Until there is well-dialysis-patient statistical reporting and a substantial financial incentive for increasing employment rates, we are unlikely to see major improvements in patients' lives, technology, system infrastructure, or societal lost opportunity costs. Unfortunately, the business focus of the largest for-profit provider has been to drive out the competition by providing minimalist, standardized dialysis care utilizing their forty-year-old technology. They are unlikely to embrace changes that will damage their business model and also give opportunities for other providers to further surpass them in terms of positive patient outcomes.
US nephrology is still a long way away from having an effective understanding of the harmful effects of the financial incentives in its dialysis care system. More than any other medical specialty, US nephrology has tied its practice of medical to junk-bond financiers, resulting in a system of care that nephrologists would avoid for themselves and their own family members. Like chiropractors and naturopaths, too many of them fool themselves into believing they are doing the right thing... and take the money.