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More staff please. California staffing ratio bill heats up dialysis industry.

Doctors and Nurses

There is a lot of debate happening these days in California around a proposed staffing ratio bill that has been introduced. It has led to considering the impact this would have on the quality of care for the dialysis patient in California. The Conditions for Coverage that govern dialysis providers nationally give this guidance: "Adequate number of qualified personnel are present whenever patients are undergoing dialysis so that the patient/staff ratio is appropriate to the level of dialysis care given and meets the needs of the patients." Now that is adequately vague.

SB 349, the Dialysis Patient Safety Act, introduced by state senator Ricardo Lara, D-Bell Gardens, proposes a 1:8 nurse to patient ratio, a 1:3 patient care technician to patient ratio, and a 1:75 social worker to patient ratio. When compared to the nine other states that have already passed laws with some kind of staffing ratio language included, California would hold the most stringent ratios.

What if we look at California's dialysis industry quality measures as defined by the Centers for Medicare & Medicaid Services (CMS) compared to the states that have these mandatory staffing ratios? One would expect more staff means better quality of care for the patient. After looking at the Dialysis Facility Compare website, which houses public information by state for several quality measures, the results are surprising. This site includes billing and self-reported data for public transparency of dialysis quality of care. As it turns out, yes, California is lagging in a few measures namely hospitalizations. Interestingly, California fares better than its closest counterpart Texas in the important issue of survival.

What matters to the HealthInsight ESRD Alliance in Southern California? First and foremost it is about quality care and access to care for the dialysis patient. Will care improve? Will there be access to care issues if clinics shut down due to the financial burden or shifts are eliminated due to mandated time between shifts? Will patients experience more individualized care? Will the current nursing shortage impact the providers' ability to meet these ratios?

A friend of mine in California who has been a long time dialysis patient gave this perspective: most patients believe there is a staff shortage and current staff are spread pretty thin, which can impact the culture of care for patients. He did, however, relate that he has received excellent care in most centers he has dialyzed, in spite of the staff shortage he observed. So, the argument may not be that quality measures would improve with adequate staffing, but perhaps staff stress, burnout and turnover may experience a reprieve. And happy, healthy staff can provide better patient experience of care.

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