A N.J. law is costing patients real time and money with no real benefit

There are a lot of great things that make New Jersey unique — costly dialysis clinic regulations that might limit access to the most vulnerable residents of the state should not be one of them.

Diabetes nationally has afflicted more and more Americans, and New Jersey is not immune to this problem. According to the United States Diabetes Surveillance System, the percentage of New Jersey residents with diabetes nearly doubled from 4.1% in 1994 to 8.1% in 2016. Unfortunately, this also means that more New Jersey residents are being diagnosed with kidney failure or end-stage renal disease (ESRD). Diabetes is one of the leading risk factors for kidney failure.

Dialysis clinics in New Jersey and across the United States are operated 80 to 90 hours a week to accommodate patients’ needs. Registered nurses play an essential role in dialysis clinics — serving as both administrators and supervising or assisting technicians with providing care to patients.

Having access to high-quality health care at dialysis clinics is critical for New Jersey citizens. We have no doubt that regulators had the best of intentions in 2005 when they enacted a unique new rule — no other state has followed New Jersey’s lead and enacted a similar rule.

The rule requires that if a nurse is serving in an administrative capacity for even a few moments, that nurse may not assist with providing care to patients. A hard barrier is created between the administration of the dialysis clinic and providing care. Essentially this requires dialysis clinics to hire two additional full-time equivalent administrators or registered nurses that must function solely as administrators — they are not permitted to be involved with providing care to patients.

The rule was enacted to ensure that New Jersey dialysis patients receive the best care. But is that what has happened? In a recent paper, published by the Center for Growth and Opportunity at Utah State University, we investigate this question.

Using state-level data from the United States Renal Data System, we find no evidence that the passage of the New Jersey rule reduced the death rate of patients. Further, we are unable to find evidence suggesting that the rule reduced the number of hospitalizations of New Jersey dialysis patients with Medicare.

And there are costs associated with the regulation. We find suggestive evidence that the 2005 rule reduced the number of dialysis clinics in the state. Fewer clinics mean patients may have fewer choices and may likely have longer commutes to receive treatment. Unfortunately, diabetes rates tend to be much higher among the poor — one study estimates an incidence that is nine times higher among the poor relative to the middle class. New Jersey residents who can least afford the costs associated with transportation to dialysis clinics may be hit the hardest by this unique rule.

Regulators should always carefully consider the costs and benefits associated with new rules and regulations both before implementation and regularly thereafter. If no other state has enacted a similar rule, this should give policymakers pause. There must be a good reason why no other state has enacted a similar rule.

It is no doubt true that regulations are needed in the health care market in New Jersey. Proponents of this rule may argue that protecting patients should always be the top priority.

There is not much evidence that the regulation is meeting its primary objective, which is why it is important for policymakers to carefully reconsider this particular rule that costs dialysis patients real time and money with no real benefit. In general, it is important for regulations to be subject to some form of review process to ensure that the needs of citizens are being met best — the challenges that regulation seeks to overcome can change and perhaps be solved using an alternative strategy.

In the case of this unique New Jersey rule in particular, perhaps the need was never there. The new year and decade can provide the perfect opportunity to fix these past mistakes.

CGO scholars and fellows frequently comment on a variety of topics for the popular press. The views expressed therein are those of the authors and do not necessarily reflect the views of the Center for Growth and Opportunity or the views of Utah State University.

A 15-year-old N.J. law is costing patients real time and money with no real benefit, study finds

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A 15-year-old N.J. law is costing patients real time and money with no real benefit, study finds

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