Congratulations! It sounds like it was a close vote. Hopefully people have been writing their legislators. I can only see positives from this legislation for everyone – patients and facilities alike. I don’t understand why everyone wouldn’t be in favor of every technician working in dialysis having a basic level of competency as proven by one of the national certifying organizations – list at http://www.dialysistech.org/news/certificationa.htm – especially since technicians have until 1/1/09 to be certified. I have a hard time believing anyone who says that they support quality of care for dialysis patients if they oppose legislation that would improve the quality and consistency of technician training and documenting minimum competency through a certifying exam.
Beth,
It seems we have some Republicans who agree with you! We passed the Colorado State Senate Appropriations Committee by a 9-1 vote! Thank you both Democrats and Republicans!
I understand there should be a 2nd reading tomorrow and an unofficial vote - then a final vote on Wednesday or Thursday - then to the Governor.
Last chance to have your say with our State Senators:
contact info:
Colorado_State_Senators
We passed the state Senate 23-11! All that is left is for the Governor to sign it! I talked to my rep and he is pretty confident of that happening; he said he would get back to me if anything changes - so I guess I can stop the email blitz.
It has been quite a roller-coaster ride, but the end is in sight.
That’s great, Plugger! I’ve been reading all your posts here and elsewhere, I just haven’t really replied! lol You are doing a GREAT job!! I applaud you! 
Congratulations plugger. Do you get to go to the signing ceremony?
What’s the final text?
Bill,
Thanks! Yes, I do get to go to the signing ceremony - I’m looking forward to it! Here is a link to the final text (at least I think it is final):
It looks like a real good Bill plugger.
I hope you get a pen. And take some pictures.
We did it!!! The governor signed the bill Thursday (May 31st)! It looks like we have more work ahead
of us, but the framework is now in place.
I got this from my state rep:
“Congratulations! HB-1131 was signed into law today. Good work and now we just need to make
sure that the law is implemented and enforced as we envisioned.”
We didn’t get a ceremony and I didn’t get a pen - but I think I will get over it.
That’s fantastic, Plugger! You’ve really showed what committed, caring people can accomplish when they keep plugging on (pun intended) despite all the obstacles in the way. There was opposition to this, and there were times when victory was by no means assured, and you kept on fighting. Way to go! This bill will make a real difference to a lot of people.
That’s great Plugger. I look forward to updates as you watch the implementation.
You deserved at least a pen but it’s the signature that counts.
The governor had a big backlog of bills to sign and we weren’t one of the ones he highlighted - funny some of the ones he does highlight. But maybe it will add fuel to the fire when I go into any meetings (didn’t get my durn pen!)
YOU GO BOY! This was a great accomplishment on behalf of dialysis patients and I’m sure all concientious dialysis staff thank you, too. Now, help us figure out how we can get certification in every state and fines for units that cut corners.
I can tell how we did it, maybe that will help. I did decide to tell the story of how the Colorado Hemodialysis Technician Training Standards bill came about. I just wanted to show how a small determined group of people got it done.
Besides the story I’ve also added a friend’s response to the state report that almost shot us down and a fact sheet with some stats. I plan to add more but this will do for now.
I posted what I have at the new Patient Rights Advocacy healthcare forum where I’m a moderator. This is an organization that believes in the one-two punch of both legislation and legal action - not only for dialysis, but healthcare in general.
Patient Rights Advocacy link:
http://www.patientrightsadvocacy.org/index.php
My topic is in the Healthcare Forum, under “Dialysis Company” heading, and the “Colorado Tech bill story” topic.
[QUOTE=plugger_;13787]I can tell how we did it, maybe that will help. I did decide to tell the story of how the Colorado Hemodialysis Technician Training Standards bill came about. I just wanted to show how a small determined group of people got it done.
Besides the story I’ve also added a friend’s response to the state report that almost shot us down and a fact sheet with some stats. I plan to add more but this will do for now.
I posted what I have at the new Patient Rights Advocacy healthcare forum where I’m a moderator. This is an organization that believes in the one-two punch of both legislation and legal action - not only for dialysis, but healthcare in general.
Patient Rights Advocacy link:
http://www.patientrightsadvocacy.org/index.php
My topic is in the Healthcare Forum, under “Dialysis Company” heading, and the “Colorado Tech bill story” topic.[/QUOTE]
Reading your account with great interest, Plugger. I am reading through the Sunrise Report at present. I have a question about the following:
"In addition to continuous quality assurance programs and projects, Colorado’s largest provider of dialysis services employs professional staff, many of whom began their careers as hemodialysis technicians in the following capacities:
-
Vascular Access Managers
-
Anemia Managers
-
Bone and Mineral Managers
-
Infection Control Managers
These managers are highly trained experts in their individual areas of dialysis care and treatment, and they are available to assist and educate hemodialysis technicians, particularly in difficult or non-routine dialysis situations."
I have heard of nurses who handle the anemia management for a unit, but have never heard of the other managerial positions mentioned. Especially the manager for Infection Control- is this a joke? Surely this can not be serious- I have rarely seen dialysis staff observe infection control practices. Who are these highly trained experts this section of the report is referring to?
I suspect these “managers” are dialysis staff who have been assigned responsibility for tracking:
– what type of access the patient has/Kt/V/revisions/replacement (vascular access manager)
– the number and types of infections/hospitalizations for infection/antibiotics (infection control manager)
– control of calcium/phosphorus/PTH through diet, prescribed IV Vitamin D and oral phosphate binders (bone disease managers)
– control of hemoglobin/hematocrit by prescribing iron/EPO (anemia managers)
These are some of the clinical performance measures that CMS (Medicare) and ESRD Networks want dialysis clinics to monitor and improve. CPM areas should be discussed by dialysis clinic personnel not only as they pertain to individual patients but to all patients in the dialysis facility. A dialysis provider should have a CQI (continuous quality improvement) committee that consists of at least one member of each discipline with responsibility to review how care is provided, what problems have been identified, potential reasons for those problems including problems in the system of care, and the team should develop interventions and timelines that help them to fix problems.
[QUOTE=Jane;13795]Reading your account with great interest, Plugger. I am reading through the Sunrise Report at present. I have a question about the following:
"In addition to continuous quality assurance programs and projects, Colorado’s largest provider of dialysis services employs professional staff, many of whom began their careers as hemodialysis technicians in the following capacities:
-
Vascular Access Managers
-
Anemia Managers
-
Bone and Mineral Managers
-
Infection Control Managers
These managers are highly trained experts in their individual areas of dialysis care and treatment, and they are available to assist and educate hemodialysis technicians, particularly in difficult or non-routine dialysis situations."
I have heard of nurses who handle the anemia management for a unit, but have never heard of the other managerial positions mentioned. Especially the manager for Infection Control- is this a joke? Surely this can not be serious- I have rarely seen dialysis staff observe infection control practices. Who are these highly trained experts this section of the report is referring to?[/QUOTE]
[QUOTE=Beth Witten MSW ACSW;13800]I suspect these “managers” are dialysis staff who have been assigned responsibility for tracking:
– what type of access the patient has/Kt/V/revisions/replacement (vascular access manager)
– the number and types of infections/hospitalizations for infection/antibiotics (infection control manager)
– control of calcium/phosphorus/PTH through diet, prescribed IV Vitamin D and oral phosphate binders (bone disease managers)
– control of hemoglobin/hematocrit by prescribing iron/EPO (anemia managers)
These are some of the clinical performance measures that CMS (Medicare) and ESRD Networks want dialysis clinics to monitor and improve. CPM areas should be discussed by dialysis clinic personnel not only as they pertain to individual patients but to all patients in the dialysis facility. A dialysis provider should have a CQI (continuous quality improvement) committee that consists of at least one member of each discipline with responsibility to review how care is provided, what problems have been identified, potential reasons for those problems including problems in the system of care, and the team should develop interventions and timelines that help them to fix problems.[/QUOTE]
Oh my goodness…actually, my first question to Plugger was- “WHO” wrote this report and where did he/she get their information??? Describing ordinary dialysis techs and some nurses as “highly trained (Manager) experts in their individual areas of dialysis care and treatment” is highly misleading. Yes, in too many units dialysis staff are “trackers” who are tracking problems that occur rather then preventing problems from occuring, very serious ones (i.e. infections giving patients pain, landing them in the hospital, causing the loss of their accesses, up and down hgb, bone problems and many other problems) BECAUSE patients are not given adequate education and their care is not managed efficiently. All of the latter results in pain and suffering/loss of life for dialysis patients and bigger bucks for units and hospitals. So, “highly trained experts” NO - insufficently trained “trackers” YES!
“A dialysis provider should have”-YES - SHOULD HAVE are the key words, but too many units DO NOT HAVE - they are NOT doing the job CMS mandates them to do and CMS is not monitoring them.
PLugger, like the patient (Mary) who critiqued the report, I see plenty to critique, too, and will do so as I find time to read on.
At this point, Medicare funding only allows a surveyor to walk through the door of a dialysis clinic on average once every 3 years unless there is a complaint or unless a survey is triggered by the State Agency because the facility is performing poorly on certain outcomes that Medicare is looking at. I believe there are regulations that require surveys of other types of healthcare settings like home health agencies and nursing homes annually. There are many complaints about nursing homes and home health agencies and that’s why they need to be surveyed as often as they are. I don’t believe that there is any federal regulation that requires states to survey dialysis facilities more often.
If you believe it would improve quality of care for dialysis patients to have dialysis facilities surveyed more often, there are a couple of ways I’ve heard of to advocate for this:
– Contact your federal elected officials and ask for regulation requiring that dialysis facilities be surveyed annually and increased funding in CMS (Medicare) specifically allocated for surveys of dialysis facilities. If the funds are not allocated for dialysis, State Agencies may end up using the funds to survey other health settings if there are complaints about problems in those areas.
– Contact your state elected officials and advocate for state legislation that would require licensing of dialysis facilities that would require that each facility pay a fee to the state that would be used to assure that quality care is being provided to renew the license.
Some people don’t like regulations and government oversight, but I believe if you’re doing a good job, having government oversight won’t be a problem for you.
Huh? Beth, maybe I’m missing something here, but I’m not clear on how surveying rules/practices is relevant to a discussion of whether or not dialysis staff are being accurately described as “highly trained experts in ___.” Wanna help us follow your logic?
I’ve never seen the “highly trained expert” claim before, and find it kind of interesting. It may well be that the LDOs have some sort of extra training or certification for these “expert” positions, but I’ve never heard of it. Has anyone else?
Jane had posted:
“A dialysis provider should have”-YES - SHOULD HAVE are the key words, but too many units DO NOT HAVE - they are NOT doing the job CMS mandates them to do and CMS is not monitoring them."
I was explaining why that didn’t seem to be happening when the “highly trained professionals” were “managing” the clinical performance measures and how to advocate for more oversight. This thread started with Plugger’s advocacy effort. I’m suggesting another advocacy effort.
[QUOTE=Beth Witten MSW ACSW;13805]Jane had posted:
“A dialysis provider should have”-YES - SHOULD HAVE are the key words, but too many units DO NOT HAVE - they are NOT doing the job CMS mandates them to do and CMS is not monitoring them."
I was explaining why that didn’t seem to be happening when the “highly trained professionals” were “managing” the clinical performance measures and how to advocate for more oversight. This thread started with Plugger’s advocacy effort. I’m suggesting another advocacy effort.[/QUOTE]
Okay, that helps me at least. 
Nursing homes (which are often inspected by the same folks who do dialysis centers) are required to be inspected every year. There are not enough surveyors to go around, at the moment, to survey dialysis centers every year, too, so as you point out, it would take a pretty concerted advocacy effort to get CMS to devote additional resources to this area and/or to obtain legislation to require annual inspections of dialysis centers. Of course, we’re all about home on this site, and CMS inspections are less relevant there.
Beth and I have both had some opportunities to help ensure that the CMS surveyors are exposed to self-management philosophy, home dialysis, and educational resources that they can share with staff in the centers they inspect (who may not have the chance to attend national meetings and find out about these things). It’s always a shock to find out how few people know about resources that we tell folks about every day.