Competition stakes claim on hospital’s turf: Dialysis center would sit 1 block south of Methodist

A real estate company has filed plans to build a medical office building and dialysis center downtown, in the shadow of Methodist Hospital and Clarian Health Partners.

A and T Realty wants to plop a 13,416-square-foot office on what now is a parking lot a block south of Methodist, according to plans filed with the city. The development has no connection to Clarian, according to Mike Quinn, a lawyer representing A and T.

Clarian, whose three downtown hospitals all offer some form of dialysis, says it has no worries about the competition. But it still wants a say in how the owner develops the site at 15th Street and Senate Avenue, spokesman Jon Mills said.

“Historically, we’ve been involved in discussions regarding that property,” he said.

The plans were supposed to appear earlier this month before the Metropolitan Development Commission’s hearing examiner, but that was bumped back a month at Clarian’s request. One of the reasons, Mills said, was to continue discussions about the land’s development.

Clarian would be “open to being involved in the development of the property,” according to Mills.

Plans for the land are far from certain. Conceptual drawings filed with the city show a single-story office building facing Senate Avenue and the railway used by Clarian’s People Mover.

Quinn said A and T plans to lease the building for dialysis, but said he did not know the name of the business that would provide it. A and T Realty representatives could not be reached for comment.

The office would sit among several older industrial buildings, many of which have been converted to office and medical uses, according to a Metropolitan Development staff report, which recommends approval.

That recommendation aside, the plan still has several more steps to climb before the first construction crew arrives at the site. Quinn said the hearing examiner must pass the plan on to the full Metropolitan Development Commission. Then the City-County Council has to review it.

If a dialysis center does open, it will find a market that is both crowded and crying for help.

Dialysis involves the treatment of patients with kidney failure. Clinics provide most of this care, with patients often visiting three times a week to get their blood cleaned by a dialysis machine. Each of these sessions lasts at least four hours, said Dr. Michael Kraus, medical director for Clarian’s acute and chronic dialysis units.

Methodist and nearby Indiana University Hospital, both members of Clarian’s network, are two of the biggest dialysis providers in the state, Mills said.

Another part of Clarian, Riley Hospital for Children, recently expanded its dialysis program.

Aside from the clinic settings, Clarian also has started a growing program that performs dialysis a couple of hours every day at a patient’s home, Kraus said.

Kraus counts about a half dozen dialysis clinics downtown run by several different providers. He believes there’s room for more.

“There’s an extensive need for dialysis in downtown Indianapolis,” he said, noting that nursing shortages and patient counts mean most of the dialysis units run near capacity.

The patient population grows about 7 percent each year, and Kraus said that rate is probably higher downtown. He noted that kidney failure is more prevalent among black people. A significant part of the central city population is black.

The problem extends far beyond the simple issue of dialysis care givers keeping up with the growing demand.

Many patients who live near the downtown hospitals have no insurance or depend on Medicaid or Medicare to pay the bills. Both government forms of reimbursement provide lower amounts than private insurance.

That creates a “tight reimbursement package,” according to Kraus, one big dialysis companies are not clamoring to capture.

Perhaps the biggest obstacle to a new dialysis unit is finding enough physicians who will use it. Many doctors have to abide by no-competition clauses that limit which dialysis units they work with, Kraus said.

Clarian doctors might be able to work at A and T Realty’s proposed center, he said. However, he didn’t know any details of the plan.

“I think clearly there’s a need for it; it’s just a matter of getting patients in it and figuring out which doctor groups will be able to utilize it,” he said.