I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: News Articles => Topic started by: kickingandscreaming on May 24, 2017, 06:19:29 PM
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And by “total disruption,” we mean making sure workers have time to clean the machines between patients.
HBO’s John Oliver took on the dialysis industry a couple of weeks ago, highlighting a pair of companies that have a near-monopoly on keeping your kidney functions going.
Between them, these two businesses ― one based in Colorado and one in Germany ― control 70 percent of all the dialysis centers in the U.S. In 2015, they saw a combined $2.9 billion in profit, in no small part thanks to a 45-year-old Medicare amendment that guarantees dialysis coverage for everyone and costs the nation a full 1 percent of the federal budget each year.
But Oliver neglected to mention the biggest thing happening in dialysis reform: a state bill in California that could overhaul the way dialysis providers operate.
The bill, introduced by state Sen. Ricardo Lara (D-Bell Gardens), would do several things. It would establish minimum staffing levels, require that employees get 45 minutes to “transition between patients” ― in other words, to clean the equipment properly ― and require inspections to be conducted annually, instead of the current standard of once every six years.
California dialysis center workers and patients rallied Tuesday in a show of support for the legislation.
But Lara’s bill is opposed by a coalition of doctors, patients, and dialysis centers who claim it is redundant to existing safety measures, and who argue it will harm patients, close down centers, and make dialysis treatment harder to get.
According to a statement by the California Dialysis Council, dialysis centers already satisfy 346 federal regulations to ensure the safety of their patients and the quality of the treatments they deliver.
The bill’s opponents also point to California dialysis centers’ “report card” with Medicare. About 47 percent of the state’s clinics have 4- or 5-star ratings, while the national average is just 40 percent.
But looking at that statistic another way, it also means that 60 percent of the nation’s dialysis centers don’t score very high marks ― and that the situation in the Golden State is only a little better than in most of the U.S.
Two companies control the marketplace
Each year, more than 63,000 Californians ― and about 650,000 people nationwide ― receive hemodialysis, the process by which a machine filters impurities from the blood when the kidneys fail.
It is clearly a big business, one created by a last-minute amendment to a Medicare bill in 1972 that in just a few paragraphs mandated coverage for dialysis for anyone who needed it. As Oliver pointed out on HBO, that makes your kidneys the only organs in your body to have universal health coverage.
Two for-profit private dialysis companies, Colorado-based DaVita Healthcare Partners and German conglomerate Fresenius Medical Care, control about 70 percent of the U.S. market. In 2015 alone, they saw a combined profit of $2.9 billion from their dialysis business. Together they operate about 3,900 locations nationwide — “roughly the same number of Target, Best Buy, and Publix Super Market stores combined,” according to The New England Journal of Medicine’s Catalyst publication last year.
For patients who need dialysis, the procedure is all that stands between them and certain death. But there is another side to dialysis ― namely, that the leading cause of death among dialysis patients has been infection, which is the impetus for the California measure.
The California bill says that low and inadequate staffing levels at dialysis centers have led to hospitalizations, medical errors, and “unnecessary and avoidable deaths.” Dialysis workers say their caseloads are too heavy, and that they sometimes feel like they’re working on a factory assembly line. They contend that there often isn’t enough time between patients to properly prepare the dialysis stations.
In one case, three patients contracted an infection at a dialysis clinic in Los Angeles County after workers didn’t adequately clean and disinfect the machines, according to a report in the American Journal of Infection Control.
As the California bill moves toward a vote by June 2, the hope is that California will serve as a model for nationwide legislation, said Sean Wherley, spokesman for the Service Employees International Union’s United Healthcare Workers West. While eight other states have established standards for dialysis care in the form of health department regulations, California would be the first state to actually legislate those minimal care standards.
Of the 468,000 people nationwide getting dialysis, 14 percent of them are in California, according to Wherley. “Once again, California is taking a leadership role in health care by developing legislation to regulate the dialysis industry,” he said. “Judging from the resistance that the dialysis industry is mounting, there is no question that this has national implications.”
DaVita did not respond to a request for comment.
http://www.huffingtonpost.com/entry/california-dialysis-bill_us_591cb525e4b03b485cae4d1e?ncid=inblnkushpmg00000009
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As much as i HATE gOVERNMENT STICKING IT'S NOSE INTO BUSINESS, IN THIS APPLICATION OF hEALTH cARE i bELIEVE THIS bILL TO BE A GOOD THING.
bAH! cAPPS lOCK!
The Dialysis Companies argument that this will cause clinics to close is a lot of hogwash! Their profits are high enough they can easily absorb the lost 'seat time' For example, in my clinic running 43 people a day times the 3/4 hour between patients adds up to a total of 32.25 hours. Which divided by say 4 hour treatments is 8 treatment times. Multiply that by how much Social Security pays them and the Company will scream they are losing that much money daily.
Sure. And as if that is going to close a clinic that is making multi-million dollars annually.
I don't think so.
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The dirty duo treats its employees worse then they treat their patients. Where I usually go the sit the 3 or 4 patients a tech is working on next to each other. Last year my primary center was closed for 6 weeks in the center we were sent to a new center 3 miles away. There the techs are assign 4 patients spread around the facility so they have to run from patient to patient to answer alarms. By the end of shift the techs look worse than the patients.
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There will be unintended consequences.
Want to re-schedule at your local clinic so you can attend a wedding? Need a chair at an out of town clinic for a vacation? You may find that it's harder to book because you will run into "we have a chair at that time but seating you would put us above our ratio so it must remain empty".
Simple solutions rarely are.
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I did dialysis in CA for 2 years before I moved back to WA. I can tell you a couple of problems that they didn't mention. 90 percent of the workers are Filipino. They barley speak English and their Hygiene is not what we are use to. Like washing your hands after you use the bathroom..... Twice I stopped them from giving me insulin. I asked what they were giving me and they said insulin and I said I'm not diabetic... OMG They said "what DNR mean"... I said it does not mean I'm diabetic....
Another CA problem is the illegals dialyze for FREE. I've seen them come in after a weekend with the same bandages on.... That would make the infection rate climb.
I dialyzed in the 80's when it was all non-profit. I was so happy when it went for-profit because I was sure our care would improve. But, unfortunately GREED took over.
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. I asked what they were giving me and they said insulin and I said I'm not diabetic... OMG They said "what DNR mean"... I said it does not mean I'm diabetic....
This makes no sense. Even if one is diabetic, it takes a medical order for the type of insulin; timing and dose. You don't just "give insulin" because someone is diabetic.
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Tell me about it and it happened twice. That is why I was a "problem" patient. I always asked what they were doing.
Where I'm at now I have "some" trust. At least I can understand what they are saying about me. :waving;
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The clinic I go to is abou 50 percent Filipino, mostly the nursing staff. They are remarkable for their dedication to the health of their patients. The training nurse is a remarkably well educated male nurse from the philapines if he has trained you and you lived then you are a great nurse or tech. The funny thing about you observation is it's the fillapino personnel in this clinic that insist you scrub your arm, then they follow up by washing it again with disinfectant. The clinic is jointly run by Fresenius and a local hospital and the techs and nurses are all hospital employees.
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I feel the need to defend wide swaths immigrant care givers. My center started out with a very nice and highly competent Filipino nurse who moved on to a new center who was replaced by a competent Korean nurse who was a tech in the center and only filled in when nurses were on vacation (she has more problems communicating well). My favorite tech was a Somali who wore a Hijab, she also moved to the new center and now a young new tech of Latin American decent (likely second generation) was trained and has became my favorite. The techs become my favorites because they seem to be making good choices and care about my care beyond the minimum set by the system.
We also have a new tech who was a doctor in Afghanistan who could become a doctor here after various rounds of testing with each test costing something like $2,000 - he is still learning and less confident. There are a few other male techs who are either of Filipino or Latin American decent (likely second generation) who are good but either I don't connect with as well or it feels like their role is mostly just a job for them.
On the doctor side my long time nephrologist is white, and his partner who now cares for me appears to be north African or Middle Eastern. I'm confident in both and I trust their advice.
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I can definitely see where the California bill would be beneficial in helping the work day go smoother, but I do think it will add time to the work day and the staff would probably still be encouraged to disinfect the chair and machine quickly and then do water room tests for the rest of the 45 minutes. We try to stagger our chair times so no one has to wait that long and have 15 minutes in between patients. Change over is crazy, but works. Most of our infections come from catheters, very few from fistulas or grafts.
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Smart cookie...I would hope that the infections in the caths are not due to your center...but from issues with the patients at home?
Sterile technique is of the upmost importance with a CVC....and it's pretty simple to hook up a patient with a cath, compared t someone with a fistula.... :beer1;
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I think so, Xplantdad. Plus catheters are just more likely to become infected. My patients I see infections the most with are our fragile patients, like ones with sickle cell, autoimmune or HIV.