DVA – DaVita HealthCare Partners

[walkie518]

They are really downplaying the AKF legislation issue...it is a legitimate loophole in reimbursement laws they have built the last ~10 years of their business on

DaVita won the last suit ... the CA governor vetoed for very good reason

The new bill is not so far from the last one...largely sponsored by health insurers who don't want to provide coverage, this new one is likely no different

Winning by hurting people doesn't seem to be the way of the future but the dark side of capital markets

[cubsfan]

They are really downplaying the AKF legislation issue...it is a legitimate loophole in reimbursement laws they have built the last ~10 years of their business on

DaVita won the last suit ... the CA governor vetoed for very good reason

The new bill is not so far from the last one...largely sponsored by health insurers who don't want to provide coverage, this new one is likely no different

Winning by hurting people doesn't seem to be the way of the future but the dark side of capital markets

Yup, it's bogus and won't go away anytime soon, with each new administration, they'll take another shot. But the AKF keeps the system working well
for patients who can not afford these costly lifesaving treatments. The insurance companies get plenty of benefits, given the way the system is set up.

[ander]

FOCUS-U.S. seeks to cut dialysis costs with more home care versus clinics

https://finance.yahoo.com/news/focus-u-seeks-cut-dialysis-120000932.html

[Spekulatius]

Transplants are limited by the availability of transplant organs. the problem with home care is complexity and compliance. A lot of dialysis patients have issues (drug addiction, tendency of negligence, mental etc) and home care requires skill , compliance, hygiene and a partner who can support, when something goes wrong. A lot of patients probably couldn’t do the necessary task them selves at this point or wouldn’t comply. While home care is preferable from a clinical POV (the more frequent treatment cycle causes less issues), the home dialysis systems need to be simplified from a users perspective to increase the addressable market.

[cubsfan]

Transplants are limited by the availability of transplant organs. the problem with home care is complexity and compliance. A lot of dialysis patients have issues (drug addiction, tendency of negligence, mental etc) and home care requires skill , compliance, hygiene and a partner who can support, when something goes wrong. A lot of patients probably couldn’t do the necessary task them selves at this point or wouldn’t comply. While home care is preferable from a clinical POV (the more frequent treatment cycle causes less issues), the home dialysis systems need to be simplified from a users perspective to increase the addressable market.

+1 - great insights

[MrB]

Transplants are limited by the availability of transplant organs. the problem with home care is complexity and compliance. A lot of dialysis patients have issues (drug addiction, tendency of negligence, mental etc) and home care requires skill , compliance, hygiene and a partner who can support, when something goes wrong. A lot of patients probably couldn’t do the necessary task them selves at this point or wouldn’t comply. While home care is preferable from a clinical POV (the more frequent treatment cycle causes less issues), the home dialysis systems need to be simplified from a users perspective to increase the addressable market.

Expanding on the above the sad reality is that the average patient became a dialysis patient because they've not been good at managing certain complexities of life in a disciplined manner e.g. bad lifestyle choices and sticking to a healthy diet. Now you're expecting them to manage home dialysis. Easier said than done.

[rogermunibond]

George Church lab at Harvard is using CRISPR to create transgenic porcine hearts, kidneys etc for transplant.

Still years off at scale but pretty neat.

[rogermunibond]

Azar wants to promote in-home dialysis away from centers.

https://www.fiercehealthcare.com/payer/azar-hhs-rethinking-payments-to-expand-access-to-home-dialysis-kidney-transplants

[DooDiligence]

My Mom gets periodic antibiotic infusions at home.

Techs frequently don't show up on time or they show up but don't have what's needed to do the treatment.

She prefers going to the hospital to have it done

Maybe in home dialysis will work though.

[walkie518]

In the Far East, I believe PD is the norm.  In the US, however, in-center HD is--maybe for good reason, maybe not. 

90% of patients are gov't funded since Nixon signed into law.  We all know that these patients are lowest margin for DVA and those covered by private insurance keep the lights on.

Given that a portion of the business might shift away from in-center to inventory management and drug/dialysate reimbursement, I wonder how the economics could not be better for DaVita? More reimbursement for admin and drug and less spend on in-person care?

Has anyone done an analysis of these economics?