Our Sustainability Accounting Standards Board (SASB) Index discloses information in alignment with SASB’s Health Care Delivery and Medical Equipment & Supplies standards. This is part of our commitment to provide transparent and relevant information on our economic, environmental, and social performance to our stakeholders. Going forward, we will continuously strive to improve our disclosure of quantitative metrics and further enhance our SASB reporting. The majority of references within this index refer to our Non-Financial Group Report.
Some of the information requested relates to United States requirements. For this reason, answers provided to these questions are limited to our business in the United States. In other regions, we are also subject to health care products and services standards in line with local laws and regulations.
|SASB Code||Accounting Metric||Response / Sources|
Health Care Delivery
|HC-DY-130a.1||(1) Total energy consumed, (2) percentage grid electricity, (3) percentage renewable|| |
(1) 9,283,309 GJ (2.6 million MWh)
|HC-DY-150a.1||Total amount of medical waste, percentage (a) incinerated, (b) recycled or treated, and (c) landfilled|| |
In 2021, we continued to analyze the waste streams of our production sites and dialysis clinics in all regions. Waste is managed on a local and regional level, allowing us to adhere to all applicable laws and regulations. In the context of our Global Sustainability Program, we are planning to develop a global approach to consolidating waste data and to defining reduction targets. For further information on our waste management activities, see our Non-Financial Group Report – Waste (page 108).
|HC-DY-150a.2||Total amount of: (1) hazardous and (2) nonhazardous pharmaceutical waste, percentage (a) incinerated, (b) recycled or treated, and (c) landfilled|
|Patient Privacy & Electronic Health Records|
|HC-DY-230a.1||Percentage of patient records that are Electronic Health Records (EHR) that meet "meaningful use" requirements||Only employed or contracted practitioners in medical practices owned or operated by Fresenius Medical Care in North America are eligible to participate in the “meaningful use/promoting interoperability” incentive programs. The other health care services delivery businesses (e.g., dialysis facilities, ambulatory surgery centers, etc.) are not eligible to participate. A subsidiary company of Fresenius Medical Care in North America, Acumen Physician Solutions, LLC, offers a "meaningful use" EHR software (utilizing Epic Systems) as a service that is available to both affiliated and unaffiliated nephrology practices.|
|HC-DY-230a.2||Description of policies and practices to secure customers’ protected health information (PHI) records and other personally identifiable information (PII)|| |
For a description of policies and practices related to securing our patients’ health information and further data, see our Non-Financial Group Report – Data Protection and Cybersecurity (pages 102 f.). See our Notice of Privacy Practices for a description of how medical information is used and disclosed in the United States.
|HC-DY-230a.3||(1) Number of data breaches, (2) percentage involving (a) personally identifiable information (PII) only and (b) protected health information (PHI), (3) number of customers affected in each category, (a) PII only and (b) PHI||In 2021, the United States business identified three data breaches as defined by applicable state and federal law. These breaches affected PHI. Fresenius Medical Care also reported two data breaches in Canada as defined by applicable law.|
|HC-DY-230a.4||Total amount of monetary losses as a result of legal proceedings associated with data security and privacy|| |
Fresenius Medical Care did not incur monetary losses in the United States during the reporting period as a result of legal proceedings associated with data security and privacy.All relevant legal proceedings and related financial effects are disclosed in our Annual Report – Notes to the Consolidated Financial Statements (pages 251 ff.).
|Access for Low-Income Patients|
|HC-DY-240a.1||Discussion of strategy to manage the mix of patient insurance status||In our dialysis clinics, we treat patients with all kinds of insurance status. In the United States, the insurance mix includes the federal health insurance programs Medicare and Medicaid, as well as private/alternative payors such as commercial insurance and private funds. For information on our efforts to expand access to high-quality care for more patients, see our Non-Financial Group Report – Access to Health Care (pages 91 ff.).|
|HC-DY-240a.2||Amount of Medicare Disproportionate Share Hospital (DSH) adjustment payments received||Not applicable.|
|Quality of Care & Patient Satisfaction|
|HC-DY-250a.1||Average Hospital Value-Based Purchasing Total Performance Score and domain score, across all facilities|| |
We do not operate acute care hospitals in the United States. Consequently, this indicator is not relevant for us. For general information on quality of care and patient satisfaction, see our Non-Financial Group Report – Quality of Care (pages 90 ff.).
|HC-DY-250a.2||Number of Serious Reportable Events (SREs) as defined by the National Quality Forum (NQF)||We do not report this data. For information on quality of care and patient satisfaction, see our Non-Financial Group Report – Quality of Care (pages 90 ff.).|
|HC-DY-250a.3||Hospital-Acquired Condition (HAC) Score per hospital||We do not operate acute care hospitals in the United States. Consequently, this indicator is not relevant for us.|
|HC-DY-250a.4||Excess readmission ratio per hospital||We do not operate acute care hospitals in the United States. Consequently, this indicator is not relevant for us.|
|HC-DY-250a.5||Magnitude of readmissions payment adjustment as part of the Hospital Readmissions Reduction Program (HRRP)||We do not operate acute care hospitals in the United States. Consequently, this indicator is not relevant for us.|
|Management of Controlled Substances|
|HC-DY-260a.1||Description of policies and practices to manage the number of prescriptions issued for controlled substances||The United States dialysis services business does not permit controlled substances to be kept or administered in its outpatient dialysis units. Dialysis facility staff do not prescribe controlled substances.|
|HC-DY-260a.2||Percentage of controlled substance prescriptions written for which a prescription drug monitoring program (PDMP) database was queried||Not applicable to the United States dialysis services business.|
|Pricing & Billing Transparency|
|HC-DY-270a.1||Description of policies or initiatives to ensure that patients are adequately informed about price before undergoing a procedure||The United States dialysis services business provides insurance coordination services to help its patients understand available insurance options, and informs each of its patients that they have the right to information about charges not covered by their health insurer. Additionally, the business has implemented processes to accommodate various state price transparency laws.|
|HC-DY-270a.2||Discussion of how pricing information for services is made publicly available||Pricing information for our services is generally not publicly available. The business makes certain pricing information publicly available where required by price transparency laws. Pricing is usually subject to local law and reimbursements.|
|HC-DY-270a.3||Number of the entity’s 25 most common services for which pricing information is publicly available, percentage of total services performed (by volume) that these represent|
|Employee Health & Safety|
|HC-DY-320a.1||(1) Total recordable incident rate (TRIR) and (2) days away, restricted, or transferred (DART) rate|| |
(1) For the total recordable incident rate, see our ESG Performance Data – Occupational Health and Safety (page 9).(2) We do not report the days away, restricted, or transferred (DART) rate. As part of our Global Sustainability Program, we have been working to create a centralized reporting process for injuries and fatalities. In 2021, we identified three global KPIs to report on: total recordable injury frequency rate (TRIFR), lost time injury frequency rate (LTIFR), and number of work-related fatalities. We plan to report the TRIFR in 2023. For further information on employee health and safety, see our Non-Financial Group Report – Occupational Health and Safety (pages 98 ff.).
|Employee Recruitment, Development & Retention|
|HC-DY-330a.1||(1) Voluntary and (2) involuntary turnover rate for: (a) physicians, (b) non-physician health care practitioners, and (c) all other employees||Our total voluntary turnover rate is 16.5%. Our total involuntary turnover rate is 5%. For the North America region, which represents around 50% of our employees, the voluntary turnover rate for physicians was 10.4% in 2021 and the involuntary turnover rate was 2.6%. For non-physician health care practitioners, the voluntary turnover rate was 18.3% in 2021 and the involuntary turnover rate was 4.2%. For further information on voluntary and involuntary turnover rates, see our ESG Performance Data – Talent Management (page 7) and our Non-Financial Group Report – Employees Worldwide (page 96).|
|HC-DY-330a.2||Description of talent recruitment and retention efforts for health care practitioners||Nephrocare website, our corporate website, and our career website in the United States.|
|Climate Change Impacts on Human Health & Infrastructure|
|HC-DY-450a.1||Description of policies and practices to address: (1) the physical risks due to an increased frequency and intensity of extreme weather events and (2) changes in the morbidity and mortality rates of illnesses and diseases, associated with climate change||We have dialysis clinics in many regions of the world with diverse geographic, social, and economic conditions, serving a vulnerable population of patients who need regular dialysis treatment multiple times a week. To allow us to continue treating our patients in extreme conditions, we have developed an emergency response system comprising regional disaster response teams. For further information on our disaster response activities, see our Risk and Opportunities Report – Unpredictable Events (page 74) and our Non-Financial Group Report – Crisis and Emergency Response (pages 91 f.). Additionally, take a look at the disaster relief fact sheet and our website communication on disaster response in emergencies.|
|HC-DY-450a.2||Percentage of health care facilities that comply with the Centers for Medicare and Medicaid Services (CMS) Emergency Preparedness Rule||The United States dialysis services business developed policies and procedures to be adopted by all of its outpatient dialysis facilities, consistent with the Emergency Preparedness Rule.|
|Fraud & Unnecessary Procedures|
|HC-DY-510a.1||Total amount of monetary losses as a result of legal proceedings associated with Medicare and Medicaid fraud under the False Claims Act||The United States business did not sustain any monetary losses as a result of such proceedings during the reporting period.|
Medical Equipment and Supplies
|Affordability & Pricing|
|HC-MS-240a.1||Ratio of weighted average rate of net price increases (for all products) to the annual increase in the U.S. Consumer Price Index||Pricing information for our products is generally not publicly available. The business makes certain pricing information publicly available where required by price transparency laws. Pricing is usually subject to local law and reimbursements.|
|HC-MS-240a.2||Description of how price information for each product is disclosed to customers or to their agents|
|HC-MS-250a.1||Number of recalls issued, total units recalled||In accordance with the law, we report to the respective authorities recalls issued and the maximum number of affected units.|
|HC-MS-250a.2||List of products listed in the FDA’s MedWatch Safety Alerts for Human Medical Products database|| |
Fresenius Medical Care Renal Therapies Group manufactured products related to all report types from both Manufacturer and User Facility can be found in the FDA Manufacturer and User Facility Device Experience database.NxStage products involved in FDA MedWatch Safety Alerts in 2021 include the following item numbers: CAR-170-C, CAR-172-C, CAR-500, SAK-302, NX1000-1, NX1000-3, NX1000-3-A, NX1000-5, NX1000-5-A, NX1000-16, NX1000-16-A.
|HC-MS-250a.3||Number of fatalities related to products as reported in the FDA Manufacturer and User Facility Device Experience database||We do not report this data. For information on product safety and quality, see our Non-Financial Group Report – Product Safety and Quality (pages 94 f.).|
|HC-MS-250a.4||Number of FDA enforcement actions taken in response to violations of current Good Manufacturing Practices (cGMP), by type||There were no FDA enforcement actions taken for violations of cGMP for NxStage and Fresenius Medical Care Renal Therapies Group products in 2021.|
|HC-MS-270a.1||Total amount of monetary losses as a result of legal proceedings associated with false marketing claims||All relevant legal proceedings and related financial effects are disclosed in our Annual Report – Notes to the Consolidated Financial Statements (pages 251 ff.).|
|HC-MS-270a.2||Description of code of ethics governing promotion of off-label use of products||Our Code of Ethics and Business Conduct outlines our commitment to always be truthful, accurate, and not misleading when promoting our products and services. For further information on advertising and promotion, see our Code of Ethics and Business Conduct – Advertising and Promotion (page 22).|
|Product Design & Lifecycle Management|
|HC-MS-410a.1||Discussion of process to assess and manage environmental and human health considerations associated with chemicals in products, and meet demand for sustainable products|| |
To help us understand the environmental impact of our products, we conduct simplified product life cycle assessments for selected products. These assessments identify the life cycle phase with the highest impact and the processes and materials we need to focus on to improve the eco-performance of our products and services. For further information on our life cycle assessments, see our Non-Financial Group Report – Eco-performance of Products and Services (page 109). In 2021, we started the process of further integrating specific environmental criteria in our research and development activities. We are also working to include sustainability topics in the early stages of innovation projects. For further information on research and development, see our Non-Financial Group Report – Digitalization and Innovation (pages 93 f.).It is essential that our products and services are effective and reliable, and pose as low a risk as possible to patients. Our standards for planning, conducting, and monitoring clinical studies help us to enhance product quality and safety, and improve patients’ health. For further information on the safety of our products, see our Non-Financial Group Report – Product Safety and Quality (pages 94 f.).
|HC-MS-410a.2||Total amount of products accepted for take-back and reused, recycled, or donated, broken down by: (1) devices and equipment and (2) supplies|| |
We donate funds, dialysis machines, and medical supplies to organizations that require support. In our global survey on corporate citizenship activities, it was reported that we donated more than one metric ton of devices and equipment reflecting a total value of around 107,000 €. We also donated more than 35 metric tons of supplies reflecting a total value of around 372,000 €.For further information on waste reduction initiatives, see our Non-Financial Group Report – Waste (page 108).
|Supply Chain Management|
|HC-MS-430a.1||Percentage of (1) entity's facilities and (2) Tier I suppliers' facilities participating in third-party audit programs for manufacturing and product quality||Not applicable.|
|HC-MS-430a.2||Description of efforts to maintain traceability within the distribution chain||We are currently analyzing the environmental and social impact associated with our supply chain. For further information on our supply chain management, see our Non-Financial Group Report – Supplier Management (page 104).|
|HC-MS-430a.3||Description of the management of risks associated with the use of critical materials|| |
Sourcing of mineral raw materials is an important aspect of our commitment to sustainable procurement.
We are subject to the provisions of Section 1502 of the U.S. Dodd-Frank Wall Street Reform and Consumer Protection Act (Dodd-Frank Act) relating to conflict minerals. As outlined in our Conflict Minerals Policy, we adopt standards in line with the Organization for Economic Co-operation and Development’s (OECD) Due Diligence Guidance for Responsible Supply Chains of Minerals from Conflict-Affected and High-Risk Areas.
We are committed to compliance with Section 1502 of the Dodd-Frank Act and encourage our suppliers to foster similar commitments of their supply chain related to conflict minerals disclosures. Suppliers who are non-compliant with our Conflict Minerals Policy are reviewed for continued business.For additional information on this topic, see our corporate website.
|HC-MS-510a.1||Total amount of monetary losses as a result of legal proceedings associated with bribery or corruption||All relevant legal proceedings and related financial effects are disclosed in our Annual Report – Notes to the Consolidated Financial Statements (pages 251 ff.).|
|HC-MS-510a.2||Description of code of ethics governing interactions with health care professionals||We have a Code of Ethics and Business Conduct that covers general compliance concepts and standards, including the expectation that all employees perform their duties in accordance with the Company’s purpose, global values, policy, the Code of Ethics and Business Conduct, and the law. The general principles in the Code of Ethics and Business Conduct are supported by policies that address specific situations in accordance with all applicable local laws, including interactions with health care professionals.|