Author: IPRO

CMS Proposes 2018 Policy and Payment Rate Changes for End-Stage Renal Disease Facilities

Proposed rule builds patient-centered system of care to increase competition, quality and care.

 

CMS has issued a proposed rule that would update payment policies for the ESRD Prospective Payment System (PPS). The ESRD PPS proposed rule is one of several for calendar year 2018 designed to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care.

The ESRD Quality Incentive Program (QIP) proposed changes are for payment years 2019, 2020, and 2021, and affect a number of key dialysis data methodologies and quality measures. The proposed rule also invites comment on how to include individuals with acute kidney injury in the ESRD QIP. 

For a fact sheet on the proposed rule, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-06-29.html

The ESRD proposed rule (CMS 1674-P) can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/

 

Resources to Help Reduce Healthcare Disparities in Vulnerable Populations

CMS has established programs and educational resources to promote the reduction of healthcare disparities in the medically vulnerable patient population. The CMS Equity Plan for Medicare aims to help healthcare practitioners take action to reduce disparities among minority populations.

“The Office of Minority Health’s (OMH) vision is to eliminate disparities in healthcare quality and access and to help all CMS beneficiaries achieve their highest level of health.” The ESRD Networks, QIO Program, and CMS have made several resources available to support these efforts.

Please click here to access resources that will help staff members better understand how to collect, measure, and reduce disparities in healthcare outcomes. Also included are success stories and best practices for reducing health disparities that can be leveraged by practitioners and care partners.

 

CMS Survey and Certification Updates

Recently, the CMS Center for Clinical Standards and Quality/Survey and Certification Group sent out the following memorandums related to the ESRD recertification surveys:

  1. Filling Saline Syringes at the Patient Treatment Station – ESRD facilities may not fill syringes with saline from the single dose saline bag or IV tubing connected to the patient at the dialysis station. This guideline became effective as of July 2, 2017.
  2. Cleaning the Patient Station – To prevent cross contamination, a dialysis station should be completely vacated by the previous patient before the ESRD staff may begin cleaning and disinfecting the station for the next patient. Patients should not be moved from the dialysis station until they are clinically stable.
  3. Hepatitis C (HCV) Screening Exception – All infection control recommendations developed by the CDC and referenced in the Conditions of Coverage for ESRD must be followed with the exception of HCV screening.

 

Vascular Access Reporting in CROWNWeb

CMS has tasked all dialysis facilities with ensuring that clinical data is accurately entered, tracked, and reported in CROWNWeb. To assist with this process, the Network encourages all facilities to compare their internal electronic medical records (EMRs) of patient level vascular access data with what has been entered in CROWNWeb on a monthly basis (both systems should be the same). The CROWNWeb Vascular Access in Use report can be used to support data validation.

If your organization utilizes batch submission, data in your EMRs upload to CROWNWeb. If there are discrepancies between the Vascular Access in Use report and your facility’s EMRs, please follow the guidelines provided in the Vascular Access Data Cleanup in CROWNWeb to reconcile the data.

Vascular access data is a clinical indicator for the Quality Incentive Program (QIP), and errors in reporting can affect payment and, ultimately, your facility’s scoring in Dialysis Facility Compare.

Previewing Your Facility’s 2016 Performance Data

The preview period for reviewing your facility’s 2016 performance data will begin July 17, 2017, when CMS will make the preview Performance Score Report (PSR) available to facilities.  These reports show the performance results that CMS will use to determine if a facility will incur a payment reduction for Payment Year (PY) 2018. 

For information about the PY2018 QIP process please visit: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/Downloads/PY-2018-Program-Details.pdf

During the month-long Preview Period, facilities can review their measure scores and ask CMS questions about how their scores were calculated.  Facilities will also be able to submit one formal inquiry if they find or suspect an error in how their scores were calculated.  To access your facility’s data visit https://dialysisdata.org and sign in using your Enterprise Identity Management (EDIM) sign in and password. 

 For information regarding performance year 2016, which will affect PY 2018, refer to CMS ESRD Measures Manual Version 1.0.

Central Venous Catheters in Dialysis: The Good, the Bad and the Ugly

Central venous catheters (CVC) continue to remain a common modality of vascular access in end stage kidney disease patients maintained on hemodialysis. The increased morbidity and mortality associated with CVC, when compared to arteriovenous fistulas and grafts, is a serious health problem and a big challenge to the nephrology community. An article “Central Venous Catheters in Dialysis: The Good, the Bad and the Ugly” written by Nabil J. Haddad, Sheri Van Cleef , Anil K. Agarwal and published in the Volume 10, 2017 issue of The Open Urology & Nephrology Journal, presents the pros and cons of CVC, in addition to the different complications and excessive economical costs related to their use.

According to the authors, a CVC is placed in the acute setting when immediate treatment can be lifesaving.   For long term therapy though, the complications can be life threatening secondary to a poorly functioning catheter, central venous stenosis or blood stream infection (BSI).

The dysfunctional catheter leads to suboptimal dialysis clearance and impacts on the patients general wellness and quality of life.  If bacteremia is noted by positive blood cultures the course of treatment requires long-term antibiotic therapy with the possibility of sepsis and extended hospitalization.  Lastly the central venous stenosis (CVS) may require the patient to undergo both endovascular procedures and surgical intervention to correct the stenosis.

The authors conclude the best plan of care for the patient who requires renal replacement therapy is early referral to a nephrologist and vascular surgeon for placement of an arteriovenous fistula or a graft.  Early intervention decreases the incidence of morbidity and mortality with the goal of improving patient outcomes, quality of life and financial stewardship of healthcare resources.

The full article can be found in The Open Urology & Nephrology Journal, 2012, 5, (Suppl 1: M3) 12-18, at  https://benthamopen.com/FULLTEXT/TOUNJ-5-12

Updated EIDM Password Policy Requirements

Enterprise Identity Management(EIDM) has implemented a Dictionary word exclusion password  policy. A restriction has been placed on passwords by prohibiting  the use of any password that contains words consisting of three  letters or more that form dictionary words.”

The new password needs to be random letters, numbers, a special character, and capital letter.  An example, of a password that is acceptable is Hbfc#8675.

To learn more about acceptable passwords for EIDM.

Please click on link to read CROWN Memo.

Improve the Safety of the Care You Provide with a Focus on Vaccinations

The vaccines needed to maintain health and well-being are determined by your age, life style, health conditions, job, and international travel. There are many vaccines adults need to catch up on as their childhood immunity can wear off over time. As adults you are still at risk for acquiring a variety of diseases that can be prevented with vaccination.Vaccination is one of the most convenient and safest preventive care measures available for you and your patients.

Focusing on vaccination as a method to improve safety for your staff and patients will help prevent the spread of disease in the healthcare setting and improve vaccination rates.

One of the most important vaccines for your patients and staff to receive annually is the influenza (FLU) vaccine. It is recommended for all age groups and is especially important for those with end stage renal disease since they are at greater risk than the general population for contracting contagious diseases.

Now is the time to discuss with your medical director which flu vaccine is preferred for your clinic and how many doses will be required to vaccinate the patients and staff. The period to pre-order vaccines will begin in early July and continue through August. Planning today will help you be prepared to start vaccinating when the influenza season begins in September.

Please click here to take a fun quiz to determine what vaccines are recommended for adults based on age, health conditions, job, lifestyle and other factors.

To read more about vaccinations, please click on the CDC link below:

https://www.cdc.gov/vaccines/adults/rec-vac/index.html

Get Started Today! Exploring CMS New ESRD Patient Orientation Packet (NEPOP

After beginning hemodialysis treatments, all new end-stage renal disease (ESRD) patients receive a mailing from CMS, the federal agency that administers the Medicare program. The New ESRD Patient Orientation Packet (NEPOP) is distributed through a collaborative effort among CMS, the 18 ESRD Networks, and the ESRD National Coordinating Center (NCC).

The NEPOP includes materials to help new patients understand and manage their plan of care. One way for patients to feel better and be healthier is to learn as much as they can about their illness. Materials included in the NEPOP are valuable resources to help people living with ESRD obtain the information needed to make informed choices about their care.

The ESRD Network and each state’s Survey Agency (SA) can also help patients find services, solve care-related problems, and obtain educational information.

To learn more about NEPOP or access the packet enclosures, please visit the ESRD NCC website at:
http://www.esrdncc.org/en/resources/patients/starting-treatment/

Emergency Preparedness for Healthcare Providers

People are exposed to many different types of emergencies. Weather related emergencies can include, but are not limited to, hurricanes, blizzards, earthquakes, and flooding. Additional emergencies can include terrorist attacks, illness pandemics, as well as many other scenarios. Emergency situations can lead to increased emergency department visits, hospitalizations, and even an increase in mortality rate. Medicare- & Medicaid-participating providers and suppliers are required to plan adequately for both natural and man-made disasters, and coordinate with federal, state, tribal, regional, and local emergency preparedness systems in order to meet the needs of patients. Dialysis facility leadership should ensure that all staff members have adequate training on the facility’s emergency response plan, and have a clear understanding of response functions and/or roles during an emergency. Staff should be able to identify gaps and lessons learned from previous disasters as a way to continuously improve their facility’s emergency response plan.

To read about lessons from Sandy and how healthcare systems can prepare for future disasters, click here.