Free-standing renal dialysis facilities in New Jersey would be required to provide a percentage of their treatment to the uninsured under legislation approved by a Senate panel today.

Health and Senior Services Commissioner Fred M. Jacobs, M.D., J.D. testified before the Senate Health, Human Services and Senior Citizens Committee today that the legislation is necessary because some uninsured patients have had difficulty finding private dialysis facilities willing to provide care.

Several hospitals have called the department over the past two years asking it to intervene in cases where uninsured patients have remained in New Jersey hospitals for months—after they were medically discharged—because hospital social workers and patients could not find dialysis centers willing to accept uninsured patients.

 “We are talking about care that prevents severe disease and death,’’ Commissioner Jacobs told the committee. “Patients with chronic renal disease die if they do not get dialysis.

“Patients in need of life-sustaining dialysis treatment in this state should not be denied care because they lack health insurance….not in the wealthiest state in the nation—a global leader in the pharmaceutical industry…a leader in biotechnology research and medical innovation,’’ Dr. Jacobs testified.

The Senate Health, Human Services and Senior Citizens Committee today approved legislation that would require the 83 free-standing private renal dialysis centers in the state to provide care for the uninsured that is equal to 3.5 percent of the total number of treatments the facility provides each year.

Hospitals in the state are required to provide charity care. More than 400 ambulatory care facilities in the state are required to pay an assessment on their revenues to help pay for charity care. Currently, renal dialysis facilities are exempt from the assessment on ambulatory facilities because they receive the majority of their revenue from Medicare and the federal health insurance program prohibits such assessments.

And now, renal dialysis centers are being asked to share—in a limited way—in the responsibility for providing life-sustaining treatment to residents who lack health insurance.

Over the years, New Jersey hospitals have moved away from inpatient renal dialysis and the care has shifted to 83 free-standing dialysis facilities. Between 2000 and 2005, 1,000 fewer inpatient dialysis patients were seen in New Jersey hospitals.

At the same time, the number of dialysis patients statewide has increased 17 percent from 8,100 to 9,455.

The number of free-standing dialysis facilities increased by 38 percent from 60 facilities in 2001 to the current 83.

As a result of this shift, uninsured patients—which hospitals are required by law to serve—have had difficulty finding private dialysis facilities willing to provide care.

To me, as commissioner of the Department of Health and Senior Services, this is not only an access to care issue but a health disparities issue,’’ Dr. Jacobs said. Some of these patients eventually qualify for Medicare but not until several months after they are diagnosed with end stage renal disease. Some of these patients may have an insufficient work history to qualify for Medicare.  

Dr. Jacobs has made reducing health disparities his highest priority at the Department so he viewed this legislation as essential to ensure that patients without health insurance have equal access.

Over the past two years, the Department of Health and Senior Services has intervened in several cases in which uninsured dialysis patients were forced to remain in the hospital for months because the hospital could not find an ambulatory care willing to take them.

In one case, a dialysis patient languished on the oncology floor in JFK Hospital Edison for 121 days—four months—because the hospital could not find a dialysis facility willing to take an uninsured patient.  The Department interceded and found a facility to provide services for the patient.