Author Topic: DVA – DaVita HealthCare Partners  (Read 190844 times)

DooDiligence

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Re: DVA – DaVita HealthCare Partners
« Reply #630 on: July 11, 2019, 07:12:21 AM »
It's funny the articles and tweets about Davita and Fresenius taking 20% of the Medicare budget.  These companies collect about 20bn in revenues total against a 700bn medicare budget.  And their net profit after expenses and reinvestment is peanuts in the scheme of the health system profit pool.  It's amazing how badly these dialysis companies have lost control of the narrative.  They must surely be the smallest, lowest margin, most un profitable part of the us healthcare system and their publicity has got so bad that even the fintwit community is lambasting them for gouging and over-earning  :o
In 1973, Medicare in the US was expanded to cover all who needed dialysis (a first for a specific medical condition). FWIW, this is also when medicine became 'socialized' where I live; the establishment showed significant resistance but was seduced by the promise of more consistent payments, sweeping under the rug the growing but unrecognized issue of who was really in the driver's seat. In 1973, for the US, the initial expansion concerned about 10 000 patients and the expected inflation-adjusted cost was felt to never exceed about 1 billion in today's USD. The number of people covered has been multiplied by about 40 and costs have followed the tapeworm curve.

The outlook is meshed with capacity to adapt.

Under the Berkshire umbrella, recently, it has been decided to sell (unusual move) an insurance sub (Applied Underwriters) because of different vision and strategy among the various subs serving the workers comp market. I would say Berkshire Hathaway is in a similar situation today in the cost-value proposition in healthcare and will need to choose if they keep their DaVita position. Opinion: DaVita is relatively ill positioned to adapt. The outlook is related to the capacity to earn a reasonable return but the definition of 'reasonable' goes way beyond its financial boundary and politicians occasionally respond to their constituents (not meant to turn this into a political discussion, just meant to define the context in which dialysis providers operate).

https://fas.org/sgp/crs/misc/R45290.pdf

Footnote 38: Social Security Administration, “DI 45001.001 End-Stage Renal Disease (ESRD) Entitlement Provisions,” at https://secure.ssa.gov/poms.nsf/lnx/0445001001; and CMS, Medicare Coverage. In an effort to spur greater use of home dialysis, the End-Stage Renal Disease Amendments of 1978 (P.L. 95-292) eliminated the three-month waiting period for Medicare coverage if a beneficiary elected home dialysis treatment, subject to certain requirements. In addition, §2145 of the Omnibus Budget Reconciliation Act of 1981 (P.L. 97-35) instituted a new reimbursement formula that provided greater incentives for home dialysis treatment.

Me - Incentives for home dialysis have been around since 1981 & haven't taken hold. What has/have been the impediment(s)?

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Page 18: When initially implementing the PPS, CMS set the bundled payment rate at 98% of the existing cost of dialysis services. In the American Taxpayer Relief Act of 2012 (P.L. 112-240), Congress authorized CMS to gradually reduce, or rebase, the PPS base rate to take into account cost savings from a sharp decrease in the use of intravenous drugs for treating anemia, along with other payment revisions.81 Congress has included provisions in the Protecting Access to Medicare Act of 2014 (P.L. 113-93) and other statutes making further adjustments to the PPS.82

Me - How can you expect a business to continue to operate if you demand that the companies lose 2% on their services? I knew this already but what am I missing? Is this what's going to happen to all healthcare & pharma providers in the coming years? If so, republican lawmakers need to quit screaming socialism.

---

As to increasing the supply of donor kidneys. What's Trump going to do, start using Mexican detainee kidneys?

---

I agree with thefatbaboon (I know I'm biased due to DVA ownership stake but) FinTwit shorts are representing here but don't seem to be attacking other areas of healthcare which, IMO, are operating under the same profit motives & are doing so in a far more abusive fashion (pharma).

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I'm staying long & will absorb the pain until these assholes cover.
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DooDiligence

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Re: DVA – DaVita HealthCare Partners
« Reply #631 on: July 11, 2019, 09:04:07 AM »

As to increasing the supply of donor kidneys. What's Trump going to do, start using Mexican detainee kidneys?


Squashing my own conspiracy theory.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127446/

---

I can't wait for Trump to Tweet

"Mexicans have bad kidneys & that's why we don't want them here."

 ;D
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thefatbaboon

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Re: DVA – DaVita HealthCare Partners
« Reply #632 on: July 11, 2019, 10:33:55 AM »

"...so great looking and smart, a true Stable Genius!"  ;D ;D ;D ;D

He's on fire today so we could easily get onto Mexico's dodgy kidneys!




thefatbaboon

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Re: DVA – DaVita HealthCare Partners
« Reply #633 on: July 11, 2019, 10:38:18 AM »
It's funny the articles and tweets about Davita and Fresenius taking 20% of the Medicare budget.  These companies collect about 20bn in revenues total against a 700bn medicare budget.  And their net profit after expenses and reinvestment is peanuts in the scheme of the health system profit pool.  It's amazing how badly these dialysis companies have lost control of the narrative.  They must surely be the smallest, lowest margin, most un profitable part of the us healthcare system and their publicity has got so bad that even the fintwit community is lambasting them for gouging and over-earning  :o
In 1973, Medicare in the US was expanded to cover all who needed dialysis (a first for a specific medical condition). FWIW, this is also when medicine became 'socialized' where I live; the establishment showed significant resistance but was seduced by the promise of more consistent payments, sweeping under the rug the growing but unrecognized issue of who was really in the driver's seat. In 1973, for the US, the initial expansion concerned about 10 000 patients and the expected inflation-adjusted cost was felt to never exceed about 1 billion in today's USD. The number of people covered has been multiplied by about 40 and costs have followed the tapeworm curve.

The outlook is meshed with capacity to adapt.

Under the Berkshire umbrella, recently, it has been decided to sell (unusual move) an insurance sub (Applied Underwriters) because of different vision and strategy among the various subs serving the workers comp market. I would say Berkshire Hathaway is in a similar situation today in the cost-value proposition in healthcare and will need to choose if they keep their DaVita position. Opinion: DaVita is relatively ill positioned to adapt. The outlook is related to the capacity to earn a reasonable return but the definition of 'reasonable' goes way beyond its financial boundary and politicians occasionally respond to their constituents (not meant to turn this into a political discussion, just meant to define the context in which dialysis providers operate).

https://fas.org/sgp/crs/misc/R45290.pdf

Footnote 38: Social Security Administration, “DI 45001.001 End-Stage Renal Disease (ESRD) Entitlement Provisions,” at https://secure.ssa.gov/poms.nsf/lnx/0445001001; and CMS, Medicare Coverage. In an effort to spur greater use of home dialysis, the End-Stage Renal Disease Amendments of 1978 (P.L. 95-292) eliminated the three-month waiting period for Medicare coverage if a beneficiary elected home dialysis treatment, subject to certain requirements. In addition, §2145 of the Omnibus Budget Reconciliation Act of 1981 (P.L. 97-35) instituted a new reimbursement formula that provided greater incentives for home dialysis treatment.

Me - Incentives for home dialysis have been around since 1981 & haven't taken hold. What has/have been the impediment(s)?

---

Page 18: When initially implementing the PPS, CMS set the bundled payment rate at 98% of the existing cost of dialysis services. In the American Taxpayer Relief Act of 2012 (P.L. 112-240), Congress authorized CMS to gradually reduce, or rebase, the PPS base rate to take into account cost savings from a sharp decrease in the use of intravenous drugs for treating anemia, along with other payment revisions.81 Congress has included provisions in the Protecting Access to Medicare Act of 2014 (P.L. 113-93) and other statutes making further adjustments to the PPS.82

Me - How can you expect a business to continue to operate if you demand that the companies lose 2% on their services? I knew this already but what am I missing? Is this what's going to happen to all healthcare & pharma providers in the coming years? If so, republican lawmakers need to quit screaming socialism.

---

As to increasing the supply of donor kidneys. What's Trump going to do, start using Mexican detainee kidneys?

---

I agree with thefatbaboon (I know I'm biased due to DVA ownership stake but) FinTwit shorts are representing here but don't seem to be attacking other areas of healthcare which, IMO, are operating under the same profit motives & are doing so in a far more abusive fashion (pharma).

---

I'm staying long & will absorb the pain until these assholes cover.

Dont despair DooDiligence!  Luckily we have United Health, the hospital groups, and the pharma companies to protect us from Davita and Fresenius chiseling the system  ;D
« Last Edit: July 12, 2019, 03:06:16 AM by thefatbaboon »

Cigarbutt

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Re: DVA – DaVita HealthCare Partners
« Reply #634 on: July 11, 2019, 05:02:25 PM »
The Mexican level of care is an interesting reminder, a lot of respect has to be given to the US system for innovation and Kent Thiry agrees with the above arguments but dialysis treatment in the US is more expensive and shows poorer outcomes when compared to other similar developed countries.

Buying DVA a few years ago was prescient in the sense that there was huge potential for economies of scale and scope but the path going forward assumes that there will be more of the same or that it will be possible to adapt. The HHS Secretary has a plan in mind and I would not underestimate a person who is also called a czar and whose father suffered from kidney failure.

https://www.statnews.com/2019/05/29/dialysis-care-offers-lessons-for-achieving-health-equity-in-the-u-s/
https://www.kidney.org/news/hhs-secretary-azar-speaks-transforming-kidney-care-kidney-patient-summit



DooDiligence

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Re: DVA – DaVita HealthCare Partners
« Reply #635 on: July 11, 2019, 08:35:22 PM »
The Mexican level of care is an interesting reminder, a lot of respect has to be given to the US system for innovation and Kent Thiry agrees with the above arguments but dialysis treatment in the US is more expensive and shows poorer outcomes when compared to other similar developed countries.

Buying DVA a few years ago was prescient in the sense that there was huge potential for economies of scale and scope but the path going forward assumes that there will be more of the same or that it will be possible to adapt. The HHS Secretary has a plan in mind and I would not underestimate a person who is also called a czar and whose father suffered from kidney failure.

https://www.statnews.com/2019/05/29/dialysis-care-offers-lessons-for-achieving-health-equity-in-the-u-s/
https://www.kidney.org/news/hhs-secretary-azar-speaks-transforming-kidney-care-kidney-patient-summit

Thanks.

I don't doubt Azar's motives but this seems like low hanging fruit when you take into consideration the savings that could be achieved in other areas of healthcare, in particular the PBM's & pharma.

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Azar made the following statement on 10 July,

"For decades, across all of American healthcare, and kidney care in particular, the focus has been on paying for procedures, rather than paying for good outcomes."

https://www.hhs.gov/about/leadership/secretary/speeches/2019-speeches/remarks-on-advancing-american-kidney-health-initiative.html

This seems disingenuous given that pricing is transparent & Davita provides detailed information on outcomes. Unless their reports are falsified, they appear to be doing a good job.

https://www.davita.com/physicians/clinical

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From the same "NHS July 10, 2019 remarks on advancing American kidney health initiative" link,

"We’ve set out specific, ambitious goals: reducing the number of Americans developing end-stage renal disease by 25 percent by 2030, reducing the number of Americans receiving dialysis in a dialysis center, from 2019 levels, by 80 percent by 2025, and doubling the number of kidneys available for transplant by 2030."

It's easy to toss up nebulous numbers (this administration does a lot of that) but how are you going to reduce ESRD & increase donors?
What does a 25% reduction even mean? And double donors while reducing patients?

I can see the shift to home dialysis being incentivized but what will happen to outcomes?

Home dialysis is not as easy as they are making it sound.

Patient training & monitoring will be needed.

(see attachments)

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The dialysis industry looks like the whipping boy in a world full of bad actors.

Why don't they force pharma transparency & put the hammer on Medicare Part D payments like they do on ESRD?

Betting on the rational behavior of politicians is probably not a good idea & I know that complaining doesn't provide anything worthwhile towards analysis.

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ESRD is not going away & I don't see how they're going to incentivize huge numbers of (edit: compatible) donors.

I'm going to trust that Davita will make the pivot into home dialysis & will continue to provide valuable services at a reasonable cost.

---

Thanks again for taking the time to help.

I'm living up to my signature...
« Last Edit: July 11, 2019, 08:37:36 PM by DooDiligence »
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DooDiligence

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Re: DVA – DaVita HealthCare Partners
« Reply #636 on: July 13, 2019, 08:53:38 PM »
Why don't they force pharma transparency & put the hammer on Medicare Part D payments like they do on ESRD?

Betting on the rational behavior of politicians is probably not a good idea & I know that complaining doesn't provide anything worthwhile towards analysis.

I'm living up to my signature...

I guess this kind of answers my half baked remarks on pharma pricing?

https://www.forbes.com/sites/brucejapsen/2019/07/11/trumps-aborted-drug-pricing-rule-spares-middlemen-and-the-drug-industry/#3978214ad22e
Healthcare 32.7% - CVS DVA EW NVO // BRK.B - 20.6% // Media & Communication 8.3% - CHTR DIS

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%'s held @ MV 06/18/2019 minus 18.3% investable cash

i trumpet my ignorance

https://twitter.com/tunawish

thefatbaboon

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Re: DVA – DaVita HealthCare Partners
« Reply #637 on: July 14, 2019, 01:28:01 AM »
Why don't they force pharma transparency & put the hammer on Medicare Part D payments like they do on ESRD?

Betting on the rational behavior of politicians is probably not a good idea & I know that complaining doesn't provide anything worthwhile towards analysis.

I'm living up to my signature...

I guess this kind of answers my half baked remarks on pharma pricing?

https://www.forbes.com/sites/brucejapsen/2019/07/11/trumps-aborted-drug-pricing-rule-spares-middlemen-and-the-drug-industry/#3978214ad22e

That's a relief, poor PBMs. 

Now hopefully no more time is wasted on the pharma companies as well so we can all get back to focusing where the real fat is: Davita!

Davita is gouging the healthcare system about $6 an hour to administer 120 million hours of treatment to the terminally ill. 

Clearly that's where we should be focusing.


DooDiligence

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Healthcare 32.7% - CVS DVA EW NVO // BRK.B - 20.6% // Media & Communication 8.3% - CHTR DIS

Drinkers & Smokers 7.5% - ABEV MO // Auto's & Oil 12.4% - CLB GPC VDE // Tech 0.0%

%'s held @ MV 06/18/2019 minus 18.3% investable cash

i trumpet my ignorance

https://twitter.com/tunawish