A prominent U.S. senator is urging federal regulators to disclose findings from an investigation into the dialysis industry, where critics claim a “duopoly” is undermining the quality of essential kidney care. According to a CBS News investigation earlier this year, two companies, Fresenius and DaVita, control nearly 75% of the U.S. dialysis market, encompassing approximately 5,600 clinics nationwide.
Senator Richard Blumenthal, a Democrat from Connecticut, expressed his concerns during an interview, stating he is alarmed by what he describes as “hallmarks of unlawful abuse of market power.” He noted, “The government may feel it has no leverage against two companies that provide for almost all the dialysis treatment in the country,” emphasizing the need for stronger regulatory action.
The Federal Trade Commission (FTC) has been investigating whether the market dominance of these two companies negatively affects patient care. However, any findings from this probe have yet to be made public. Blumenthal has formally requested the FTC to “take appropriate robust enforcement action to remediate issues it has identified and protect patients, including veterans, from misconduct by these companies.”
Approximately 500,000 Americans rely on dialysis as a life-sustaining treatment while awaiting kidney transplants, making the quality of care in these clinics critical. Patients visit these facilities for blood filtration, which is often their only option for addressing end-stage kidney disease. Critics argue that the focus on profitability by Fresenius and DaVita compromises patient care. Author Tom Mueller, who wrote “How to Make a Killing: Blood, Death and Dollars in American Medicine,” commented, “This is emergency room care done in the mall. People are not given the tailored treatment that they need.”
Economist Ryan McDevitt from Duke University noted that the industry has been trending toward a duopoly for three decades. He described it as “the most concentrated health care sector across the entire U.S.” Furthermore, a CBS News review of federal data revealed that one-third of dialysis clinics failed to meet federal standards this year, with nearly 2,500 of the roughly 7,600 clinics falling short. The average score across these facilities was 60 out of a possible 100 points.
In response to these criticisms, both Fresenius and DaVita have highlighted their commitment to patient care. DaVita reported delivering more than 29 million dialysis treatments last year, generating an average revenue of $391 per session, while both companies together amassed $33.7 billion in revenue. Critics like McDevitt argue that Medicare reimbursement limits incentivize these companies to prioritize filling treatment slots, which may negatively impact patient outcomes. His research suggests that when independent clinics are acquired by Fresenius or DaVita, transplant referrals decline by 10%, patient survival rates drop by 2%, hospitalizations rise by 5%, and infection rates increase by 12%.
Fresenius responded to the concerns, asserting that they are dedicated to improving “quality of life, strengthening clinical outcomes, and extending the lifespan of those we have the privilege to serve.” DaVita countered by claiming that problems within clinics are “rare and isolated,” characterizing them as exceptions rather than systemic failures.
For years, the Center for Medicare and Medicaid Services (CMS) has conducted routine assessments of dialysis clinics, having cited U.S. facilities for over 115,000 deficiencies since 2013, including issues related to hygiene and training. Fresenius pointed out that more than 65% of its dialysis centers received three stars or higher on Medicare’s five-star rating scale, which the company asserts is above the national average for all U.S. dialysis providers.
Senator Blumenthal has specifically highlighted the impact of these for-profit clinics on American veterans, indicating that approximately 40,000 veterans depend on dialysis while awaiting kidney transplants. In his letter to FTC Chairman Andrew Ferguson, he urged the agency to take decisive action against these companies, alleging that the industry is “ripe with predatory, monopolistic potential practices.”
Fresenius acknowledged the ongoing inquiry and stated that they are fully cooperating with the FTC but refrained from further comment due to the active investigation. The FTC and DaVita have not yet responded to requests for additional information. As the situation develops, the implications for patient care and industry regulation remain significant.
