As the ESRD population grows, many providers try a more pampering approach to patient care.


A mural featuring a sun-dappled lake, crimson and azure birds, lush flowers, and palm trees adorns one waiting room wall. In another, a comfy couch beckons; a cheery blaze crackles in the fireplace, and the aroma of hot coffee wafts from an adjacent kitchenette. Hardly typical of what springs to mind when one thinks of outpatient dialysis centers, but that’s exactly where these scenes are set.

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In the treatment rooms, patients use chairs with massage and heat options, and individual lighting fixtures that can be dimmed or turned off with the flip of a switch. If a patient wants to work, she can plug in her laptop. If another feels like watching TV, there’s an easy-to-manipulate flat-screen set right at his fingertips.


The dialysis experience is undergoing a sea change. More centers are opening outside hospitals in convenient, community-based locations, and dreary institutional décor is giving way to patient-pleasing perks. “Fifteen years ago patients had to take what we gave them,” says Dave Hirsch, director of corporate development at DaVita, Inc., the nation’s largest independent provider of dialysis services. “We’d tell them, ‘Come to this building; here’s the machine, there’s the chair, and be sure to arrive at a specific hour.’ We were more in the driver’s seat. But when you have more than 1,000 dialysis centers and many ways to build them, things change. Also, patients are more sophisticated than they used to be.”


There are also more patients, and they’re getting dialysis longer. The number of people being treated for end-stage renal disease (ESRD) has risen dramatically in the past three decades, up from about 7,000 in 1972 to nearly 400,000 today, according to the U.S. Renal Data System. And as the prevalence of diabetes and hypertension continues to climb, that number will grow. The surge is prompting providers to rethink the way dialysis services are delivered, and to do more to help patients pass their time as constructively and pleasantly as possible.


“We are looking at ways to make the environment less stressful and more pleasant,” says Dede Erickson, DaVita’s regional operations director. “We put in sound systems, water fountains, fireplaces, and comfortable couches. We also offer aroma therapy. The next thing we’re doing is trying not to have phones ringing throughout the facility.”


DaVita is also focusing more on fun, which Erickson says is one of the company’s core values. “There are more activities, like crazy hat day, birthday celebrations, and bingo and other games and learning activities to teach patients about their disease,” she says. “Our patients enjoy it; to them, this place is like a second home.”


Wall of Fame

To encourage that personal connection, several years ago DaVita began installing what Hirsch and Erickson call a “Wall of Fame” in each of its centers. Once a year, photos are taken of all of a center’s physicians, patients and teammates—the term DaVita uses to denote staff members — and each person is asked to supply information about such things as hobbies, favorite foods, and family members. All of the pictures and personal information are then arranged and displayed. In addition to building a sense of community, “Patients really appreciate” the Wall of Fame, says Erickson. “They spend time looking at it and it creates a cohesive bond.”


DaVita is not alone in trying to make its dialysis centers more welcoming. “We don’t want our facilities to look like a hospice,” says Jeff Dale, director of project management at American Renal Associates (ARA), a company that operates some 60 outpatient dialysis centers in California, Texas, and up and down the East Coast.


“We have beautiful artwork on the walls, and at each treatment station we make sure everything that touches the patient brings feelings of well-being. We want to create a spa-like atmosphere that makes each patient feel pampered.”

To that end, each ARA center is decorated in one of several soothing color schemes, including earth tone and blue and green, all in muted hues. In addition, Dale says ARA, like a number of other dialysis providers, has switched from old, bulky television sets to personal, flat-screen TVs connected to cable or satellite, with individual headphones for each viewer. It’s a major improvement, say Dale and others, over the ceiling-mounted TVs that used to be shared by several patients, and even the ordinary individual TVs that were introduced at dialysis centers seven or eight years ago.


ARA is also installing satellite radio at its centers, so patients can tune into jazz, classical, rock, or any other radio format they like, and is putting in individual, patient-controlled lighting fixtures. Soon, the company will introduce a treatment chair with heat and massage features at two new clinics in Pennsylvania.


“A major chair manufacturer has gone through the rigor of getting an Underwriters Laboratory, Inc.-approved chair built,” says Dale. Such chairs, he notes, have already been introduced in cancer centers for patients undergoing chemotherapy, and now they’re starting to be used in the dialysis setting. “For the most part, we all have evolved a better mousetrap,” Dale says. “We see it as our duty; the least we can do for these patients is to create a place of comfort and dignity.”


It’s also a good idea from a business perspective, he adds. “If you do the right thing by the patients, doctors and staff, positive results will flow.”


Paying for perks?

Not everyone favors the trend toward pampering patients. “I would hate to see people be drawn to flat-screen TV or a warm chair at the expense of good care,” says David Shepherd, vice president of Greenfield Health Systems (GHS), a nonprofit group that provides dialysis services to about 2,000 patients in 15 outpatient clinics in Michigan and Ohio.


“ESRD care is largely funded by government programs and we are spending public money.” As such, Shepherd says, “The focus should remain on the content of care in conjunction with a safe, accessible, clean, and comfortable environment. Patients deserve this and taxpayers expect this. When spending on amenities becomes excessive, it might be viewed as an abuse of public trust. There is an important balance to be maintained between what meets appropriate expectations of care and comfort and things that make for the appearance of comfort alone.”


DaVita rejects such criticism. “We are publicly traded and money is scarce; Medicare is slow to increase rates,” says Dave Hirsch. “And over half of our costs are for dialysis equipment, water quality systems, and other clinical necessities.” By standardizing the company’s dialysis centers, how-ever, DaVita can enhance its purchasing power through savvy vendor contracting and group-discount pricing, he explains. “The volume of business we do,” he says, “allows us to keep our costs under control.”


Renal Care Partners (RCP), which has 14 facilities in Massachusetts, Florida, and other Eastern states, takes a different approach. Rather than standardizing its centers, RCP tailors each facility to its specific locale. “Some major companies have cookie-cutter dialysis units, but we’ve seen that there’s a better way,” says Christopher Pyrek, vice president of business development at RCP. “Every dialysis unit we build is unique to its area.”


Pyrek says all members of RCP’s senior management team are veterans of large dialysis companies, and RCP does not operate by what Pyrek calls “corporate dictate,” but by developing joint financial ventures with nephrologists and hospitals. “We’re true partners, so physicians, employees, and hospital personnel are in this with us from day one.” As such, all major participants make joint decisions on everything from selecting locations to choosing color schemes.


Pyrek says that while RCP provides some patient amenities, including jacks for wireless Internet service, flat-panel TV screens, and piped-in background music, many perks are provided on a case-by-case basis based on patient request. “We have gone out and bought things, such as heating pads, if there’s something someone says they’d like.”


Pyrek says his company prides itself on being flexible and on working with and listening to its patients and staff. “Each of our facilities is an individual entity, and doctors, nurses, patients and administrators are bringing in new ideas all the time. If a patient or staff member needs anything, they get it quickly.”


Looking toward tomorrow

As they look toward the future, dialysis providers say that several things are likely to happen. For one, outpatient centers will continue to shift away from hospital settings and into the community, which will cut down on patients’ transportation problems.


Given the aging of the population in general and the dialysis population in particular, more attention will have to be paid to managing a variety of health problems and disabilities. “Facilities are going to have to provide higher levels of care to an older, more comorbid population,” Dave Shepherd says.


Patients are also becoming more technologically savvy, and are asking to be more involved in treatment, both at dialysis centers and at home. “We’re looking at remote monitoring and telemedicine,” says Shepherd.


Patients seeking control

On this point, Shepherd and Da Vita’s Dede Erickson emphatically agree. “Patients are asking to be more involved,” Erickson relates. “As a result, we’re developing a self-care model at some centers where patients check in, check their own vital signs, cannulate their needles, and set up machines. They do everything but actually start the treatment, but still have the security of nurses and other teammates for assistance as needed. It’s cool.”


Finally, RCP’s Christopher Pyrek predicts that the dialysis experience will continue to evolve until such treatment is no longer needed. “Ultimately, we all hope for a cure for kidney disease, and once we have that, we won’t be talking about this,” he says. “But in the next 10-15 years the ESRD population is going to double, and we’re scrambling to keep up with the pace. Anything that enhances patient care, we’ll be first in line to try it.”