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California voters reject new rules for dialysis clinics

SAN FRANCISCO (AP) — California voters have rejected a ballot measure to require a doctor or highly trained nurse at each of California’s 600 dialysis clinics.

With more than 9 million votes tallied Tuesday, Proposition 23 had just 37% of votes. It is the second measure seeking to regulate dialysis clinics placed on the ballot in recent years by unions that represent health care workers and drew more than $110 million in spending.

Opponents, financed by dialysis clinic companies, say that under that mandate, between two and three doctors would be required at every facility because most are open at least 16 hours a day, creating a financial burden that could lead some clinics to close.


Proposition 23 was the second attempt by the unions to increase regulation of dialysis clinics in California, where DaVita Inc. and Fresenius Medical Care — two of the country’s largest for-profit dialysis providers — operate about three-quarters of the state’s dialysis market.

THIS IS A BREAKING NEWS UPDATE. AP’s earlier story follows below.

SAN FRANCISCO (AP) — California voters are deciding whether to require a doctor or highly trained nurse at each of the state’s 600 dialysis clinics whenever patients are being treated to improve patient care.

Proposition 23 was placed on the ballot by unions that represent health care workers and has attracted more than $110 million in political spending to persuade voters.

Opponents, financed by dialysis clinic companies, say that under that mandate, between two and three doctors would be required at every facility because most are open at least 16 hours a day, creating a financial burden that could lead some clinics to close.

Proposition 23 is the second attempt by the unions to increase regulation of dialysis clinics in California, where DaVita Inc. and Fresenius Medical Care — two of the country’s largest for-profit dialysis providers — operate about three-quarters of the state’s dialysis market.

In 2018, a separate initiative sought to cap dialysis clinics’ profits and force them to invest more of their profits in patient care. Voters rejected the measure, which became the most expensive initiative on the 2018 ballot and one of the most expensive in history, generating more than $130 million in campaign spending: $111 million from dialysis companies and $19 million from unions.

This time around, unions have raised nearly $9 million, while the coalition against Proposition 23 — led by DaVita and Fresenius, along with the California Medical Association and American Nurses Association-California — has raised more than $105 million.

The nonpartisan Legislative Analyst’s Office estimates dialysis companies make roughly $3 billion a year from their California operations.

Dialysis providers say most California clinics offer high-quality care and are regulated by federal and state authorities. They also point out that all patients already have a nephrologist — a kidney specialist who oversees their care — and that nephrologists direct each California clinic. Both initiatives have been part of a tactic to pressure dialysis companies to unionize workers.

Dialysis patients typically undergo four-hour treatments at

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Prop. 23 aimed at dialysis industry trailing in early results

INGLEWOOD, CA. AUGUST 28, 2014 --- Giraldo Garcia, 54, gets dialysis at DaVita Dialysis Center on August 28, 2014 in Inglewood. (Irfan Khan / Los Angeles Times)
Giraldo Garcia, 54, receives dialysis treatment at DaVita Dialysis Center in Inglewood in 2014. ( Los Angeles Times)

A $100-million effort to impose new regulations on the dialysis industry appeared to be heading for defeat in early results Tuesday.

Proposition 23 would require dialysis clinics to employ at least one doctor who would be on site whenever patients are receiving treatment. Supporters of the measure, including the Service Employees International Union-United Healthcare Workers West, said dialysis clinics were putting profits over patient care by not having a doctor available in the event of complications or an emergency.

Opponents, however, argued the measure was the latest attempt by SEIU-UHW to weaponize the ballot box to try to force the dialysis industry to spend millions to defend itself when the union’s real interest is getting clinic workers to unionize. The dialysis industry put more than $100 million into fighting the measure, saying the unnecessary added cost would lead to dialysis clinics closing, which would put patients at risk.

In California, there are roughly 600 dialysis clinics treating thousands of people suffering from kidney failure with machines that remove a patient’s blood and filter it to remove waste and excess fluids before returning the blood to their body. Patients typically require dialysis three days a week for about four hours a day in order to live. Due to the high demand for dialysis, clinic operators say they are typically open six days a week for up to 16 hours a day.

In addition to having a doctor on site at all times, Proposition 23 would require clinics to report dialysis infection information to the California Department of Public Health every three months, which would be posted on the state agency’s website. Clinics could face a fine of up to $100,000 for failing to report the data or reporting inaccurate information.

Clinics are currently required to report dialysis infection-related information to the U.S. Centers for Disease Control and Prevention.

The measure would also require clinics to obtain approval from the state’s public health department before closing or substantially reducing services. Proposition 23 would bar clinics from refusing access to a patient based on their insurance.

Most people on dialysis in California are covered by Medicare, which extends coverage to people with kidney failure regardless of age or disability status.

This story originally appeared in Los Angeles Times.

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California Voters to Decide on Dialysis Clinics Care | California News

By OLGA R. RODRIGUEZ, Associated Press

SAN FRANCISCO (AP) — California voters are deciding whether to require a doctor or highly trained nurse at each of the state’s 600 dialysis clinics whenever patients are being treated to improve patient care.

Proposition 23 was placed on the ballot by unions that represent health care workers and has attracted more than $110 million in political spending to persuade voters.

Opponents, financed by dialysis clinic companies, say that under that mandate, between two and three doctors would be required at every facility because most are open at least 16 hours a day, creating a financial burden that could lead some clinics to close.

Proposition 23 is the second attempt by the unions to increase regulation of dialysis clinics in California, where DaVita Inc. and Fresenius Medical Care — two of the country’s largest for-profit dialysis providers — operate about three-quarters of the state’s dialysis market.

In 2018, a separate initiative sought to cap dialysis clinics’ profits and force them to invest more of their profits in patient care. Voters rejected the measure, which became the most expensive initiative on the 2018 ballot and one of the most expensive in history, generating more than $130 million in campaign spending: $111 million from dialysis companies and $19 million from unions.

This time around, unions have raised nearly $9 million, while the coalition against Proposition 23 — led by DaVita and Fresenius, along with the California Medical Association and American Nurses Association-California — has raised more than $105 million.

The nonpartisan Legislative Analyst’s Office estimates dialysis companies make roughly $3 billion a year from their California operations.

Dialysis providers say most California clinics offer high-quality care and are regulated by federal and state authorities. They also point out that all patients already have a nephrologist — a kidney specialist who oversees their care — and that nephrologists direct each California clinic. Both initiatives have been part of a tactic to pressure dialysis companies to unionize workers.

Dialysis patients typically undergo four-hour treatments at least three times a week, during which machines remove the blood in the patient’s body, filter toxins out, then put the blood back in, temporarily performing the functions of the kidneys.

Rick Barnett, who runs the largest nonprofit dialysis provider in California, Satellite Healthcare, with 60 clinics, said a kidney specialist oversees the care of every dialysis patient, highly trained nurses and technicians staff the clinics and both federal and state officials conduct scheduled and random inspections.

“This is not about quality of care so, my question is, what problem are they trying to solve?” Barnett asked.

Find AP’s full election coverage at APNews.com/Election2020.

Copyright 2020 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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California’s $100M dialysis battle comes with ancillary benefits for labor union


A patient undergoes dialysis at a clinic in Sacramento, Calif.

A patient undergoes dialysis at a clinic in Sacramento, Calif. | Rich Pedroncelli/AP Photo

OAKLAND — In initiative-happy California, one set of ads stands out — those involving dialysis clinics, an industry that’s historically been a lower-profile player in politics.

The ads are unusual not only because of their unlikely topic but their volume, which is high because industry opponents of a labor ballot measure are spending more than any group opposing the other 11 proposals California voters must decide on.

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The massive spending gap between the $100 million opponents, including DaVita Inc., have raised and the $8.9 million by supporters led by SEIU United Healthcare Workers West means that the dialysis industry has flooded airwaves as it defends itself against organized labor. The same chain of events played out two years ago, resulting in a resounding defeat for the union’s ballot initiative.

California’s ballot wars have escalated in recent years as industries see little problem spending more than $100 million — and nearly twice that amount in the gig industry’s case — to persuade the electorate. Businesses and organizations that don’t get their way in the state Capitol often use the ballot to change state laws or as leverage to pressure lawmakers and other powerful interests. Proposition 23 is the third most expensive ballot initiative in 2020, according to data compiled by POLITICO.

While SEIU-UHW says it is committed to passing Prop 23, political strategists suggest that labor backers may simply be playing the long game by placing an initiative on the ballot every two years challenging the industry. Win or lose, the union is putting pressure on dialysis companies to spend gobs of money each general election.

“The threat of a ballot measure is something UHW has used strategically,” said Brian Brokaw, a Democratic strategist in Sacramento who is not involved in the Prop. 23 campaign. “In order for a threat to actually be credible, sometimes you have to put it on the ballot. But appearing on a ballot and actually running a campaign to support something are two different things.”

Proposition 23 faces long odds not just because of the industry’s $100 million war chest, but also because it involves a regulatory matter on a crowded ballot — a perfect recipe for voter rejection.

Two years ago, Californians voted 60-40 to reject Prop. 8, another SEIU-UHW-backed initiative that would have capped dialysis profits. But to get that win, the dialysis industry, led by the dominant franchises DaVita Inc. and Fresenius Medical Care, invested about $111 million to defeat it, or nearly six times what the proponents spent.

One day after that Nov. 6, 2018 election, the union vowed to refile the initiative in California and other states. SEIU-UHW did file another initiative, but Prop 23 looks dramatically different, focusing on requirements that clinics must meet such as staffing one doctor on site.

John Logan, director of labor employment studies at San Francisco State University, said unions have long used non-traditional tactics like ballot-box campaigns to get

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