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Nearly half of dialysis technicians failing skills test

Wikimedia CommonsOnly about 56 percent of dialysis technicians are passing a new competency test.

A large percentage of dialysis technicians are failing a new competency test required by federal authorities, cutting into the patient-care workforce in California.

Dialysis patients rely heavily on services provided at storefront facilities to do what their kidneys can no longer do – clean their blood.

Medicare and Medicaid are key funders of the service. Those federal programs decided in 2008 that all dialysis technicians must pass a test proving [PDF] that they know what they’re doing.

But the test has proven challenging. The California Dialysis Council, which has administered its test to about 1,200 people so far, is seeing a pass rate of about 56 percent, according to the group’s executive director.

Statewide, the workforce of dialysis technicians has fallen from a steady 5,200 to about 3,800, according to a Department of Public Health spokesman. That’s a 27 percent drop in the number of certified technicians.

Driving the drop in certified workers was a deadline in April 2010. By then, all California dialysis workers had to pass the new test. Workers who fail can keep working with supervision from other facility staff, and they can take the test as many times as they want.

Michael Paget, executive director of the California Dialysis Council, said he has seen little hand-wringing about a retracting workforce.

“I haven’t heard the complaint ‘We’re desperate for patient-care technicians,’” Paget said of his board members, many of whom work for large for-profit dialysis chains.

The dramatic weeding of the dialysis technician field is happening nationwide, said Mimi Eckert, executive director of the National Nephrology Certification Organization.

“A lot of people who have been in dialysis for years and years are not able to pass the test,” Eckert said in an interview. “It’s not because they’re not good people, but they have been taught in a small dialysis environment and have learned by doing, as opposed to knowing some of the vocabulary.”

Peter Anas, executive director of Bonent, another large testing organization, declined to comment on the test pass rate that he's seeing among dialysis technicians. He said the national rate is not tracked by any single organization.

Other medical professionals seem to do far better on standardized tests that are key to their performance. About 87 percent of nurses passed [PDF] their licensing exam last year. In 2009, about 92 percent of doctors passed a license test.

And a thorough investigation of the dialysis industry by ProPublica shows that there is room for improvement, particularly in California facilities that can go years between inspections.

Reporter Robin Fields obtained a never-published database that shows the mortality rate at dialysis facilities in California and nationwide, and puts that rate in context of the expected rate of patient deaths. Fields also highlight how vital it is for dialysis technicians to be in good supply and on top of their game:

Clinics must have board-certified physicians as medical directors, but usually have no doctor on site, and some struggle to meet the federal requirement of at least one full-time registered nurse. Technicians, who can start with just a high-school diploma and an in-house course (though they are later required to pass a state or national certification test), have been the field's workhorses for a generation. Medicare sets no staffing ratios for dialysis centers, and most states don't either.

Although some clinics are orderly and expert – attentive not only to patients' health, but also to their dignity – others are run like factories, turning over three shifts of patients a day, sometimes four. Safety experts say technicians shouldn't monitor more than four patients at once, but some operators save money by stretching them further. The pace can be so intense, inspections show, that clinics have allowed patients to soil themselves rather than interrupt dialysis for a bathroom break. One technician said he quit his job at a large Colorado clinic because he often had to juggle six patients or more. "The last two years, I was just getting old," he said.



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