Dialysis providers have formed a coalition of doctors, nurses, patients, veterans and other health care providers in California to fight efforts by a health care workers’ union to get a measure on the California statewide ballot in November that would cap dialysis clinic profits. A similar union-backed initiative to limit profits has begun in Ohio.

The proposed ballot initiative is being developed by a group called the Californians for Kidney Dialysis Patient Protection, funded by the Service Employees International Union-United Healthcare Workers West (SEIU-UHW). The proposition sets limits on what insurance companies pay for dialysis care.

The coalition, called the Patients and Caregivers to Protect Dialysis Patients, funded primarily by DaVita Kidney Care and Fresenius Medical Care North America, will lead opposition to the union effort.

“[Renal Physicians Association] RPA fully supports all efforts to improve health outcomes in dialysis, but we are concerned that this initiative will negatively affect patients on dialysis in California,” Michael D. Shapiro, MD, MBA, FACP, CPE, president of the RPA, which is a member of the coalition, said in a press release. “If dialysis clinics close or reduce the number of patients they are able to treat because of this initiative, patients would find it harder to access life-saving care. We can’t support any policy that jeopardizes quality kidney care.” Other groups that are part of the coalition include the National Renal Administration Association, the Chronic Disease Coalition and the California Dialysis Council.

Bryan Wong, MD, a practicing nephrologist and board member and past president of the California Dialysis Council, said in the release, “UHW is using the threat of a terrible ballot initiative to try to force dialysis providers into complying with their union organizing demands. While a union has every right to try to organize workers, it is wrong, irresponsible and dangerous for UHW to use patients as pawns in this endeavor.”

According to the coalition, the ballot initiative would limit what insurance companies pay (Medicare and MediCal are exempt) to outpatient dialysis clinics for patient treatments. The limits would require clinics to issue annual rebates to private health insurance companies if any charge exceeds 115% of patient services costs. However, the coalition notes that the initiative does not allow for clinics to includes overhead costs for personnel as part of those costs.

“The proposition’s definition of ‘patient care services costs’ does not cover the actual cost of providing care at a clinic and excludes many necessary costs — including those important to patient care such as the physician medical director and the nurse clinical coordinator. If necessary dialysis clinic costs aren’t accounted for, clinics will be forced to cut back services or close, leaving patients with limited options for getting life-saving dialysis care,” according to the coalition. –by Mark E. Neumann