The VA Bows to the Dialysis Duopoly

https://prospect.org/health/2024-04-29-va-bows-to-dialysis-duopoly/


The federal contracting system has long been riddled with monopolists, union-busters, and rampant profiteers. From the Pentagon to the Department of Agriculture, bad behavior from private companies is routinely and paradoxically rewarded with public funds, and little oversight from the government institutions. Sometimes, these corrupt dynamics literally cost lives. The Department of Veterans Affairs (VA) has long been assailed for the costly and ineffective contracting network it has built to (often, grossly inadequately) service veterans’ health care needs.

This dysfunction has been both caused and worsened by privatization schemes that transfer untold billions to private corporations, at the cost of basic access to care for veterans. These ineffectual privatization schemes extend to everything from the VA’s IT network to its provision of mental health treatment. Each additional iteration of privatization undermines veterans’ basic access to quality care, allows the obscene profiteering of taxpayer money by private companies, fosters the formation of abusive monopolies, and endangers workers and patients alike. Perhaps nowhere is this dynamic more viciously on display than in the VA’s relationship with its dialysis contractors.



There are over 40,000 veterans enrolled in the Veterans Health Administration (VHA) who are suffering with kidney failure, as per the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Kidney failure is largely treated by dialysis, and approximately 81 percent of veterans who received dialysis treatment through the VHA do so through so-called “community providers,” which is now largely accomplished via two distinct programs; the Nationwide Dialysis Services Contract (NDSC) program and the Community Care Network (CCN). NDSC is significantly more expensive for dialysis services, in part because its fees are not capped by Medicare rates, as CCN is.

This is on its face obscene, given that providers have been found to charge NDSC patients significantly increased rates compared to Medicare patients, while providing no rationale for such a significant price differentiation. Of course, while (appropriately) attempting to remediate pricing discrepancies between government programs, CCN has itself proven to be a wildly inadequate system, reliant on private care providers that routinely underdeliver in their care commitments. Even so, it is the preferable (and significantly less expensive) system for dialysis care within the VHA and, except for limited circumstances, veterans are supposed to be referred to providers secured under the CCN umbrella first.

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