Three years ago, when kidney transplants were failing at twice the normal rate and at least five transplant patients died at the University Medical Center in Las Vegas, the Centers for Medicare and Medicaid Services moved to decertify the hospital’s kidney transplant program. US Representative Shelley Berkley (D-Nevada) intervened, along with two other members of the Nevada delegation.
The difference, according to Eric Lipton, writing for the New York Times, is that Berkley’s strong-arm tactics directly benefitted Larry Lehrner, her nephrologist husband. Lehrner “directs medical services at the hospital’s kidney care department—an arrangement that expanded after her intervention and is now reflected in a US$738,000-a-year contract with the hospital,” reports Lipton. “Ms. Berkley’s actions were among a series over the last five years in which she pushed legislation or twisted the arms of federal regulators to pursue an agenda that is aligned with the business interests of her husband, Dr. Larry Lehrner. In addition to the hospital contract, he operates a dozen dialysis centers in Nevada and has played a central role in an industry campaign to lobby members of Congress—including his wife—on behalf of kidney care providers.”
This illustrates exactly why the Stark Law was written: To prohibit physician self-referral (when a physician refers a patient to a medical facility in which he has a financial interest. Dialysis services are specifically excepted from the Stark Law under the “safe harbor” provisions of the law.
For an excellent analysis of the high stakes involved in the Stark Law exception for dialysis services, see Jennifer Brown’s excellent article for the Denver Post in 2009—just as dialysis provider giant DaVita was moving its headquarters to Denver—about sharp-elbowed approach to dealing with competitors.
My experience jibes with Brown’s reporting. My nephrologist group is closely-linked with DaVita and I’ve been told that if I moved outside of DaVita clinics no one in the practice would be able to see me. I have strong history with just about every partner in the group, and they’re individually and collectively the best in town, but they’re joined at the hip with a corporation where, as Brown cites in the Pikes Peak nephrologist group’s countersuit against DaVita, “‘cost-cutting measures and administrative bureaucracy’ were taking precedence over patient care.”
I’ve been a patient at two Saint Paul DaVita-owned dialysis clinics since 2000. I have excellent relationships with my nephrologist and DaVita staff and feel that I get excellent care. But I did switch clinics several years ago because the quality of care at my original clinic had degraded each year. The only competing option in the Twin Cities metro area is the second-largest dialysis provider in the US, Fresenius. As a non-Medicare patient, I’d really like to see competition for providing dialysis services in this market. And I’d just about kill for one of those heated massage chairs they have out in Denver.
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