicians will remain largely unchanged (most of the staff are planning on working for DaVita) the support that DaVita will be able to provide for other staff — such as dieticians, social workers, home dialysis services — will be augmented. From my perspective as a physician, bringing DaVita to our community is of benefit to my patients. This is a positive development.
During this entire process EMMC has welcomed our input as nephrologists and has worked to find the best fit with regards to a partner in this agreement. I think the public has a right to know that EMMC did its due diligence and had multiple national providers of dialysis present their vision for the dialysis program.
The decision to divest the dialysis program was not taken lightly. The process of replacing the work of the human kidney through man-made means is incredibly complicated and highly regulated. Due to the increasingly complex and ever-evolving nature of the rules and regulations surrounding dialysis, the hospital concluded — finally, and with the support of our independent nephrology group — that patient care would be best served by going with a national company, with dialysis as its only focus.
Questions about the proposed agreement are both welcome and expected, as change always brings about uncertainty. While there will be some changes to the program during this transition, much will remain familiar. Again, because the staff, physicians and locations will remain largely unchanged, this should ease some of the natural anxiety.
I am confident that partnering with DaVita will allow our dialysis program to grow and adapt to the ever-changing landscape of dialysis and continue to provide outstanding patient care.
Michael McGoldrick, MD practices nephrology in Bangor.