Prop. 23 Asks: Ought to Dialysis Clinics At all times Have A Doctor On Web site? (Transcript)

Prop. 23 Asks: Should Dialysis Clinics Always Have A Physician On Site? (Transcript)
February 10, 2021 0 Comments

Voice 1 [00:00:22] Prop 23 requires at the least one licensed doctor onsite throughout remedy at outpatient kidney dialysis clinics.

Olivia Allen-Value [00:00:30] This one sounds easy on the floor, however has lots occurring if you take a more in-depth look. We’ll undergo the ins and outs as we speak on Proposition 23, the dialysis prop.

Olivia Allen-Value [00:00:43] KQED well being correspondent April Dembosky has been following Prop 23. Hey, April.

April Dembosky [00:00:47] Hey, Olivia.

Olivia Allen-Value [00:00:48] Let’s begin off with simply the highest line right here. What are we voting on in Prop 23?

April Dembosky [00:00:52] Proposition 23 is aimed toward bettering care at dialysis clinics in California. There are just a few completely different components to it, however the primary factor is that it might require clinics to have a doctor onsite throughout all hours sufferers are receiving remedy.

Olivia Allen-Value [00:01:07] One among my first ideas after I noticed this on the poll was, did not we already vote on this? Like I bear in mind a poll initiative from simply a few years in the past about dialysis.

April Dembosky [00:01:16] Yeah, lots of people are having deja vu on this one. Two years in the past, there was one other dialysis measure on the poll and the identical teams that had been for and towards it final time are the identical teams duking it out this time. So, on the core of each poll measures is a labor dispute on the sure aspect is SEIU [Service Employees International Union] a union that represents well being care staff at numerous hospitals like nurses and upkeep employees. And so they’ve been attempting to arrange staff at dialysis clinics for about 4 or 5 years now. However the corporations put up a fierce resistance to these efforts. That is DeVita and Fresenius [Medical Care], the 2 large dialysis corporations in California, they don’t seem to be excited by seeing their workforce unionized.

April Dembosky [00:01:56] So in 2018, SEIU put a measure on the poll to attempt to get leverage with the dialysis corporations. And that is really a typical MO of the union. Up to now, they’ve put measures on the poll that sound interesting to voters however that they know will irk the hospital they’re combating with. Then in the event that they get what they need from the hospital, they withdraw the measure. Now, with Prop 23, the businesses say that the union is at it once more and the union says they’ve given up attempting to unionize dialysis staff, however they realized lots about clinics alongside the way in which and the way in which that sufferers are cared for. And so they say they’re doing this for the sufferers. That is Steve Trossman, a spokesman for the union.

Steve Trossman
[00:02:35] This initiative is about bettering situations for sufferers, bettering security for sufferers and making the dialysis clinic spend among the billions of {dollars} they make yearly to enhance their clinics.

Olivia Allen-Value [00:02:50] So is Prop 23 the very same measure that we voted on in 2018?

April Dembosky
[00:02:54] No, it is completely different. Two years in the past, the measure was about attempting to restrict the revenues that dialysis corporations might soak up to attempt to direct more cash to staff and affected person care. And the union was attempting to hit them within the pockets. However it was a very complicated measure and voters voted it down. So the union went again to the drafting board just about immediately to give you a brand new measure, one which they hoped could be simpler for voters to know and maybe extra interesting. And so they selected this: Let’s require dialysis corporations to have docs onsite full time for so long as sufferers are receiving remedy. Now, quite a lot of dialysis facilities are open from 5:00 within the morning to eight:00 p.m. at evening, so most are going to want two or three docs to maintain them totally staffed. And the state Legislative Analyst’s Workplace says that is a number of hundred thousand {dollars} a yr for every clinic. So, it is nonetheless a manner for the union to hit the clinics within the pockets, however this time, possibly a bit extra interesting to voters.

Olivia Allen-Value
[00:03:52] Now, earlier than we get into the small print of the measure, are you able to clarify a bit about what dialysis is first and who will get it?

April Dembosky [00:03:59] Dialysis is for individuals with kidney failure. It is a process that cleans toxins from the blood. Most sufferers go thrice every week for 3 to 4 hours every time. And also you’re exhausted afterwards. So it is a large disruption to life. Lots of people must give up their jobs. Kidney failure may end up from a wide range of well being situations, however most frequently it is brought on by diabetes or hypertension. And since individuals of shade usually tend to expertise these well being situations, they’re extra more likely to be on dialysis. 57% of dialysis sufferers in California are both African American or Latino.

Olivia Allen-Value [00:04:37] Now, after I first learn this measure, I believed, yeah, having docs round to assist with sufferers appears like an excellent concept. I assume, is that this a good suggestion?

April Dembosky [00:04:46] So, healthcare is difficult and it is exhausting to know if this may actually assist sufferers or if it might need unintended penalties. So sufferers have already got their very own docs. They arrive see them within the clinics as soon as a month or as soon as every week to test on their dialysis, prescription medicines, to watch their labs. And researchers have studied whether or not the frequency of physician’s visits makes a distinction in sufferers’ well being. Again in 2004, Medicare, the federal government well being program that pays for many dialysis remedy, created a brand new incentive to encourage docs to go to their dialysis sufferers extra typically. So as an alternative of 1 or two instances a month, it pushed them to go to 4 or extra instances monthly. Effectively, after greater than 10 years of doing this, it seems seeing your physician extra typically has no influence on well being outcomes. Actually, sufferers who had been seen much less typically by their physician really had higher survival charges. So the federal government was paying docs more cash for extra providers with no conclusive advantages to indicate for it.

April Dembosky [00:05:51] Then there is a query of emergencies. Emergencies do come up. Sufferers and workers have informed me that they’ve seen sufferers faint throughout remedy, or code, which suggests their coronary heart stops. If somebody’s coronary heart stops whereas they’re within the clinic, nurses or technicians will do CPR. Perhaps use a defibrillator and they’ll name 911 to have paramedics take them to the hospital. I spoke with Magellan Handford. He is been a dialysis nurse for nearly 20 years and he is in favor of Prop 23. He says having a physician on website would assist with these sorts of emergencies.

Magellan Handford [00:06:23] Earlier than we used to have – in our crash cart – we used to have medicines like epinephrine and bicarb and various things to help in a code. And we do not have these anymore. They took all of these off our crash carts as a result of there is not any physician there to present directions.

April Dembosky [00:06:41] However the individuals on the no aspect say that having a physician there will not change any of the protocols and will not make any distinction whether or not the affected person survives or not. They’d do the identical CPR the nurses do, and they’d nonetheless name an ambulance to take them to the ER. And there are some research on the market methods to stop this sudden cardiac demise from taking place, however they give attention to medicines sufferers take commonly or having sufferers use a wearable defibrillator to watch their coronary heart exercise. However I have not discovered any research that recommend having a physician at a clinic full time will influence sudden cardiac demise amongst dialysis sufferers.

Olivia Allen-Value [00:07:17] May having docs round assist with different facets of dialysis affected person well being?

April Dembosky [00:07:21] The opposite large concern at dialysis clinics is infections. You are utilizing catheters and needles to entry the bloodstream. And dialysis sufferers have weakened immune programs that make it tougher to battle an infection. However all the most effective practices round how you can stop infections must do with sanitation, cleansing the dialysis station, sporting gloves, washing your arms, and different antiseptic protocols. And physician time does not actually appear to have an effect on this. Giving nurses extra time to do this stuff might enhance outcomes. However this measure does not point out something like this. It might require clinics to report an infection knowledge to the state, however they already report the identical knowledge to the federal authorities.

Olivia Allen-Value [00:08:03] Is there probably a draw back to having docs on website full time?

April Dembosky [00:08:06] So, simply to be clear, clinics do have docs affiliated with them, they’re simply not full time. Federal rules require them to have medical administrators they usually’re required to be kidney specialists. Prop 23 does not specify that the physician on website needs to be a kidney specialist. And there is a query about whether or not there’s even sufficient kidney specialists within the state to go round. Dialysis sufferers will let you know that they’ve had encounters with different docs on the hospital who aren’t specialists, who do not actually know how you can deal with them or they make errors. And so this really sort of scares them a bit, that this could possibly be dangerous.

Olivia Allen-Value [00:08:42] Yeah, among the advertisements that I’ve seen are actually scary and paint this as a difficulty of life or demise. Let’s hear to 1 from the no on Prop 23 marketing campaign.

No on Prop 23 commercial [00:08:52] One particular curiosity group, once more, is placing my life in danger. And Prop 23 might shut down my clinic. I am not going to die from dialysis. I’ll die with out it. Prop 23 is harmful. Please vote no.

Olivia Allen-Value [00:09:09] So, April, let’s discuss this. Is it true that clinics will shut if this passes as a result of they simply develop into too costly to function?

April Dembosky [00:09:17] So this is similar MO the dialysis corporations used final time, threatening to close down clinics. Two years in the past they spent 111 million {dollars} on advertisements like this one to defeat the earlier measure, they usually’re approaching comparable spending on this one. And whereas it is attainable that some clinics might shut, it might doubtless not be a rare quantity. And this is why: 3/4 of dialysis clinics in California are owned by two corporations, DaVita and Fresenius. They’re each for revenue corporations, and final yr, they each did very effectively. Each made greater than a billion in earnings, and DaVita had a 16% working margin final yr. And for Fresenius it was 13%. And for well being care, that is excellent. However even past the query of whether or not these corporations might even take in these prices, there are methods that they may move them on. So, they may go to insurance coverage corporations and say, hey, California handed this regulation, it is now going to price us X % extra to ship dialysis remedy, and since we management a lot of the market, we will want you to shoulder a few of that prices. In any other case, we’re not going to ship the care.

Olivia Allen-Value [00:10:23] OK, so possibly this would possibly not bankrupt the dialysis clinics, but it surely’s not likely clear how a lot having docs round will actually assist the state of affairs both. So, I assume, is that this value some cash?

April Dembosky [00:10:34] So, there is a large image consideration right here. You recognize, extra shouldn’t be all the time higher in well being care. The U.S. spends virtually 18% of GDP on well being care, and that is greater than every other developed nation. However our outcomes are worse. And so, you already know, spending more cash on well being care doesn’t all the time end in sufferers doing higher. And well being care coverage on the whole is attempting to take this into consideration. California and the nation have really been shifting in the wrong way of getting docs do every little thing. Physician’s time is basically costly and there is a recognition that there are quite a lot of well being care duties that simply do not require the experience of a physician.

April Dembosky [00:11:12] So, in reality, the governor, California governor, simply signed a pair new legal guidelines that give nurse practitioners and nurse midwives extra autonomy to apply with out a physician’s supervision. Well being advocates imagine that these sorts of measures will really make healthcare extra inexpensive and extra broadly out there, like in rural areas the place it is exhausting to draw sufficient docs. So, placing this measure on the poll, voters are being given a giant accountability right here, they’re being requested to make well being coverage. We’ve to resolve how a lot better issues is perhaps having docs on website, and if it is value the associated fee. And quite a lot of sufferers on the market are actually uncomfortable with voters being the one doing this balancing act, they suppose lawmakers must be the one to weigh all these components and make selections about how clinics must be regulated. I talked to 1 affected person, DeWayne Cox, and he doesn’t like Prop 23 in any respect due to this:

DeWayne Cox [00:12:05] After I see these propositions which are put earlier than the voters, who do not know what we undergo and what’s essential to preserve us alive, it makes me indignant. As a result of they’re, they’re taking part in politics, for no matter their causes are, however they’re placing sufferers like me in the course of it.

Olivia Allen-Value [00:12:32] April, what is the spending ban on this poll measure up to now?

April Dembosky [00:12:34] It has been fairly lopsided. The dialysis corporations have been placing in about 93 million {dollars} up to now to attempt to defeat the measure. And the unions have put in just a bit bit over 6 million to attempt to get voters to move it.

Olivia Allen-Value [00:12:51] All proper, KQED well being correspondent April Dembosky, thanks.

April Dembosky [00:12:55] You are welcome.

Olivia Allen-Value [00:12:58] In a nutshell, a vote sure on Prop 23 says you need dialysis clinics to comply with these new necessities. A no vote says you wish to preserve issues the way in which they’re now.

Olivia Allen-Value [00:13:12] Be part of us tomorrow for our episode on Prop 24 about client privateness. It is one of many extra difficult measures on the poll this yr. Bay Curious Prop Fest is made by Katrina Schwartz, Rob Speight, Katie McMurran, and me, Olivia Allen-Value. Our present is produced in San Francisco at Member Supported KQED. Thanks for listening.

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