Wednesday, May 9, 2018


The California Dialysis Initiative is up for vote in November. Its avowed purpose is to set arbitrary limits on what insurance companies pay dialysis clinics for actual patient care. The initiative sounds like it might be a protective device shielding patients from being overcharged. It isn't.

The dialysis clinics will be obliged to pay physicians and other providers less if they want to maintain current levels of corporate  profit. At the same time, to keep administrative charges intact, the clinic administrations will be obliged to scramble their physicians and require them to see more patients per unit of time.  It's called "efficiency." 

The California Medical Association is opposed to the initiative  because it poses potential harm to patients, but probably also because it poses financial hardship on large clinics and healthcare plans. For instance, healthcare contracts to provide care would have to be revisited and revised downwards. Current contracts would have to be renegotiated.  Physicians, through no fault of their own, would be obliged to bear the brunt of reduced remuneration to keep the money flowing to the upper echelons of administration. That's how business is done in America, isn't it? 

Once profitability is reversed recruitment of providers will drop. The trouble is that dialysis patients aren't in-and-out customers -- they often need lengthy visits, often more than occasionally -- so in the final analysis this initiative is against their best interests. That's why this initiative needs to go back to the drawing board.  


  1. Patients are going to die if this passes. No drama, just fact. Whether for profit or because of inadequate reimbursement, dialysis clinics in CA are already cutting major corners. Antisepsis is a joke. A dialysis patient I know, who also has some orthopedic problems, has suffered with a broken dialysis chair for months because fixing it wasn't in the clinic's budget. He takes his own antiseptic wipes with him, because he has observed serious breaches of infection-control mandates. The clinics are chronically understaffed, and/or using semi-skilled staff to perform nursing work. There have been some very close calls with machines malfunctioning in ways that threaten patient health and even life. These are some of the most vulnerable patients a physician sees, yet the doctor has to keep the time with each patient within arbitrary, non-medically-based guidelines, or s/he is working for free. The insurance companies make huge profits on people who have insurance and rarely use it, then whine if they have to pay the benefits they promised to provide, once the insured become older and/or develops a serious medical condition. Since patients with ESRD are automatically Medicare-eligible, this also shifts the burden from the insurance companies, who contracted for it, to Medicare, MediCal, and the taxpayers.

    1. The trouble with anonymous information is that it can't be verified even if the accusations are correct. So the clinic or clinics that are "understaffed" or use "machines malfunctioning in ways that threaten patient health" get away with their incompetence. - RLW, editor, The Weinmann Report

  2. Thanks for your opinion on Prop 8.

    -- Randy VanderHeyden