June 20, 2018
2 min read

Union, dialysis providers disagree about discussing California ballot initiative with patients

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The union that is backing a Nov. 6 ballot initiative in California aimed at limiting profits for dialysis providers says patients at Fresenius Medical Care clinics are being asked by staff workers to sign a petition to oppose the initiative. However, Fresenius says its educational efforts are aimed at making sure patients understand the effect of the initiative – possibly closed clinics – if it passes.

“We have serious concerns that the proposed ballot initiative would reduce options for our patients who depend on life-sustaining dialysis,” Fresenius Medical Care said in a statement. “ ... We believe that patients should have the opportunity to express their opinion on this measure as they would be the ones most directly impacted.” Fresenius said it is using its Patient Freedom Coalition to “help patients have their voices included in this discussion."

Los Angeles-based Service Employees International Union-United Healthcare Workers West recently won approval from the California Secretary of State to place the initiative, called the Fair Pricing in Dialysis Act, on the November ballot. If approved by voters, it would limit dialysis providers’ profits to 115% of their direct patient costs; any revenue beyond that would be sent back to commercial insurers in the form of rebates.

Dialysis providers, mainly Fresenius Kidney Care and DaVita Kidney Care, have funded a coalition called Patients and Caregivers to Protect Dialysis Patients to oppose the proposition. They say on the coalition’s website that the “deeply flawed” ballot measure sets artificially low limits on what insurance companies pay for dialysis treatments “that fail to cover all costs necessary to provide high-quality patient care ... nothing in the initiative requires one dollar of these potential rebates to be passed along to consumers.”

The coalition also says the initiative fails to account for the actual cost of providing care; it does not allow for dialysis providers to include costs such as medical director and nurse manager salaries, insurance counselors, facility administrators and facility security and professional services like accounting, human resources, payroll and legal services.

If payments from health insurers do not cover clinic operating costs, cutbacks in clinic services and clinic closures are possible, according to the coalition.

Earlier this month, the National Kidney Foundation released a statement opposing the proposition, saying the initiative “may be well intentioned but could end up harming the very patients it seeks to help.”

“While dialysis providers have room for improvement, including the frequency of facility inspections, The Fair Pricing for Dialysis Act will not have that effect,” the NKF said in a statement. “All parties, including patients and providers, should come to the table for an open and honest dialogue to develop solutions that will result in a benefit to patient care.”


The measure is also opposed by emergency room doctors, patient advocacy groups and dialysis clinics who say it puts the lives of dialysis patients at risk.

“This initiative is an example of a special interest looking to exert political pressure at the patient’s expense. This harmful and misleading measure will limit patients’ access to lifesaving dialysis treatment and endanger their lives,” Scott Bruun, executive director of the Chronic Disease Coalition, said in a May 30 release from Patients and Caregivers to Protect Dialysis Patients. – by Mark E. Neumann