"We're going to talk about kidney dialysis," John Oliver announced yesterday on his HBO show, "Last Week Tonight."
Many of your eyes glazed instantly over. But if you work at DaVita, one of downtown Denver's major employers, your cheeks may have tensed.
"We're spending the most to essentially get the least," Oliver said, pointing out that people on dialysis die more often in the United States than almost any other industrialized nation, despite massive government spending.
And for the following 23 minutes he would excoriate DaVita for its alleged shortcomings in the provision of that care. Here are the claims and their sources.
It's an "amazing case study of good intentions being thwarted by bad incentives, poor oversight and profiteering," Oliver said.
Cut to Kent Thiry, the CEO of DaVita, doing a bizarre gymnastics routine while wearing a costume based on his life's inspiration, the film "The Man in the Iron Mask."
Context:
A little context first. In 1972, Richard Nixon signed a bill into law saying that the government would pay for dialysis care -- like universal health care for one organ, as if "only your kidneys are Canadian," Oliver quips.
Nearly half a million people now are on dialysis, taking up 1 percent of the federal budget, he continues, and a "vast industry has emerged ..."
The vast majority of that industry is owned by two companies: Fresenius Medical Care and DaVita, both massively successful. Thiry has taken DaVita from near-bankruptcy to a $13 billion market capitalization, and the company now is preparing for a major expansion of its downtown office space.
Claims:
Oliver cites claims that DaVita clinics rush treatments in order to maximize numbers, including an interview with Megallan Handford, a nurse who reportedly was fired after a decade for his unionizing efforts.
"You want to get them in, get their dialysis done, and get the next patient done," Handford said, adding that "you were not properly disinfecting" equipment.
DaVita disputes that claim, Oliver said.
Oliver goes on to criticize the government oversight of clinics like DaVita's, saying out that one clinic maintained a four-star rating despite an inspector's serious grievances.
Also mentioned: DaVita in 2014 paid $389 million to settle federal charges that it paid illegal kickbacks to doctors who referred patients, which potentially would bias their decisions about patient care. DaVita denies wrongdoing.
And in 2011, a director at one DaVita facility claimed that DaVita defrauded Medicaid by throwing away leftover drugs and billing the government. DaVita did not admit wrongdoing and agreed to pay up to $495 million to settle.
Then there's Epogen, a drug that a whistleblower claimed DaVita used in unnecessarily high amounts. DaVita did not admit wrongdoing while settling related fraud claims for $55 million in 2012.
"Just the three cases I have mentioned in the last five years have resulted in them paying out nearly $1 billion in settlements, and that doesn't exactly give you confidence in their product," Oliver said.
Then there's oversight. Oliver argues that the kidney-dialysis industry as a whole does an inadequate job of telling patients that a kidney transplant does much more to improve patient survival than continued dialysis.
Hoping to check on that claim, Last Week Tonight sent staffers to DaVita education classes. They found that transplants were in some cases presented as an equivalent to dialysis, rather than the preferred option, Oliver claims.
One DaVita educator said that some people choose to stay in the dialysis "family" and "community" instead of getting a transplant, according to Last Week.
Oliver goes on to criticize the industry broadly. "We focused on DaVita because they have the most patients," he says, and because of Thiry's antics, which the comedian exults in for some time. He adds that Fresenius also has paid at least one sizable settlement.
Oliver calls for better oversight and better incentives for transplants to happen -- including a call for more people to donate a kidney through giveandlive.us or through post-death organ donation.
DaVita's response, as emailed to me:
"We are proud of our differentiated clinical outcomes, our teammates’ dedication to patient care and our strong culture. Our teammates are passionate about delivering high-quality patient care and enabling our patients to live fulfilling lives. We will continue to advocate for our patients and invest in our teammates and our culture."
