Author: IPRO

Changes in the ESRD PPS and Payment for Dialysis Furnished for AKI in ESRD Facilities for CY 2021

CMS issued a new MLN Matters Article MM12011 on Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2021 (PDF). Learn about rate and policy updates.

October 12-17, 2020 is National Dialysis Technician Recognition Week

Each year, the National Association of Nephrology Technicians / Technologists (NANT) recognizes hemodialysis technicians for the vital contributions they make to the nephrology field. It’s essential to make recognition, including rewards, part of your everyday culture. But that doesn’t mean National Dialysis Technician National Recognition Week should go unnoticed. These extra-special perks will remind all your NCTs and NBTs how much you care. Click here to download resources you can use in your facility to express appreciation.

National Dialysis Technician Recognition Week

AAKP Recognizes IPRO ESRD Network of the South Atlantic for Service to the Kidney Patient Community

The IPRO End Stage Renal Disease (ESRD) Network of the South Atlantic has been selected as the 2020 recipient of the American Association of Kidney Patients (AAKP) Dominick Gentile, MD, Memorial Award – an AAKP National Legacy Award.

Recognizing extraordinary services and programs that significantly benefit the kidney patient community, the award is being given to the IPRO ESRD Network of the South Atlantic for its work on the “Enhanced Patient Engagement to Improve Patient-Centered Outcomes Among Chronic Kidney Disease Project;” an AAKP-led Patient-Centered Outcomes Research Institute (PCORI) Dissemination grant; its longstanding leadership in promoting the important work of the Southeastern Kidney Transplant Coalition; and its ongoing commitment to serving the kidney patient community of Georgia, North Carolina and South Carolina.

“It is an honor for our Network staff to be selected for this prestigious award by a national, patient-led, patient-focused organization that represents the interests and needs of the renal population we are committed to serve,” says Susan Caponi, CEO of IPRO’s ESRD Network Program. “This award spotlights the excellent work of our ESRD Network program staff and the value that the ESRD Network Program brings to kidney patients across the country.”

Shannon Wright, Executive Director, ESRD Network of the South Atlantic adds, “We are thrilled to be recognized with such a highly-regarded award. We value the opportunity to collaborate with our colleagues at AAKP and members of the Southeastern Kidney Transplant Coalition to improve healthcare outcomes and experience of care for the kidney community.”

“AAKP is fortunate to have such a good partnership with IPRO ESRD Network of South Atlantic. They are a valuable resource for the patients and staffed with true professionals. Their team has contributed substantively to the success of the AAKP-lead PCORI project,” said Richard Knight, transplant recipient and President of AAKP.

AAKP patients have been heavily involved in every kidney-related research study, over seventeen funded by PCORI since its inception. Officials from PCORI are regularly involved in AAKP national meetings including the AAKP Annual Policy Summit.

AAKP, the oldest and largest fully independent kidney patient organization in the United States, is dedicated to improving the lives and long-term outcome of kidney patients through education, advocacy, patient engagement and the fostering of patient communities. AAKP fights for early detection; increased kidney transplantation and pre-emptive transplantation; full patient choice of either in-center or home dialysis; protection of the patient/physician relationship; promotion of research and innovation; and the elimination of barriers for patient access to available treatment options. The award was named in honor of Dr. Dominick Gentile (1932-1997), a Board Member of AAKP at a time when the organization was known as the National Association of Patients on Hemodialysis (NAPH), who helped conceptualize the ESRD Networks, its Medical Advisory Board, and the National Forum of ESRD Networks.

The IPRO ESRD Network of the South Atlantic is one of four ESRD Networks managed by IPRO, a non-profit organization that works with government agencies, providers, and consumers to design and implement innovative programs that improve that bring policy ideas to life. In addition to serving as the ESRD Network for the South Atlantic, IPRO manages the ESRD Network of New England, ESRD Network of the Ohio River Valley, and ESRD Network of New York.

Under the direction of the Centers for Medicare & Medicaid Services, the IPRO ESRD Network Program supports the renal community in ensuring safe, effective, patient-centered care for more than 132,000 renal patients in 13 states.

Click here for the official press release.

Advancing American Kidney Health (AAKH): 2020 Progress Report

On August 17, 2020, the U.S. Department of Health and Human Services (HHS) released a progress report and related press release on the Advancing American Kidney Health (AAKH) Initiative that was first announced in July 2019. The report highlights the public awareness activities launched by HHS relating to chronic kidney disease (CKD) and the voluntary kidney payment models for managing persons with late stage CKD and ESRD. With regard to the mandatory ESRD Treatment Choices (ETC) model, the progress report simply notes that the proposed rule was released in July 2019.

Joint Statement: Roadmap for Maintaining Essential Surgery during COVID-19 Pandemic

On August 13, 2020 the American Hospital Association (AHA) along with the American College of Surgeons (ACS), American Society of Anesthesiologists (ASA) and Association of periOperative Registered Nurses (AORN) released a Joint Statement: Roadmap for Maintaining Essential Surgery During COVID-19 Pandemic. This new joint statement provides a list of principles and considerations to guide physicians, nurses, and hospitals and health systems as they provide essential care to their patients and communities. The joint statement builds on the Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic released by the AHA, ACS, ASA, and AORN on April 17, 2020.

New ESRD Quality Incentive Program (QIP) Instructions

On June 1, 2020, the Centers for Medicare & Medicaid Services (CMS) will start the next chapter of its ESRD Quality Reporting System (EQRS) modernization efforts by implementing the first phase of a two-part ESRD Quality Incentive Program (ESRD QIP) User Interface (UI) rollout, in support of the ESRD QIP Payment Year (PY) 2021 Preview Period.

The purpose of this email is to provide guidance related to the June 1, 2020 ESRD QIP UI release. It summarizes the purpose and benefits of the ESRD QIP UI implementation into EQRS, outlines specific tasks that EQRS users who need to access the ESRD QIP UI must complete at this time, and details how users can access available training resources. 

Purpose and Benefits of ESRD QIP UI Implementation into EQRS:

Incorporating the ESRD QIP UI into the EQRS system supports CMS’s efforts to consolidate the functionalities of the CROWNWeb, ESRD QIP, and Renal Management Information System (REMIS) applications into a single system. Users can now use one account to access multiple CMS EQRS business needs via a single platform – the EQRS Global Application.

This rollout of the ESRD QIP UI into EQRS is the first significant change to the ESRD QIP procedures since the inception of the program. The updates to the ESRD QIP UI will improve overall user experience and reduce burden. Phase 1 of the rollout consists of a new role request process and user interface with enhanced navigation features. Fictitious data will be visible in this first release for illustrative purposes only. Phase 2 will be released when the ESRD QIP PY 2021 Preview Period starts in mid-July 2020. Phase 2 will include facilities’ actual PY 2021 data, as well as consist of a streamlined communication and inquiry submission process.

What You Need to Do at This Time:

First, you should check with your organization to confirm if you need an ESRD QIP UI role as a Facility Point of Contact to submit inquiries and access reports, or as a Facility Viewer to see previously submitted inquiries as well as access reports within the ESRD QIP UI.

The June 1, 2020 implementation supports the PY 2021 Preview Period, which is scheduled to start mid-July 2020. This rollout provides users with early access to the ESRD QIP UI to allow them to verify and manage their roles and become familiar with the new UI prior to the start of the PY 2021 Preview Period.

Between June 1, 2020 and mid-July 2020, you should:

NOTE: Roles maintained in the previous ESRD QIP system were automatically migrated into EQRS. Existing roles can be updated, and new users can request access.

  •     Verify that your roles and organizations were migrated over correctly, update an organization’s role, or submit a new ESRD QIP role request.
  •     Click the QIP Scores link in the menu.
  •     Navigate through the ESRD QIP UI to ensure that you are able to access the screens.

IMPORTANT NOTE: Scores and measure feedback shown in the ESRD QIP UI between June 1, 2020 and mid-July 2020 ARE FOR THE PURPOSES OF ILLUSTRATION ONLY – USING FICTITIOUS DATA. THIS DOES NOT REFLECT FACILITIES’ PY 2021 PREVIEW PERIOD SCORES.

  •     Attend ESRD QIP UI Training and PY 2021 Preview Period webinar events.
  •     Maintain system access and log in to the ESRD QIP UI at the start of the PY 2021 Preview Period to access reports and submit necessary inquiries.

Training Materials and Assistance:

Users who still need to complete the HARP account registration process or needs step-by-step instructions on how to request roles within the EQRS system can review training videos, Quick Start Guides, Frequently Asked Questions, and additional materials via MyCROWNWeb.org at https://mycrownweb.org/harp-training/.  

ESRD QIP UI Training and PY 2021 Preview Period webinar events will be provided prior to the start of the PY 2021 Preview Period. Event registration details will be sent via email and posted on www.MyCROWNWeb.org. Sign up for the EQRS Mailing List via www.MyCROWNWeb.org to receive updates regarding upcoming events.

Should you need assistance with accessing EQRS or HARP account or roles, contact the QualityNet Service Desk at Email: qnetsupport-esrd@hcqis.org, phone: 1-866-288-8912, or TRS: 711. Please DO NOT contact the QualityNet Service Desk regarding the FICTITIOUS ESRD QIP scores and measures in the ESRD QIP UI.

Should you need assistance with navigating through the ESRD QIP UI, contact the ESRD Network for your area https://esrdncc.org/en/ESRD-network-map/ and ask for the Data Manager.

CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response

Earlier today at the White House Task Force Press Briefing, the Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.

As more healthcare providers are increasingly being asked to assist with the COVID-19 response, it is critical that they consider whether non-essential surgeries and procedures can be delayed so they can preserve personal protective equipment (PPE), beds, and ventilators.

“The reality is clear and the stakes are high: we need to preserve personal protective equipment for those on the front lines of this fight,” said CMS Administrator Seema Verma.

This will not only preserve equipment but also free up our healthcare workforce to care for the patients who are most in need. Additionally, as states and the nation as a whole work towards limiting the spread of COVID-19, healthcare providers should encourage patients to remain home, unless there is an emergency, to protect others while also limiting their exposure to the virus. They should also urge patients to follow the President’s recently issued guidelines to help slow the spread of the virus.

The recommendations provide a framework for hospitals and clinicians to implement immediately during the COVID-19 response. The recommendations outline factors that should be considered for postponing elective surgeries, and non-essential medical, surgical, and dental procedures. Those factors include patient risk factors, availability of beds, staff and PPE, and the urgency of the procedure. This will help providers to focus on addressing more urgent cases and preserve resources needed for the COVID-19 response. The decision about proceeding with non-essential surgeries and procedures will be made at the local level by the clinician, patient, hospital, and state and local health departments.

The recommendations can be found here:  https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-procedures-recommendations.pdf

These recommendations, and earlier CMS guidance and actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here www.coronavirus.gov for further information. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak

The Trump Administration today announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare—administered by the Centers for Medicare & Medicaid Services (CMS)—will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.

“The Trump Administration is taking swift and bold action to give patients greater access to care through telehealth during the COVID-19 outbreak,” said Administrator Seema Verma. “These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus. Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”

On March 13, 2020, President Trump announced an emergency declaration under the Stafford Act and the National Emergencies Act. Consistent with President Trump’s emergency declaration, CMS is expanding Medicare’s telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. This guidance and other recent actions by CMS provide regulatory flexibility to ensure that all Americans—particularly high-risk individuals—are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the spread of coronavirus disease 2019 (COVID-19).

Prior to this announcement, Medicare was only allowed to pay clinicians for telehealth services such as routine visits in certain circumstances. For example, the beneficiary receiving the services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. In addition, the beneficiary would generally not be allowed to receive telehealth services in their home.

Click here to read more.

CMS Announces Actions to Address Spread of Coronavirus

CMS calls on all health care providers to activate infection control practices and issues guidance to inspectors as they inspect facilities affected by Coronavirus

Today, the Centers for Medicare & Medicaid Services (CMS) is announcing several actions aimed at limiting the spread of the Novel Coronavirus 2019 (COVID-19). Specifically, CMS is issuing a call to action to health care providers across the country to ensure they are implementing their infection control procedures, which they are required to maintain at all times. Additionally, CMS is announcing that, effective immediately and, until further notice, State Survey Agencies and Accrediting Organizations will focus their facility inspections exclusively on issues related to infection control and other serious health and safety threats, like allegations of abuse – beginning with nursing homes and hospitals. Critically, this shift in approach, first announced yesterday by Vice President Pence, will allow inspectors to focus their energies on addressing the spread of COVID-19.

As the agency responsible for Medicare and Medicaid, CMS requires facilities to maintain infection control and prevention policies as a condition for participation in the programs. CMS is also issuing three memoranda to State Survey Agencies, State Survey Agency directors and Accrediting Organizations – to inspect thousands of Medicare-participating health care providers across the country, including nursing homes and hospitals.

Click here to read more.

ESRD Proposal May Inadequately Reimburse Medicare Advantage Plans

Medicare Advantage proponents are concerned that the new CMS proposal may result in underpayment to Medicare Advantage plans for end-stage renal disease care.  While payers and Medicare Advantage proponents applauded elements of the Medicare Advantage rule that CMS proposed yesterday which will increase plans’ revenues by nearly one percent, many expressed concerns about the proposed rule’s approach to chronic disease management costs for patients with end-stage renal disease (ESRD).

Click here to read more.

ACO Care Coordination Toolkit and Beneficiary Engagement Toolkit Available

The Centers for Medicare & Medicaid Services worked with 21 Medicare Accountable Care Organizations (ACOs) and End-Stage Renal Disease Seamless Care Organizations (ESCOs) participating in the Shared Savings ProgramNext Generation ACO Model, and the Comprehensive ESRD Care Model to identify promising practices and innovative strategies for coordinating care for Medicare beneficiaries.

Specifically, the ACO Care Coordination Toolkit focuses on care coordination for Medicare beneficiaries who:

  • Recently received care in an emergency department,
  • Require treatment in a skilled nursing facility,
  • Have recently been discharged home after a hospital or emergency department visit,
  • Have been diagnosed with a chronic condition or have a complex medication regimen, or
  • Have conditions affected by the social determinants of health.

Working with the same methodology, CMS also has released the ACO Beneficiary Engagement Toolkit which highlights strategies used by ACOs and ESRD Seamless Care Organizations (ESCOs) to engage beneficiaries. Specifically, the toolkit explores how ACOs and ESCOs:

  • Engage beneficiaries in ACO governance,
  • Elicit beneficiary and family feedback,
  • Support beneficiaries in self-care management,
  • Enhance beneficiary communication in the clinical setting, and
  • Communicate with beneficiaries about the ACO as a value-based care organization.

These toolkits are part of a broader series of toolkits designed to educate the public about the strategies ACOs use to provide value-based care while also providing actionable ideas to current and prospective ACOs to help them improve or begin operations.

For more information on the toolkits and case studies please visit the ACO General Information webpage.

Kidney Care Choices Model

The Centers for Medicare and Medicaid Services (CMS) released clarifications to the Kidney Care Choices (KCC) Model’s Request for Applications (RFA) that was posted on October 24, 2019.
These clarifications were created in response to questions from applicants regarding the Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) Options. This document expands upon eligibility requirements regarding revenue calculations and practices’ Tax Identification Numbers (TINs).
The KCC Model is designed to help health care providers reduce the cost and improve the quality of care for patients with late-stage chronic kidney disease and end stage renal disease by aiming to delay the need for dialysis and encourage kidney transplantation.
The clarifications, full RFA, and additional resources can be found on the Kidney Care Choices websiteThe Model is expected to run from 2020 through December 31, 2023. The deadline to apply is January 22, 2020.