A conversation with Dr. Bryan Wong, a partner in East Bay Nephrology Group in Berkeley, California, and a member of Patients and Caregivers to Protect Dialysis Patients, a coalition opposing a proposed ballot measure that would cap cost of care for patients with private insurance.
Dr. Maddux: You have been following a proposed ballot proposition in California that could appear before voters in November. Why are you so concerned about it?
Dr. Wong: The SEIU-United Healthcare Workers union is trying to qualify a ballot measure that could significantly reduce patient access to dialysis treatment. The proposed measure would impose unprecedented limits on what health insurance companies are required to pay community dialysis clinics, capping those reimbursements at 115 percent of the so-called cost of care.
My concern is that those reimbursements would simply not cover the cost of providing high-quality care. For example, the initiative specifically prohibits clinics from billing for necessary work by clinic physician medical directors, clinic coordinators, and other critical staff positions, such as people who provide education or help patients navigate insurance questions. It even prohibits billing for positions that are required by the Centers for Medicare and Medicaid Services. It’s a flawed ballot initiative that would certainly harm my patients in the Bay Area who have kidney failure and need access to dialysis three times a week.
Dr. Maddux: Specifically what concerns do you have about access to dialysis care in California?
Dr. Wong: If reimbursements don’t cover operating costs for the dialysis center, I would expect that they will have to cut services or possibly close their doors. That would significantly reduce access to care, particularly in poor and rural communities where dialysis clinics already struggle. Demand for dialysis in California is increasing at nearly five percent a year. Dialysis patients already have difficulty getting convenient appointments. We know that missing even a single appointment can result in a trip to the emergency room or even death. So this could have a major impact on our patients.
Dr. Maddux: What do you see as the motivation for the union pushing this ballot proposition in California?
Dr. Wong: I am not an expert in politics, but even a lay person can recognize the sole reason UHW is pushing this measure is to organize workers in dialysis clinics. The union wants to use the threat of a ballot initiative to scare dialysis providers into complying with their demands. It is irresponsible and dangerous for UHW to use patients as pawns.
UHW’s misguided strong-arm tactics need to stop. A report this year disclosed that since 2012, UHW has spent nearly $22 million in California on ballot measures that would have jeopardized patient care. This election cycle, the union is pursuing two statewide ballot measures and seven local ballot measures to seek an advantage in negotiations. I understand that politics can be a rough business. But it is unacceptable that a union that claims to represent the interests of health care workers and patients is putting them at risk.
Dr. Maddux: What is happening with the ballot initiative now and what is the plan to defeat it?
Dr. Wong: The SEIU-UHW organizers have submitted signatures with the goal of qualifying the dialysis measure for the November election. The California Secretary of State will decide in the next few weeks if it officially qualifies and will appear on the ballot.
Dr. Maddux: Can you describe the coalition that is opposing this ballot initiative?
Dr. Wong: We are lucky to have a broad coalition of more than 75 organizations who recognize the potential harm to our patients if this proposal passes. This coalition includes doctors, nurses, patients, caregivers, veterans, and other health care providers who have joined together to fight on behalf of California dialysis patients, called Patients and Caregivers to Protect Dialysis Patients.
Dr. Maddux: What advice would you give to fellow nephrologists in California?
Dr. Wong: It will take a sustained effort to help educate everyone involved in the dialysis field how our patients would be impacted by this ballot initiative, as well as explain it to the wider voting public. I hope my fellow physicians will take the time to learn more and speak to their patients about this important issue. I’m confident if we come together we will expose the flaws in this proposal. At the end of the day, the patient’s voice is the most important, and as physicians we can help ensure their voice is heard.
Dugan Maddux, MD, FACP, is the Vice President for CKD Initiatives for FMC-NA. Before her foray into the business side of medicine, Dr. Maddux spent 18 years practicing nephrology in Danville, Virginia. During this time, she and her husband, Dr. Frank Maddux, developed a nephrology-focused Electronic Health Record. She and Frank also developed Voice Expeditions, which features the Nephrology Oral History project, a collection of interviews of the early dialysis pioneers.
Bryan Wong, MD, is a nephrologist with the East Bay Nephrology Medical Group in California. He completed his medical degree and fellowship at University of California San Francisco, and his internship and residency at UCLA Harbor General Hospital. Dr. Wong is a member and past president of the California Dialysis Council and Medical Director with Fresenius Kidney Care and DaVita Dialysis.