Editor’s Note: This post is from our data newsletter, the Rural Index, headed by Sarah Melotte, the Daily Yonder’s data reporter. Subscribe to get a weekly map or graph straight to your inbox.
For millions of rural residents, the nearest dialysis clinic lies outside their county – or is owned by DaVita, a for-profit company with a documented history of kickbacks to doctors and involuntary patient discharges.
Approximately 6.1 million rural Americans live in a nonmetropolitan county where a DaVita facility is the only Medicare-certified dialysis clinic, according to my analysis of data from the Centers for Medicare and Medicaid Services (CMS). Another 16.5 million rural Americans live in a county with no facility at all.
DaVita, a Denver-based healthcare company that owns 2,700 dialysis clinics across the country, allegedly offered illegal kickbacks to doctors if they referred patients to their own clinics, according to a 2014 press release from the Department of Justice. DaVita paid out more than $400 million in the whistleblower settlement that year.
For-profit dialysis clinics like DaVita and its German rival, Fresenius, tend to have worse health outcomes compared to independent, non-profit clinics. Duke University’s Fuqua School of Business found that, after dialysis clinics were acquired by large, for-profit, companies, the likelihood of each patient being hospitalized each month increased by 4.5%. One 2019 study found that mortality rates increased by 10% after acquisition by a for-profit chain.
In a 2024 investigation, Mother Jones reporter Carrie Arnold told the story of Tommy, a man who died of Chronic Kidney Disease after being involuntarily discharged by a DaVita clinic. The government agencies meant to oversee discharges don’t follow up with the clinic to verify their justifications for discharge, according to interviews by Mother Jones.
In this edition of the Rural Index, I’m using data from the CMS dialysis facilities dataset, which includes all clinics with at least 11 patients in the fiscal year 2024. The following map illustrates counties where there are no clinics, or where DaVita is the only clinic.
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In 300 counties, 190 of which are nonmetropolitan, or rural, DaVita runs the only clinics in the county. In rural counties, about 31% of clinics are owned by DaVita. There are 1,431 counties that don’t have any clinics at all. About 81% of those counties are rural.
About 22.8 rural Americans – just over half of the total rural population – live in a county where either DaVita is the only clinic, or there is no clinic at all.
About 59% of rural counties don’t have a single Medicare-certified dialysis clinic. And in places like rural Central Nebraska or Western Kansas, patients might be several counties away from the nearest clinic.
In a 2021 meta-analysis in the International Journal of Health Services, researchers at the Spencer Foxx Eccles School of Medicine at the University of Utah advocated for improved regulations and policies, pushing for-profit dialysis centers to “achieve a higher standard of care.” Their analysis of dialysis data found that 3,800 excess deaths could be avoided if for-profit clinics matched non-profit mortality rates.
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