Re: “DaVita defends drug decisions,” May 8 news story.
This is not a criticism of the team of reporters who worked hard on a complex, arcane subject that is a narrow part of the clinical care we provide. Your article suggested that we “continue to battle” controversies related to anemia management. In reality, those battles died a natural death in the media long ago.
I am the chief medical officer at DaVita, and prior to that was professor of medicine, director of the dialysis program and associate dean at the David Geffen School of Medicine at UCLA. Because the story could inappropriately alarm thousands of dialysis patients, and call into question the integrity of physicians across the country, we wanted to submit a few additional facts:
• Physicians make prescription decisions. Our affiliated physicians did what they felt was best for each patient every day. Every week. Period.
• DaVita’s clinical protocols were developed in conjunction with hundreds of leading nephrologists from around the country. Some doctors chose to order the protocol, some chose to modify it, and others chose not to use it at all.
• We’ve been totally transparent in everything we have done in this clinical area. Our protocols are and always have been available to clinicians and the government. We report to Medicare the exact amount of the drug a physician orders, how much we provide per the physician’s order, even the patient’s hemoglobin level.
• We offered to help convene a representative forum of non-DaVita experts to discuss these issues in an objective manner. The Post declined.
• DaVita and other dialysis providers were given two years’ advance notice by the government that dialysis reimbursement was to be significantly reduced on Jan. 1, 2011. They challenged the industry to reduce drug and lab costs while maintaining quality. We raced to explore alternatives and we were successful. To criticize us for doing what Medicare wanted is frustrating.
• The science around anemia management has changed, Medicare’s position has changed, and the FDA’s position has changed — all at different times. In fact, Medicare and the FDA were literally providing different guidance at the same time. To suggest there was ever a dominant consensus is inaccurate.
• Only two individual critics were cited in the article. To value the opinions of two individuals over the judgment of over 1,000 nephrologists is imprudent.
DaVita is among the clinical leaders of kidney care in America. We’ve spent hundreds of millions of dollars on research, best practices and innovation to improve quality and reduce taxpayer burden. We will work harder to demonstrate to The Post that we are a distinctively ethical and positive citizen of the American health care community.
Dr. Allen R. Nissenson is chief medical officer for DaVita.
