Bundled EfficiencyIn the United States alone, more than 366,000 people diagnosed with end-stage renal disease (ESRD) depend on kidney dialysis as a life-sustaining therapy (Collins, Foley, Gilbertson and Chen, 2009). Most of these patients rely on expensive in-center hemodialysis (HD) three times a week to filter their blood during four-hour sessions. Since 1972, Medicare has covered patients' dialysis-related costs along with separately billed, frequently used medications that are part of treatments for end-stage renal disease. The annual price of this coverage had revealed the shocking price of $77,506 for each individual requiring chronic hemodialysis treatment (Iglehart, 2011). In the government's effort to limit the rising costs of dialysis treatments, new pooling guidelines came into effect on January 1, 2011. Organization Description Renal Care Partners is a small group of dialysis clinics headquartered in Florida. Each clinic will have entered into a different partnership with doctors who are shareholders in the clinic. As a result, each clinic may have unit-specific policies and procedures that reflect nephrologists' involvement in the company's financial situation. Overall, charitable giving as a company has been poor. In the past, RCP has participated in the National Kidney Foundation's Kidney Walk event. A few employees on an individual basis have volunteered their services and donated funds to raise awareness about chronic kidney disease. Additionally, Human Resources as Administrator has managed the clinic for the past eight years working closely with the Virginia Nephrology Group physicians. You managed the clinic's fourteen employees while... mid-paper..., if dialysis costs exceed those of the flat rate, dialysis centers must absorb the excess costs. Accordingly, dialysis clinics will be monitored by a Quality Incentive Program (QIP). Clinical outcome measures related to anemia management and dialysis adequacy will be evaluated against past performance of the clinic or national dialysis standards. Beginning in 2012, clinic failure to meet QIP standards will generate penalties that can equate to up to 2% of reduced payments (Iglehart, 2011). This display of close vigilance by CMS suggests its concerns about measuring quality in the midst of the nation's health care budget crisis. In conclusion, dialysis clinics can successfully address the financial constraint by modifying the business infrastructure to reflect clinical efficiency and expanding the home PD program.