Eideard

DaVita’s new planned world headquarters in Denver

One of the nation’s largest providers of kidney dialysis deliberately wasted medicine in order to reap hundreds of millions of dollars in extra payments from Medicare, a former clinic nurse and a doctor are charging in a whistle-blower lawsuit.

The lawsuit says that the company, DaVita, used larger than necessary vials of medicine knowing that Medicare would pay for the unused portion of each vial if it were deemed unavoidable waste. DaVita, which treats nearly a third of the nation’s dialysis patients, denies the accusations.

The accusations are the latest related to how financial incentives may have driven overuse of pharmaceuticals in the dialysis business. In January, Medicare began a payment system that pays for the overall treatment and does not pay separately for the drugs accompanying it. Many practices, including the size of some vials used, suddenly changed, providing an instant case study of how financial incentives can influence treatment choices.

The lawsuit says that until January, for example, DaVita required nurses to use one 10-microgram vial of Zemplar, a vitamin D drug, instead of a six-microgram dose in three two-microgram vials,. It then billed Medicare for all 10 micrograms even though four went unused.

Instead of giving an entire 100-milligram vial of Venofer, an iron drug, once or twice a month, the clinics gave 25-milligram doses more frequently, the suit says. But since the drug came only in a 100-milligram vial, Medicare was billed for 100 milligrams for each dose, even though 75 milligrams were wasted, the lawsuit says…

This so-called bundled payment system has instantly turned drugs from a source of profit to a cost to be avoided. And dialysis clinics have responded.

Not especially different from the ever-popular cost-plus billing often used in the military-industrial complex. My least favorite form of welfare for capitalists producing non-consumable goods. If you have a guaranteed profit of any size – and can inflate the legitimate costs 100% – you double your profit.

For the first time, human blood vessels grown in a laboratory from donor skin cells have been successfully implanted into patients, according to new research presented in the American Heart Association’s Emerging Science Series webinar.

While more testing is needed, such “off-the-shelf” blood vessels could soon be used to improve the process and affordability of kidney dialysis.

“Our approach could allow hundreds of thousands of patients to be treated from one master cell line,” said study lead author Todd N. McAllister, Ph.D….

The grafts also have the potential to be used in lower limb bypass to route blood around diseased arteries, to repair congenital heart defects in pediatric patients and to fix damaged arteries in soldiers, who might otherwise lose a limb, said McAllister.

The tissue-engineered blood vessels, produced from sheets of cultured skin cells rolled around temporary support structures, were used to create access shunts between arteries and veins in the arm for kidney dialysis in three patients. These shunts, which connect an artery to a vein, provide access to the blood for dialysis. The engineered vessels were about a foot long with a diameter of 4.8 millimeters.

At follow-up exams up to eight months after implantation, none of the patients had developed an immune reaction to the implants, and the vessels withstood the high pressure and frequent needle punctures required for dialysis. Shunts created from patients’ own vessels or synthetic materials are notoriously prone to failure…

Besides addressing a costly and vexing problem in kidney dialysis, off-the-shelf blood vessels might someday be used instead of harvesting patients’ own vessels for bypass surgery. A larger, randomized trial of the grafts is under way for kidney dialysis, and human trials have been initiated to assess the safety and effectiveness of these grafts for lower-limb bypass.

Bravo. Basic research once again leads to a range of benefits for the seriously ill.

Of course, you never get past the TSA

Researchers are developing a Wearable Artificial Kidney for dialysis patients, reports an upcoming paper in the Clinical Journal of the American Society of Nephrology (CJASN). “Our vision of a technological breakthrough has materialized in the form of a Wearable Artificial Kidney, which provides continuous dialysis 24 hours a day, seven days a week,” comments Victor Gura, MD (David Geffen School of Medicine at UCLA).

The device—essentially a miniaturized dialysis machine, worn as a belt—weighs about 10 pounds and is powered by two nine-volt batteries. Because patients don’t need to be hooked up to a full-size dialysis machine, they are free to walk, work, or sleep while undergoing continuous, gentle dialysis that more closely approximates normal kidney function.

Such a device could lead to a “paradigm change” in the treatment of dialysis patients. Despite enduring long hours on dialysis every week—with major limitations in activities, diet, and other areas of life—dialysis patients face high rates of hospitalization and death. The U.S. dialysis population currently exceeds 400,000, with costs of over $30 billion per year…

The Wearable Artificial Kidney is successful in preliminary tests, including two studies in dialysis patients. The new study provides important information on the technical details that made these promising results possible.

“However, the long-term effect of this technology on the well-being of dialysis patients must be demonstrated in much-needed clinical trials,” adds Gura. “Although successful, this is but one additional step on a long road still ahead of us to bring about a much-needed change in the lives of this population.”

Still, this can and will be a giant step for a lot of humanity. And as our population becomes more and more an elderly population – the need for devices like this will increase.