Facility Acquisition and Care Quality in the U.S. Dialysis Industry

Purpose: To evaluate whether acquisition of independent dialysis facilities by large chains is associated with changes in clinical quality metrics and patient-reported experiences of care. Methods: We conducted a longitudinal cohort study using 2016–2020 data from Medicare Dialysis Facility Care Compare (DFC) and In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS). Facility acquisition was defined as the transition of a nonchain-owned facility to chain ownership. We estimated within-facility changes in clinical and patient-reported outcomes after acquisition using linear regression with facility and year fixed effects, adjusting for ownership type and facility size. Results: Among 4,627 facilities in the DFC sample and 1,377 in the ICH-CAHPS sample, acquisition was associated with a 3.0% relative increase in hospitalization rates, a 9.4% increase in infection rates, and a 0.5% decline in dialysis adequacy. Patient-reported experiences showed a statistically significant 1.0% decline in reported information sharing while other experience metrics trended negatively but were not statistically significant. Conclusions: Facility acquisition was associated with worsening clinical performance and small declines in patient experience. These findings suggest consolidation may negatively affect dialysis care quality, underscoring the need for closer oversight of industry mergers.