The results of a survey inspection by the the Centers for Medicare and Medicaid Services caused a unit of Good Shepherd Medical Center to be shut down Friday at the downtown Longview hospital.

"During the course of their survey, we identified areas for improvement within our Hemodialysis Unit and have temporarily halted dialysis service while those items are addressed," Steve Altmiller, president and CEO of Good Shepherd Health System, said in a statement.

Asked the nature of the areas of improvement needed to continue dialysis treatment, the medical center responded, "primarily related to policies and processes."

"We are deeply appreciative of our neighboring hospitals for working collaboratively and quickly to accept those patients in need of dialysis," Altmiller said. "Providing the best possible care to our patients always comes first, and we are diligently working to restore dialysis service as soon as possible."

Other area hospitals were contacted soon after the notice of the shutdown. Seven patients were transferred to Good Shepherd Medical Center in Marshall, Longview Regional Medical Center and East Texas Medical Center.

The unit shutdown affects only patients at the center who needed dialysis in addition to other care, as Good Shepherd doesn't provide outpatient dialysis services.

In his weekly "Message from the CEO" to staff and others associated with the hospital, Altmiller shared information about the situation, which he said stemmed from the first "full survey of this nature in 20 years."

"We have found that there are areas requiring improvement, processes that need to be restructured and follow-up loops that must be closed," he wrote Friday evening. "One area that we had to address quickly was our Dialysis Unit. We received Board of Director and Medical Executive Committee approval to discontinue services in this area until Davita is able to assume operations, which will occur no later than July 11."

Also Friday, the hospital's emergency room diverted patients to Longview Regional Medical Center. Usually, diversions happen when there is a high number of people visiting the emergency room needing care, according to the medical center.

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Dialysis is costly.. Unless your treatment is subsidised by the government or covered by insurance, effective treatment is difficult simply because the costs are so prohibitive.  According to a study conducted by the Mumbai Kidney Foundation, India has 950 nephrologists, 7,000 dialysis centres and 4,000 dialysis machines. This research was conducted nearly six years ago. However, the predicaments that surround dialysis still persist. Those who suffer chronic kidney disease are in a worse position. In 2009, the All India Institute of Medical Sciences and the Health Ministry found that more than 90 per cent of nearly 230,000 people who develop CKD die within months of treatment.

These numbers don’t bode well for Indians, especially with a 123 per cent rise in diabetes (predominantly Type 2) since 1990. Simply put, India is a nation of failing hearts and kidneys, the reasons for which are numerous – including increasingly unhealthy lifestyles.

In 2009, Kamal Shah, Sandeep Gudibanda and Vikram Vuppala co-founded NephroPlus, a high-quality dialysis network, in Hyderabad. Vuppala says, “I spent about 10 years in the US after graduating from IIT Kharagpur in 1999. Towards the last few years in the US, I worked as a strategy consultant for McKinsey & Company in New Jersey. During that time, I was very clear that I would come back to India and start a healthcare venture.” Vuppala decided he wanted to work specifically within the hypertension and diabetes ecosystem due to the rapidly growing burden of these epidemics in India. At that point, Vuppala says, India had 65 million diabetic patients and 140 million suffering from hypertension. While researching, Vuppala met Kamal Shah, a chemical engineer working as an Apple software developer. Diagnosed with Hemolytic Uremic Syndrome in 1997, Shah had been on dialysis for 12 years. Since his diagnosis, Shah has been chronicling his life between dialysis sessions in a blog. “When I was in the US, I exchanged calls with him. It was an inspiring story. Today, he’s been on dialysis for 18 years. He wakes up every day, he swims every morning, he travels every month and he works full-time.” Passionate about providing this quality of life to those who can’t afford expensive treatments, Shah, Vuppala and Gudibanda, previously a Bangalore-based engineer who’d worked for social enterprises in palliative care for cancer patients, decided to start NephroPlus.

NephroPlus founder: (L-R) Vikram Vuppala, Sandeep Gudibanda and Kamal Shah

“We started in Hyderabad, because we wanted it to be home-based. Then we started a second centre in the city to understand how to run multiple centres.” It was a drill to practice running centres farther and farther away from their home base. “There were operational issues in terms of monitoring, staff and inventory. A whole lot of complexities come in in dealing with hospitals, partnering with nephrologists. The point was to take baby steps. We later expanded to Bangalore, Chennai, Pune, Noida, Rohtak, Bokaro, Nalgoda and Kanpur, totalling 34 cities across 14 states.

“Inspite of cultural issues, our core was delivering high-quality patient-centred care. We’re extremely passionate, so we were able to somehow overcome problems. But it’s not easy to be based in Hyderabad and operate in, say, UP. In fact, UP is like a different country altogether and we have five centres there.”

Vuppala says the metropolitan cities are far easier than smaller cities and towns. “When you enter a city like Agra in UP, it has its own set of complex local issues like taxation over any movement of goods. Secondly, and more importantly, finding good clinical or administrative staff in smaller cities is a challenge. Not many want to work here, so we have to think of how to recruit and retain quality staff. We still face that challenge. We try very hard to identify people who originally belong to the city in which we want our centres. That’s why I came back to my home city of Hyderabad from the US, too.” Vuppala laughs and says you simply have to pay them more, so the HR aspect of managing centres in small cities becomes problematic.

On the medical side, dialysis is straightforward. “You import technology from Japan or Germany, but you have distributors in India. The licencing is taken care of by manufacturers themselves, and these machines don’t have radiation issues. So regulation is not too strict. It’s just that the machines are expensive. Each one is around 7 lakhs.”

However, Vuppala says NephroPlus’s whole value proposition is to provide affordable healthcare. Though he says, it’s still an expensive treatment they try their best to bring down costs for patients. He adds that the reason NephroPlus is even able to do this is because they are, currently, the largest dialysis providers in India. “It gives us a unique opportunity to source better, operate better and invest in quality. Small-scale centres don’t have that advantage.”

For this reason, NephroPlus also has public-private partnerships to fulfil their commitment to providing quality dialysis care for as many patients as possible. “We’ll continue to work with the government, but reality is that it’s very, very slow to react. We focus a lot more on private, but we’re always keen to partner with the government. Dialysis is expensive. If someone has to pay out of pocket, the cost can become impossible; quality of life and clinical outcomes are never as good. The government has to respond appropriately, but it usually doesn’t.”

NephroPlus’s next step is to expand to other Asian countries. In the next few years, they’d like to be the biggest dialysis network in the region, and help governments understand the importance of taking kidney disease seriously. Over the last few decades, we’ve seen an advancement in medical sciences and also decline in global health indicators simultaneously. It’s become more and more expensive to be treated for chronic illnesses, and NephroPlus wants to be that one organisation that still believes high quality care should not be completely inaccessible to the masses.

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• ‘India is not an early adopter, leave alone an innovator,’ says Adarsh Natarajan of Aindra Systems - June 21, 2015
• ‘Dialysis is expensive. If someone has to pay out of pocket, the cost can become impossible,’ says Vikram Vuppala of NephroPlus - June 20, 2015
• ‘Whatever we’re doing, I know, is not scalable,’ says Swapnil Agarwal of Dhwani RIS - June 16, 2015

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