Financial Ties, Market Structure, Commercial Prices, and Medical Director Compensation in Dialysis

With Xuyang Xia, Wanrong Deng, Paul Eliason, Ryan McDevitt, Jimmy Roberts, and Heather Wong
Published in JAMA Health Forum, 2025
Open access article available here. BibTeX citation available here.

Key Points:

Question: How did facility ownership in the US dialysis industry evolve between 2005 and 2019, and what is its association with commercial prices and medical director compensation?

Findings: In this economic evaluation, between 2005 and 2019, the US dialysis industry consolidated both horizontally and vertically, with the share of facilities operated by the 2 largest dialysis chains, DaVita and Fresenius, increasing from 59.1% to 77.1% and the share with a physician owner increasing from 11.4% to 29.1%. During this period, markets with only 1 large chain had 495.08 dollar higher commercial prices for outpatient hemodialysis and 564.56 dollar higher medical director compensation per patient compared to markets without large chain facilities.

Meaning: This study highlights the growing consolidation in the US dialysis industry, both horizontally and vertically, and its associations with higher commercial prices for outpatient hemodialysis and compensation for medical directors.

This paper won the 2025 ASHEcon Program Chair Award in the Competition in Health Care Markets program area.