Roughly one-fifth of the 54 dialysis centers in Hawaii are either overdue for recertification or up for recertification this year.

And while that hasn’t caused the centers to close or reduce services, one company said it hasn’t opened a facility built in 2015 because it is still awaiting initial certification.

Following a slew of media coverage on nursing homes that weren’t receiving enough attention from state inspectors, the state Department of Health shifted its focus to prioritize those facilities. As a result, dialysis centers, home health agencies and same-day surgery facilities received lower priority.

In 2014 and 2015, the state failed to review a single dialysis center. By 2016, the Health Department was back on track for inspections of both dialysis centers and nursing homes, but at the cost of home health agency inspections.

Rep. John Mizuno, chair of the Health and Human Services committee, wants to shrink the backlog of dialysis centers needing recertification. Cory Lum/Civil Beat

Two measures expected to be introduced by Rep. John Mizuno, chair of the House Committee on Health and Human Services, aim to shrink the backlog of state dialysis centers awaiting certification.

One in seven Hawaii residents, or 168,000 people, suffer from chronic kidney disease. That’s higher than the national average of one in nine people.

“We’re (Hawaii residents) predisposed to kidney disease because of our ethnicity and the good food we eat,” Mizuno said at an informational briefing Wednesday.

Just before cameras were turned on to broadcast the meeting on live television, Mizuno assured the handful of people in the audience, including department heads and state employees, that the briefing would be solution-oriented and nothing negative said.

About 4,000 Hawaii kidney disease patients require dialysis three times per week, according to drafts of Mizuno’s bills.

Dialysis is required when a patient develops end stage kidney failure, when 85 percent to 90 percent of kidney function is usually lost. During dialysis, a patient’s blood is essentially cleaned. Toxins and excess fluids and chemicals are removed from the blood through a tube.

Shortage Of Inspectors

Of the 12 state health care facility inspectors, called surveyors, five are trained to conduct inspections on dialysis centers, said Keith Ridley, head of the state Department of Health Office of Health Care Assurance, at the briefing. That training can take two or three years.

Currently, six facilities are overdue for recertification. They are still operating at full capacity in the meantime, Ridley said.

Another four dialysis centers will be up for recertification this year.

Keith Ridley Dept of Health during Marijuana working group meeting held at the Capitol.
Ridley said six dialysis facilities are currently overdue for recertification. Cory Lum/Civil Beat


Two facilities want to expand service, including one that is looking to provide home services for clients, he said.

Another part of the certification delay is caused by the four-tier system on which dialysis centers are prioritized for review. The top two tier facilities receive priority for inspection.

All health care facilities seeking certification for the first time are ranked on the fourth, or bottom tier.

Every year, the queue resets and top-tier facilities receive priority once again. This makes it tough for new facilities to get started.

“We do need to work with CMS (the federal Centers for Medicare & Medicaid Services) to develop longer-term strategies — how we operate, how IT could help us in efficiencies and automation of survey processes,” Ridley said during the briefing.

Dialysis centers serve patients with end stage kidney disease. Flickr: Jim Forest

Liberty Dialysis — owned by parent company Fresenius Kidney Care — and U.S. Renal Care are the only two dialysis center operators in Hawaii.

Steve Nottingham, general manager for western Fresenius Kidney Care facilities, said most states take nine to 12 months to certify dialysis centers. In Hawaii, certification tends to take three years.

“Ultimately the one that gets affected is the patient,” said Nottingham.

Pliny Arenas, vice president of operations at U.S. Renal Care, said certification in Guam takes just six months on average, thanks to the help of surveyors it solicited from San Francisco.

In an interview with Civil Beat after the hearing, Arenas said U.S. Renal Care completed a new, but still unopened dialysis center in 2015 that is still awaiting certification.

Upcoming Legislation

Mizuno plans to introduce two bills: one as a short-term solution to address the certification backlog while recent surveyor hires are being trained and another, longer-term solution.

The short-term solution would immediately appropriate to the Health Department $150,000 to contract services to review, certify and recertify dialysis centers.

The second would appropriate an unspecified amount of money to inspect dialysis centers and an additional sum to hire three full-time employees. Two of those employees would be surveyors and the other, a supervisor, could also act as a surveyor.

The federal government would pay 80 percent of those salaries, which would range from about $90,000 to $100,000 per year, Mizuno told Civil Beat.

Read the bill drafts, with handwritten notes from Mizuno, below:

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