August 1, 2017

San Jose Mercury News: Editorial: California bill to raise costs of dialysis threatens patients’ lives

Editorial: California bill to raise costs of dialysis threatens patients’ lives San Jose Mercury News August 1, 2017 An insidious bill in the California Legislature that purports to improve medical care will actually endanger the most vulnerable of lives: Low income and elderly residents who need regular dialysis for their very survival. SB 349 by Sen. Ricardo Lara would establish the strictest-in-the-nation staffing minimums for nurses and technicians in dialysis clinics, where patients in kidney failure have their blood cleansed several times a week. It may sound humanitarian, but it’s a craven play for union support in the senator’s run for Insurance Commissioner next year. The law will raise costs, forcing reductions in life-saving service in some areas. Not only that, it purports to solve a problem that does not exist: Far from having dangerous dialysis centers, California is tied with Oregon for the lowest infection rates for dialysis in the U.S. Lara is carrying this bill essentially for the United Healthcare Workers, who have been trying, unsuccessfully so far, to unionize dialysis clinic workers. They claim there is some sort of problem among the state’s clinics and want this new set of draconian rules to improve treatment of patients. That narrative is in direct conflict with the facts. First, there is no empirical evidence that higher staffing levels per patient result in better care. On the contrary, there is statistical evidence from the Centers for Medicare and Medicaid Services. They find California’s dialysis clinics are among the safest in the nation, rating higher in qualify and patient satisfaction than clinics in other states that have mandatory staffing ratios. Second, establishing ratios imposes significant new costs on clinic operations. Those that can’t afford to cover those costs will see fewer patients. Hardest hit will be clinics in rural areas and low-income communities that treat large numbers of patients on Medi-Cal, whose reimbursement rate doesn’t cover the cost of care. Their patients are the most likely to suffer. The reduction in available clinic spots will force more dialysis patients to the state’s emergency rooms, either hoping for routine car or waiting until their condition is life-threatening. ERs are the most expensive way to deliver any routine service. So at the same time this law would put people’s lives in danger, it would cost taxpayers more. The Senate Appropriations Committee analysis came to this conclusion when it examined the costs. Renal patients, physicians, nurses, veterans groups, the National Kidney Foundation and the California Dialysis Council all oppose this bill. Loudly so. These are the interest groups that are the most affected by the changes that would be advanced in this bill. They are against SB 349, and so are we. If the Legislature passes it — Gov. Brown, get that veto pen ready.