You can involve family members and care partners in patient plan of care (POC) meetings via telephone… patients too!
Part of the responsibility of the interdisciplinary team (IDT) is to include patients, and if requested, their care partners and family members in both developing/setting goals and reviewing the patient plan of care.
Is it acceptable to hold a plan of care meeting with the IDT and the patient, their care partner or family members (if requested) via telephone conference? As stated in the CMS Interpretive Guidance for the Conditions for Coverage for End-Stage Renal Disease Facilities, the answer is “yes.”
“A substitute mechanism for a team conference needs to facilitate discussion among team members about the information gathered from the comprehensive patient assessment and provide the opportunity for team coordination and development of an effective, individualized plan of care for the patient to ensure the desired outcomes are achieved. To facilitate full team participation in conferences, any member, including the patient, may participate through telecommunication.”
CMS Interpretive Guidelines (see page 205): https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/downloads/SCletter09-01.pdf
The annual Centers for Medicare & Medicaid Quality Conference was held this year in Baltimore, Maryland on February 12 – 14. This meeting is attended by more than 2,500 individuals from across the nation. Attendees, representing a diversity of organizations that support the Medicare and Medicaid healthcare delivery system, come together to focus on bringing to life CMS’ national goals and priorities. Network staff and ESRD patients from across the country attended the conference. This year the ESRD community was recognized nationally for our quality improvement work; specifically for the success of the 18 ESRD Networks and our facility partners across the country in achieving close to a 42% national reduction in bloodstream infections.
Achieving Quality Success
“We all understand the importance of quality. Whether we’re buying something on Amazon or researching nursing homes, we want the best. Patients entering our health care system also want to be assured they’re receiving quality care. Our obligation at CMS is to ensure quality for all.
Through Patients Over Paperwork (the theme of this year’s Quality Conference), we’re advancing quality care to establish a system that always put patients first. Working with the State Medicaid Quality Champions and our many Quality Networks, we’re already making an extraordinary difference:
- Quality efforts are being supported in 12,000 nursing homes, 4,000 hospitals, 400 community coalitions, and more than 500,000 providers
- Quality efforts in just ONE hypertension control network reduced hospital read admissions by 45% and saved more than $33 million
- Quality efforts in 18 ESRD Networks produced an almost 42% national reduction in bloodstream infection.
These are just a few outstanding examples of our shared work to improve quality and safety. It all deserves a round of applause! I’m proud and grateful for what we’ve accomplished, but I also know there’s much more to do to build on these extraordinary steps.”
The Centers for Medicare & Medicaid Services (CMS) hosted a call on Thursday, February 22, 2018, discussing provisions in the Calendar Year (CY) 2018 End-Stage Renal Disease (ESRD) Prospective Payment System final rule, including plans for the ESRD Quality Incentive Program (QIP) in Payment Year (PY) 2019, 2020, and 2021.
- ESRD QIP legislative framework
- Measures, standards, scoring method, and payment reduction scale for PY 2021
- Modifications to PY 2019 and PY 2020 policies
According to the Organ Procurement & Transplantation Network (OPTN), as of March 12, 2018, there are 95,357 people in the United States waiting for kidney transplants. Every year five thousand of those people die awaiting a kidney transplant; the current average wait for a kidney transplant is 3.6 years due to the shortage of organs. Increasing living donation is a solution to the organ shortage. Living donation also has many benefits, which include: improved organ/graft survival, decreased need for antirejection medications, immediate organ function post-surgery, and immediate placement on the wait list for a deceased organ transplant as you await your living donor work up.
Unfortunately one of the most significant barriers to increasing living donation is the discomfort that patients feel discussing the topic of organ donation with friends and family. The National Kidney Foundation has developed a campaign, “The Big Ask/The Big Give” to assist patients in understanding the benefits of living donation and prepare them for this discussion. Reviewing these materials with patients in your facility who are considering transplant or on the wait list already may help them prepare for this difficult, yet potentially lifesaving conversation.
Modality options are often presented to patients in the hospital after they have had a central venous catheter placed and are in the acute dialysis setting or upon admission to a new in-center dialysis facility. Understandably, it is very difficult for patients to process all the information that they are receiving at this time, all while being very ill.
If modality education is addressed on admission and not addressed again until the 30 day care plan, it is likely that the patient has already forgotten most of what was presented to them. Modality education is often presented to a patient only three to four times during their first year on treatment. It is easy to understand why patients choose to stay on in-center hemodialysis therapy, which they are exposed to three times a week for four hours a day, rather than switch to a therapy they know very little about and to which they have had no exposure.
Modality education needs to be an ongoing conversation with patients. Patients need to know the benefits of all renal replacement therapies to make an educated choice about the right type of renal replacement therapy for them.
The following tools can be utilized to educate patients on modality options:
Celebrated every year on the second Thursday of March, World Kidney Day (WKD) is a global campaign that aims at increasing awareness of the importance of kidney health and reducing the impact of kidney disease and its associated problems worldwide.
This year WKD and the International Women’s Day 2018 are commemorated on the same day, offering us the opportunity to reflect on the importance of women’s health and specifically their kidney health. On its 13th anniversary, World Kidney Day promotes affordable and equitable access to health education, healthcare and prevention for kidney diseases for all women and girls in the world.
According to the WKD website, http://www.worldkidneyday.org/, chronic kidney disease (CKD) affects approximately 195 million women worldwide and it is currently the 8th leading cause of death in women, with close to 600,000 deaths each year.
Healthcare professionals are encouraged to share key objectives of the WKD campaign, which include:
- Raise awareness about how diabetes and high blood pressure are risk factors for kidney health, and encourage preventive behaviors,
- Educate all medical professionals about their key role in detecting and reducing the risk of CKD, and
- Encourage transplantation as a best-outcome option for kidney failure, and the act of organ donation as a life-saving initiative.
To download 2018 campaign materials, got to http://www.worldkidneyday.org/2018-campaign
Information on infections identified in the hospital setting and reported in the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN), is not easily obtained by dialysis providers. Access to these data can improve surveillance of bloodstream infections and patient outcomes. Enrollment in the Health Information Exchange (HIE) can overcome this barrier. A recent article published in Nephrology News & Issues, ” Closing the information gap: Health information exchange in dialysis“, gives an overview of the benefits of HIE and how it provides a vehicle for improving the quality and safety of patient care.
For more information on HIE, go to https://www.healthit.gov/providers-professionals/health-information-exchange/ .
For information on HIE in your state, go to https://www.healthit.gov/policy-researchers-implementers/state-health-information-exchange-cooperative-agreement-program-key
As a Medicare-certified dialysis unit, CMS expects your facility to keep Personnel Details in CROWNWeb up-to-date, within five business days of staff changes, and to review Facility Personnel information at least quarterly. CROWNWeb is the Network’s authoritative source for facility contact information. Accurate personnel information is needed to ensure proper communication among facilities, the ESRD Networks, and CMS. Instructions on how to update the information in the CROWNWeb system can be found in the Facility Personnel Update Guide.
Please continue to review personnel information for your facility in CROWNWeb and make any necessary changes.