The state is seeking to hire out-of-state contractors to help clear a backlog of health inspections of dialysis centers and other medical facilities.

There is a delay of up to three years in inspections for new dialysis centers, which can’t fully open until they are certified by the state. Meanwhile, the number of patients with kidney failure continues to climb.

The Department of Health doesn’t have enough workers to keep up with required certifications, potentially putting patient safety at risk. The state has nearly 4,000 dialysis patients.

Gov. David Ige has pledged to make funds available for contract inspectors once a bidding process has been completed, Ige’s spokeswoman said. The DOH said it will issue a request for proposals this month for services that could be completed by July 1.

Health inspectors must assess whether facilities have qualified staff, emergency procedures and sufficient equipment and whether they are providing quality care. The inspectors give priority to other health facilities over dialysis centers, which contributes to the backlog in dialysis inspections.

Without certification, new dialysis clinics can’t get reimbursed for treating Medicare and Medicaid patients, which comprise as much as 85 percent of the dialysis population.

Three new dialysis facilities are sitting idle, waiting for health inspections before they can treat patients covered by the Medicare and Medicaid insurance programs for seniors and low-income patients. Three other centers are waiting for certification to expand, and another half-dozen existing facilities are overdue for recertification. Four more will become due later this year, according to the DOH. The backlog is anticipated to get worse as another 18 facilities come up for recertification in 2019.

“The DOH will conduct initial certification inspections of new or expanded dialysis facilities and will seek qualified inspectors to conduct the recertification inspections,” said Health Department spokeswoman Janice Okubo. “Dialysis patients on Medicare and other public or private insurance may continue to receive dialysis care at any of the 28 certified facilities across the state.”

Last year, the state contracted a half-dozen Arizona inspectors at a cost of roughly $140,000 to complete delayed Medicare certifications for 11 dialysis centers.

Meanwhile, legislators are considering bills this session that would allow for the hiring of six contractors for $150,000 to get the facilities inspected this year. The DOH estimates it will cost $375,000 to clear the backlog through 2019.

There are 168,000 residents with chronic kidney disease and about 700 new patients need dialysis each year.