Questions and Answers

Is SB 349 needed to “ fix dialysis”?

No. SB 349 is a solution in search of a problem. According to the federal Centers for Medicare & Medicaid Services (CMS), California’s dialysis clinics rank among the highest in the nation for clinical quality and outcomes. SB 349 is NOT about improving patient care. SB 349 is part of a larger union organizing effort that will have negative consequences for the nearly sixty thousand Californians with kidney failure who depend on dialysis treatment to survive.

Will SB 349 improve dialysis patient safety?

No. SB 349 puts dialysis patients at risk. The dialysis clinic staffing ratios mandated by SB 349 would ultimately result in fewer appointments and a dangerous backlog of needed care. Just one missed dialysis appointment means a 30% increase in mortality.

How will SB 349 jeopardize patient access to dialysis?

The staffing ratios mandated by SB 349 would result in significantly fewer appointment slots available and dialysis clinic closures. According to a statewide survey conducted by the California Dialysis Council (CDC), under SB 349:

  • 15,379 patients could lose their current access to dialysis care
  • 121 dialysis clinics are at risk of closing statewide
  • Nearly two-thirds (63%) of California’s evening and overnight (nocturnal dialysis) patient treatment shifts are at risk of elimination.

Demand for dialysis has more than doubled since 1997 and is expected to grow rapidly for the foreseeable future. Individuals on dialysis already have difficulty finding available treatment options near their homes and suitable to their schedules. The staffing ratios and longer transition times mandated by SB 349 would result in fewer appointments and even some clinic closures. SB 349 will reduce the availability of treatment slots, increasing hospitalizations and emergency room visits by patients and creating less flexibility for working patients with kidney failure as evening and nighttime treatments would be jeopardized.

Do other states have mandatory ratios and how does their quality of care compare to California?

There are eight other states with mandatory staffing ratios at dialysis clinics, though none as strict as the ratios proposed by SB 349. There is no evidence that staffing ratios improve patient outcomes. In fact, according to CMS data, on average, California dialysis clinics outperform states with mandatory ratios in clinical quality, patient satisfaction, and infection rates.

Is there sufficient oversight?

Yes. Dialysis clinics are already highly regulated and regularly inspected, consistent with federal regulations. In addition to periodic mandatory inspections, clinics are subject to routine, unannounced inspections. Dialysis providers already adhere to 376 individual regulations which are set by CMS to ensure clinical quality and safety. In addition, the CMS-affiliated End-Stage Renal Disease (ESRD) Networks of Southern and Northern California actively collect and monitor real-time clinic data on patient outcomes and have established a formal grievance system for any patient complaints.

Wouldn’t more inspections be better?

Not necessarily. There is no evidence that the current inspection and oversight protocol is insufficient. SB 349 would increase required inspections by nearly 400%. Adding inspections only adds to the backlog of new dialysis clinics in California that are on hold to open until they can be inspected. Today, there are dozens of clinics already built and ready to see patients and awaiting inspection in order to open. The only thing preventing them from opening are lagging state inspections.

Will SB 349 increase costs to the healthcare system?

Yes. SB 349 would increase costs to provide dialysis care in California by hundreds of millions of dollars per year. In fact, an analysis by California’s former Director of Finance found SB 349 would increase costs to care for Medi-Cal patients by as much as $270,000,000 per year. This means higher costs for an already strained Medi-Cal system, higher costs for patients and reduced clinic access. 90% of dialysis patients in California rely on a combination of Medi-Cal and Medicare for coverage.

Are California’s dialysis clinics understaffed?

No. Unlike other healthcare facilities where caregivers visit patients in different rooms on a rotating basis, caregivers at dialysis clinics are in the same room with their patients – never more than a few feet away. SB 349 imposes arbitrary staffing ratios without regard to the actual needs of individuals with dialysis. For example, a clinic with a high number of patients with a Central Venous Catheter (CVC) may staff with more nurses and fewer Patient Care Technicians (PCTs) since only nurses can initiate and terminate treatment for CVC patients. Under SB 349, such a clinic would have to adjust the number of nurses to compensate for the additional PCTs on the floor, in turn reducing the number of patients that could be seen.