Dialysis Center Business Plan

Despite the high initial (front-loaded) costs of home HD due to patient setup and training, the payback period (relative to facility HD) is relatively short at approximately 14 HD, as these evaluations yield intentionally conservative estimates of cost-effectiveness (eg, no survival benefit is used in base case scenarios, despite multiple observational studies reporting this benefit).To navigate this process more easily, the following resources have been developed by a group of clinicians and administrators with first-hand experience in home HD and can be used in the development of business cases and RFPs.This resource provides guidance on the processes that are involved, including: a thorough situational analysis of the dialysis landscape, emphasizing the opportunity for a home HD program; careful consideration of the clinical and operational characteristics of a proposed home HD program at your institution; the development of a compelling business case, highlighting the clinical and organizational benefits of a home HD program; and careful construction and evaluation of a request for proposal.

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The questions in the next section should be considered in detail before starting or expanding a home HD program, or writing a business case.

For each set of questions, we have indicated specific resources that are available to the reader for further information.

It is important to clearly identify internal and external stakeholders in relation to a proposed home HD program.

These specific people or groups are those who will be required to support the program, either through mitigating clinical and financial risks or through promoting and/or directly contributing to it.

More frequent treatments have higher marginal costs per dialysis hour due to the need for new connectology, tubing sets, and dialysis membranes.

Capital equipment is one cost category where home HD is more expensive than facility HD.In order not to be overwhelmed, we recommend that clinicians and administrators work together to accomplish these goals.The importance of this relationship cannot be overemphasized—an individual nephrologist may be able to start a pilot home HD project, but only a team effort will ultimately result in a sustainable and sizeable program.The medical literature is the best starting point for evidence to support the project.Where it has been evaluated, home HD is less expensive than in-center (facility) HD and is associated with better survival and health-related quality of life.Figure 1 compares the size of home HD programs between Japan and Australia/New Zealand.Expanding a home HD program therefore requires substantial resources, and typically this requires a sound business case for financial investment.A key component to a successful launch of a new home HD program is to ensure that the program is financially sustainable.It is accepted that home HD is a cost-effective alternative to conventional facility HD and an attractive option from a health system and societal perspective.The clinical and administrative leads of the project should be comfortable that the majority of these questions have been answered to their satisfaction.In most cases, however, there is no “correct” answer.

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