May 22, 2018
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DHHS greenlights sale of EMMC dialysis clinics to national chain

By Jackie Farwell, BDN Staff

BANGOR, Maine — Eastern Maine Medical Center has cleared the final regulatory hurdle in a more than $17 million deal to sell its dialysis clinics to one of the country’s largest for-profit dialysis chains.

State Department of Health and Human Services Commissioner Mary Mayhew this week granted Colorado-based DaVita Inc. a certificate of need, wrapping up a state review process that began in March.

The deal officially closed Thursday evening, according to a DaVita spokesman.

DaVita was eager to complete the deal and “looks forward to bringing the benefits of [its] 12 straight years of improved clinical outcomes to EMMC’s dialysis patients,” the company said in a statement. “EMMC has been extremely easy to work with and we anticipate that they will be an outstanding partner in transitioning patient care to DaVita in a smooth, seamless manner.”

DaVita is taking over EMMC’s kidney dialysis clinics in Bangor, Ellsworth and Lincoln, as well as its in-home dialysis program. DaVita also will assume management of inpatient acute dialysis services at the hospital.

Dialysis is a procedure that involves filtering toxins from the blood of patients who have diseased kidneys. Many dialysis patients are older and suffering the effects of years of diabetes.

Under a subsidiary called Total Renal Care Inc., DaVita acquired the assets of EMMC’s dialysis program for $17.3 million, according to Mayhew’s Tuesday letter to the company announcing her approval of the certificate of need.

The same physicians and staff will remain at the dialysis clinics to provide care, which hospital officials expect will lead to a smooth transition for patients and their families, said Jill McDonald, vice president of communication and market development at EMMC.

The clinics employ about 60 people and serve approximately 225 patients.

Mayhew issued her approval on the condition that DaVita develop a “patient support board” that meets at least quarterly for the first three years of DaVita’s ownership. That condition was recommended by staff in DHHS’ certificate of need unit, which evaluates whether proposed health care projects meet patient demand for medical services.

The safety of patients who are seriously ill with kidney disease was raised in July at a public hearing in Bangor about the proposed sale. A nurse’s union and patient advocates spoke out against the deal, concerned that DaVita would put profits ahead of patients and highjack local doctors’ decisions about patient care.

Officials with DaVita and EMMC, as well as some dialysis nurses who contradicted the union, argued that the company bests EMMC on many quality measures and has the expertise to better manage the clinics.

Kathy Day, a patient advocate and registered nurse who formerly worked at EMMC, has spoken out against the sale, saying the loss of local control could put patients’ lives at risk.

Day said Thursday that DHHS, not DaVita, must oversee the patient support board to ensure dialysis patients are represented fairly.

“Patients want and expect high-quality, safe, clean and accessible dialysis services in the Bangor region. … Now it is the responsibility of DaVita to provide that level of service and to do it well,” she said. “Nobody should ever be turned away because of inability to pay, or dismissed without very serious cause.”

Day became concerned about the deal after learning that DaVita, operator of more than 1,800 clinics in 43 states, is facing legal challenges on several fronts.

DaVita’s purchase of the clinics marks the company’s first foray into Maine. DaVita and competitor Fresenius Medical Care, which operates 10 clinics in Maine, run two-thirds of all dialysis clinics in the country.

Complex regulations and the highly specialized nature of dialysis programs have led most hospitals across the country to sell their outpatient dialysis clinics.

“It’s a hugely complicated process to replace the function of one little kidney,” McDonald said. “We felt that it was better handled by a company that does only that; that’s a real expert.”

As a nonprofit hospital operating a dialysis program, EMMC was a member of a dying breed. More than 80 percent of the nation’s 5,000 dialysis clinics are for-profit, according to an analysis of the industry by journalism nonprofit ProPublica.

Financial incentives encouraged for-profit operators to get into the dialysis business. The shift dates back to 1972, when Congress voted to extend Medicare coverage to nearly anyone diagnosed with kidney failure, including full payment for dialysis and kidney transplants.

At EMMC’s dialysis clinics, nearly 90 percent of the patients rely on Medicare.

The hospital will use the money from the sale to fund other services, McDonald said, though she did not specify which ones.

“We need to continue to invest in other areas of care where we have expertise and can focus our time,” she said. “Certainly the proceeds will be invested in other areas of the hospital.”

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