When dialysis treatment centers close, rural patients have no choice but to drive further for care

After the Chadron dialysis center closed, Pieper's 
treatment travel time tripled. (KFF Health News photo)

Rural residents who require dialysis treatment to stay alive are having to drive longer distances for care as smaller hospitals and clinics shed unprofitable services to stay afloat, reports Ariella Zionts of KFF Health News.

When Chadron Hospital shuttered its dialysis center, which served Nebraska residents in the state's far western panhandle, Mark Pieper became one of the many displaced patients who would have to find another dialysis center for treatment.

Because the human body cannot survive without kidney-like functions that filter toxins, remove excess fluid and balance electrolytes, dialysis cannot be rescheduled or skipped. When faced with the closure of their dialysis center, renal patients like Pieper have two choices: Travel for treatment or die.

"Pieper eventually found treatment in Scottsbluff, which, with about 14,000 residents, is the biggest city in the rural Panhandle region," Zionts writes. "The hour-and-a-half drive will triple his time on the road to more than nine hours each week."

Chadron Hospital discontinued its dialysis service despite the $219 million in federal money Nebraska will receive this year from the Rural Health Transformation Program. But RHTP awards aren't meant to "help existing services stay afloat," Zionts explains. Instead, they are earmarked to help rural medical centers "explore new, creative ways to improve rural health." Only 15% of RHTP funds can be used to pay for patient care.

Chadron Hospital was "losing $1 million a year on its dialysis service due to low reimbursement rates that didn’t cover operational costs," Zionts reports. Nephrologist Mark Unruh said the "dialysis closure in Chadron reflects a wider trend of staffing and funding challenges."

Preventing kidney failure is one of the best ways rural areas can change what rural dialysis patients like Pieper are facing now, Unruh told KFF Health News. "He pointed to a tele-education program that helps primary care doctors in rural and other underserved areas prevent end-stage renal failure."

A startling look at the lack of dialysis treatment options for rural Americans experiencing kidney failure

For the roughly 240,000 rural Americans suffering from kidney failure, or End-Stage Renal Disease (ESRD), getting to a dialysis center that can deliver consistent, quality care is a struggle. The lack of reliable dialysis for rural ESRD patients has been exacerbated by too few providers within a drivable distance, with some rural residents facing travel across several counties to access dialysis.

The most common dialysis clinics near rural ESRD patients are often owned by DaVita, a "for-profit company with a documented history of kickbacks to doctors and involuntary patient discharges," reports Sarah Melotte of The Daily Yonder. Involuntary discharges are supposed to be extremely rare and regulated by the Centers for Medicare and Medicaid Services.

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. (Map by Sarah Melotte, Daily Yonder, from CMS data)

In fact, for 6.1 million rural Americans, DaVita is the only Medicare-certified dialysis clinic in their county, according to Melotte's analysis of CMS data. Melotte reports. "Another 16.5 million rural Americans live in a county with no facility at all."

Overall, DaVita and its German competitor, Fresenius, "tend to have worse health outcomes compared to independent, non-profit clinics," Melotte writes. "Duke University’s research 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%."

Using a CMS dialysis facilities dataset, in 300 counties, 190 of which are non-metropolitan, or rural, "DaVita runs the only clinics in the county," according to Melotte's anaysis. "In rural counties, about 31% of clinics are owned by DaVita."

In some rural regions, the lack of dialysis centers is even more dire. "About 59% of rural counties don’t have a single Medicare-certified dialysis clinic," Melotte writes. "In places like rural Central Nebraska or Western Kansas, patients might be several counties away from the nearest clinic."

Rural residents with diabetes are more likely to suffer from disease complications -- lack of access to care could be why

Diabetes requires continuous care.
(Photo by T. Barbhuiya, Unsplash)

Past studies have shown that rural Americans are more likely to develop type 2 diabetes, and they experienced more struggles trying to manage the disease than their more urban counterparts. In a new study, researchers from the University of Maryland School of Medicine took a closer look at rural residents experiencing diabetes complications such as heart and kidney problems. Their research, which was published in the journal Diabetes Care, showed that these rural populations are at significantly higher risk of suffering from end-stage kidney disease, heart failure and heart attacks, all of which could caused by a lack of access to medical care.

The study's corresponding author, Rozalina McCoy, told UM news: "Those who live in rural areas have a greater risk of experiencing eight out of the eleven complications that we measured compared with those living in cities. . . .They were 15 percent more likely to have dangerously low blood sugar levels, which clearly indicates that their diabetes is not being managed properly."

The study's co-author, Elsa Davis, added, "While our study didn't address why these differences exist, we do know that people living outside of city areas are less likely to receive care from diabetes specialists, to receive diabetes self-management education, and to be monitored for diabetes complications."

While the study encompassed varying degrees of rural populations, it "relied on insurance information to identify diabetes complications," UM reports. "If people could not access medical care, that complication would not be captured. Dr. McCoy noted that this finding further underscored the barriers to care in remote areas: patients are likely having high blood sugar emergencies and heart failure but cannot get to the emergency department or hospital to have them diagnosed and treated." Study authors added that further research should investigate reasons why these disparities exist.

Covid roundup: Pediatric hospitalizations up; Christian broadcasting group's spokesman fired after pro-vax op-ed

Here's a roundup of recent news about the pandemic and immunization efforts:

The number of children hospitalized for Covid-19 has soared over the summer, especially in the least-vaccinated states, leaving some children's hospitals and intensive-care units stretched thin. Read more here and here.

Stillbirths have doubled during the pandemic in Mississippi, the least-vaccinated state. State officials have recorded 72 stillbirths (spontaneous miscarriages after 20 weeks of gestation) among unvaccinated pregnant people who were infected with the coronavirus. Eight infected pregnant people have also died over the past month. Pregnant and recently pregnant people have a higher risk of becoming severely ill from the coronavirus, studies show. Read more here.

The rate of new coronavirus infections among babies and children under age 4 recently surpassed the rate of new cases among seniors. Experts discuss what steps pregnant people and parents can take to be safe. Read more here.

The spokesperson for the National Religious Broadcasters (an association of more than 1,000 Christian new media professionals) was fired at the end of August after encouraging people to get their coronavirus vaccines in a USA Today op-ed and an appearance on MSNBC's "Morning Joe." He was fired for violating the company's policy of staying neutral on vaccination, the CEO said on social media. Read more here.

Crowded jails and prisons drove millions of coronavirus infections, a new study has found. Read more here.

Coronavirus testing, hospital stays and emergency-room visits are about to get much more expensive for many Americans, as major insurers end the temporary waivers that reduced costs. Read more here.

A recent study found that unvaccinated people are 29 times more likely to be hospitalized with Covid-19 than vaccinated people. Many vaccinated people worry about breakthrough infections, but the risk depends on factors such as overall health, where someone lives, and what other risks they take. Vaccinated people who do get infected tend to suffer only mild symptoms, if any. Read more here.

People who have survived a coronavirus infection and then gotten vaccinated have what's called "hybrid immunity," and studies show it's impressively potent—not just against the Delta variant, but possibly future variants as well. Read more here.

Experts say it's especially important to get a flu shot this year: with Covid cases surging across the country, it may be difficult to get treated if you get the flu and it takes a turn for the worse. Also, getting the flu can weaken your immune system and make you more susceptible to coronavirus infection—and getting both viruses one after the other could be dangerous. Read here for more answers to frequently asked questions.

Fully vaccinated people who get a breakthrough coronavirus infection are about half as likely as unvaccinated people to suffer from long Covid, a study has found. Read more here.

A respiratory therapist describes, in seven stages, how Covid-19 typically progresses among hospitalized patients. Read more here.

Experts recommend some tips for coping with pandemic anxiety this fall and winter. Read more here.

The share of American adults willing to get vaccinated rose 5 percentage points in the last month, according to a recent poll. Read more here.

People who were hospitalized for Covid-19 are twice as likely as usual to develop kidney disease afterward, researchers have found. Read more here.