By 2008, the average zip code in the U.S. had 1.2 dialysis clinics, with some having as many as seven. Especially for young nephrologists, joint venture dialysis clinics can seem like the only viable path. Joint venture dialysis facilities take advantage of certain exceptions written into Stark Law rules, but a closely related federal law, the Anti-Kickback Statute prohibits payments for patient referrals. But the database didn’t include any information about which dialysis clinics were joint ventures, let alone the parties that owned them. With everyone profiting from the current arrangement except for patients, dialysis clinics have little incentive to change.