Changes in Dialysis Social Workers' Caseloads, Job Tasks, and Hourly Wages Since the Implementation of New Medicare Regulations for End Stage Renal Disease Facilities

BACKGROUND AND PURPOSE: In accordance with Medicare’s Conditions for Coverage (CfC) for End Stage Renal Disease Facilities (Federal Register, 2008), a Master’s level social worker is required in every U.S. dialysis center because of the many psychosocial barriers to optimal dialysis outcomes.  For example, dialysis social workers assist patients with issues such as coping with treatment regimens, pain management, end-of-life concerns, social role adjustment, and vocational rehabilitation.  Studies indicate that high dialysis social worker caseloads are associated with lower patient satisfaction, less successful patient rehabilitation outcomes, and a decreased ability to provide clinical social work interventions (Bogatz, Colasanto, & Sweeney, 2005; Callahan, Moncrief, Wittman, & Maceda, 1998; Merighi & Ehlebracht, 2002, 2005).  In October 2008, Medicare implemented a new a CfC guideline, which was the first revision of this federal rule since its creation in 1976.  The aim of this study is to examine the influence of Medicare’s new CfC on dialysis social workers’ caseloads, job tasks, and hourly wages.

METHODS: A sample of 1,091 full-time (32+ hrs/wk) and 231 part-time (20-31 hrs/wk) dialysis social workers was obtained from all 18 End Stage Renal Disease Networks in the U.S.  Survey respondents were recruited between March 31 and June 21, 2010 using the Council of Nephrology Social Worker listserv, which is administered by the National Kidney Foundation.  A 130-item online survey was conducted to gather data on renal social workers’ caseloads, salaries, job-related resources, and professional responsibilities.  The survey took approximately 25 minutes to complete.  Data analyses included descriptive statistics, chi-square tests, and ANOVAs with Bonferroni post hoc tests.

RESULTS: Since the implementation of the new CfC in 2008, both part-time (41.2%) and full-time (50.1%) dialysis social workers reported increases in patient caseloads, with a greater proportion of full-time respondents reporting an increased caseload, X²(2, N=1,290) = 6.12, p<.05.  Significant differences were found between mean caseloads for part-time respondents [i.e., caseload “stayed the same” (M=73.2) or “increased” (M=87.1), p<.001] and among mean caseloads for full-time respondents [i.e., caseload “decreased” (M=96.7), “stayed the same” (M=111.9), or “increased” (M=130.9), p<.001].  Similarly, part-time (80.2%) and full-time (85.9%) respondents reported an increase in job tasks, with a greater proportion of full-time workers having reported more tasks being performed, X²(2, N=1,286) = 10.59, p<.01.  No differences were found between the proportion of part- and full-time social workers who reported changes in their hourly wage.  However, a significant difference in hourly wage emerged for full-time respondents who reported that it “stayed the same” (M=$26.90) or “increased” (M=$28.55), p<.001.

CONCLUSIONS AND IMPLICATIONS: This study represents an important national effort to assess how the new Medicare CfC for End Stage Renal Disease Facilities has affected key job factors of part- and full-time dialysis social workers.  The findings provide empirical evidence that can be used by the Council of Nephrology Social Workers, the National Kidney Foundation, and federal policy makers in their efforts to improve the work environment of U.S. social workers who provide essential psychosocial services to patients with kidney disease.