Two companies run most of American dialysis

DaVita and Fresenius operate 74% of US dialysis facilities. The honest surprise in the federal data: their facilities slightly out-score independents on CMS ratings. The bigger concern is industry-wide — only about a quarter of all facilities earn 4 or 5 stars.

Operator	Facilities	Avg CMS star	4–5 star share	Fistula use (med)	Hospitalizations /100 pts (med)
DaVita	2,697	2.99	27%	60.1%	145.6
Fresenius Medical Care	2,701	2.89	25%	56.9%	138.1
US Renal Care, Inc.	382	2.97	29%	59.4%	141.8
Dialysis Clinic, Inc.	229	2.66	17%	55.3%	139.1
Independent	522	2.27	16%	55.6%	148.5

Scale isn't hurting quality — but it isn't transforming it either. Across all operators, only about a quarter of facilities reach 4–5 stars.

Read this carefully: Chain assignment is as reported to CMS; 'independent' facilities skew smaller and may serve different populations. Ratings compare dialysis facilities only to each other.

Source: CMS Care Compare, Dialysis Facility data (five-star ratings, fistula use, hospitalization rates), by operator. Computed 2026-06-12; reproducible from the analysis code against the files hashed on the methodology page.

When three-quarters of a sector sits below 4 stars, the constraint isn't ownership — it's operational visibility and follow-through, patient by patient.

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