MedCity Influencers,Devices & Diagnostics

Right Now: ‘Insourcing’ Dialysis Can Deliver Big Cost Savings, Better Outcomes

When facilities operate their own acute dialysis operations and no longer enlist third parties to provide treatment, they save hundreds of dollars per session. Insourcing also enables hospitals to keep trained dialysis staff on hand full-time to actively ensure quality kidney care to their patients.

Labor shortages, clinician burnout, inflation, margin pressures and an aging population. These are challenging times indeed for hospitals.

What if you could simultaneously improve patient outcomes, empower staff and secure additional profit? Kidney dialysis is a great place to start.

Dialysis is expensive, devouring approximately 7% of the U.S Medicare budget ($28 billion) even though dialysis patients make up only 1% of the Medicare population. Hemodialysis, the most common form of dialysis, costs anaverage of $90,000 annually per patient. It is a treatment often outsourced by hospitals but with varying levels of success.

Now is a good time to consider insourcing acute dialysis. Improvements in dialysis technology are now available after decades of stagnation. it’s paralleling the trajectory of telephony, becoming far more capable even as devices get simpler and sleeker. As a result, insourcing the service has become more attractive than ever.

When facilities operate their own acute dialysis operations and no longer enlist third parties to provide treatment, they save hundreds of dollars per session. Insourcing also enables hospitals to keep trained dialysis staff on hand full-time to actively ensure quality kidney care to their patients. By coordinating, delivering and closely managing treatment, the hospital forges deeper patient relationships potentially leading to better outcomes.

This article will cover potential advantages of insourcing acute dialysis today as well as some critical success factors in execution.

Ask the tough questions

The first question that leaps to mind is around insourcing is, should I take advantage of an insourcing decision to invest in the newest dialysis technology?

Absolutely, since ending an outsourcing arrangement will prompt the vendor to take its equipment with them. Many hospitals use an insourcing decision as an opportunity to invest in the newer dialysis technology, which helps them scale their dialysis volume and make their staff more productive. Newer technology automates complicated tasks, and enables real-time, remote monitoring of dialysis data.

While these gains are compelling, insourcing is a weighty decision that warrants careful analysis of other factors, including:

  • Patients – How will this change affect their journey? Will insourcing create better experiences? Will it improve care? Will it bring greater efficiencies to the care they receive? Bringing dialysis in-house can improve continuity of care, which often translates to a patient getting treatment hours earlier than they would from an external service provider.
  • Staffing models – How will staffing need to change to make this new offering successful? Can your current staffing model support the change? If you’ve opted for newer technology, the training burden can be lighter and process can be less labor-intensive, meaning there is an opportunity to develop nurses of varying backgrounds to administer treatment.


The newest dialysis technology is sleek and intuitive. In fact, in some instances, it’s designed for patient operation at home, offering clear, simple touchscreen operation resembling a smartphone or tablet. Designed for patients to dialyze themselves with minimal training, the learning process for an experienced nurse is greatly simplified.

It’s also important to ensure that new technology can operate in your facility today with minimal if any facility changes. Dialysis equipment has traditionally been large and cumbersome, sometimes requiring specialized water supply and hard wiring. Since it’s engineered with home use in mind, newer technology operates on tap water and with a standard electrical outlet, making it easy to move from bed to bed throughout the hospital.

Rolling it out

Once the right technology has been selected, plan the rollout. Nurses are the difference makers.

Successful institutions enlist a nursing leader to oversee any technology conversions. A seasoned nurse leader can serve as an anchor for the entire project and spearhead any policy changes, procedures, trainings, implementations and best practices while nurturing staff satisfaction across a network.

In hospital systems, best practice is to start with several test sites. By selecting a few facilities to serve as the first conversion models, a comprehensive and effective implementation plan can be developed to be replicated across the rest of the system.

The implementation plan should streamline training between locations. Having nurses from established sites deliver training to their colleagues helps teams quickly build confidence in the new technology.

Managing change

It’s critical to support these best practices in implementation with a sound change-management process. Start with senior staff buy-in. Involve numerous key stakeholders, including senior clinicians who might otherwise feel that a disruptive change is being thrust upon them.

It is helpful to articulate the case for change early and often. Clearly explain to all affected staff why a switch is important and perhaps urgent. Spotlight the anticipated and realized benefits. Tailor your message to roles, including administrators, senior medical staff and nurses. Demonstrate how providing employees with the best medical technology makes the work more rewarding and better serves the patient. Paint a vivid picture of the hospital delivering more effectively and efficiently on its mission.

Finally, celebrate wins. Gather and share data showing clinical quality improvement, return on investment and success rates for insourcing versus using an outside vendor.

Making the move to insourcing

Although insourcing acute dialysis is a significant change, planning and preparation will help develop a program that offers a smooth transition for both the hospital staff and the patients that benefit from its services. Amid the challenges that have recently confounded healthcare, insourcing can serve as a big, reproducible, victory for health systems today and into the future.

Photo: saengsuriya13, Getty Images

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Michael Aragon

Michael Aragon, MD is Chief Medical Officer atOutset Medical, a medical technology company pioneering a first-of-its-kind technology to reduce the cost and complexity of dialysis. Outset is the developer of The Tablo® Hemodialysis System, FDA cleared for use from the hospital to the home, and represents a significant technological advancement that transforms the dialysis experience for patients and operationally simplifies it for providers.

He is board certified in Internal Medicine and Nephrology, receiving his training at the University of Texas Health Sciences Center in Houston. His clinical research focus has been on the expansion and improvement of home dialysis options for patients with renal disease.

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