For disposable dialyzers, B. Braun is coming out with the Xevonta, which is scheduled for release mid year, 2010.

"The Xevonta will have the highest performance characteristics of any dialyzer currently available," says Amory. "It will have very high clearance rates of urea, but also very advanced middle molecule clearance and a very sharp sieving coefficient with little albumen loss."

CMS cuts add to provider costs

On the payer front, MedPAC has reported increased spending for dialysis and CMS is preparing to bundle dialysis reimbursement, which will end up being tantamount to an overall cut in reimbursement starting January, 2011. DaVita projects that the cuts would cost the company $1 billion in additional costs. Amory says that for B. Braun and other suppliers, it's little more than the status quo.

"Dialysis has always been a cost-conscious market," he says. "There hasn't been an increase in the composite reimbursement rate for dialysis from Medicare for years and years. It's a normal thing for the dialysis industry, for both the providers and the suppliers, to be cost conscious and this will just be more of the same. I think you may see some more consolidation. You may see some of the poorer operators or clinics either merged together or acquired, and I think what will be left is an even stronger operations base."

Dr. Spry says that CMS was at one point advocating home treatment, but with the new bundling taking effect, he doesn't see how it's going to provide any incentives for providers.

"We are encouraging CMS to help us with the initial expense and then do the bundle, but we don't know how successful we'll be in doing that," he says.

The dialysis aftermarket

It's a rough road for everybody and the landscape has changed greatly for companies focused on used and refurbished dialysis systems, but despite uneasy economic times, business appears to be consistent for the most part. Gia Ben-Hur, president of GIA Medical, says that quality control is everything in this business.

"This is a lifesaving device sold by prescription and everything is about the patient," says Ben-Hur. "We offer a different service as a wholesaler - we have our own equipment and we refurbish everything with OEM original parts according to the manufacturer's specifications."

GIA Medical refurbishes dialysis systems at their 80,000 square foot facility. They keep thousands of machines in inventory at any given time.

Ben-Hur interviewed with DOTmed from the tradeshow floor of the National Renal Administrators Association Meeting held Oct 7-9 in Marco Island, FL. She said the "foremost issue in the industry today," echoed by most of the independent dialysis organizations that we surveyed, was CMS' bundling of dialysis products and services.

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