Dialysis facilities across the country treat patients from a variety of backgrounds and experiences. Patients who start dialysis have multiple health comorbidities, which may also be complicated by a history of mental health issues or socio economic problems. The Network works to assist facilities in successfully managing these patients by providing guidance, resources, and policy clarification especially if patients are at risk for an issue with access to care. From patients at risk for being involuntarily discharged, to patients being lost to follow up and discontinuing treatment, a patient’s access to care is becoming a more widespread issue with significant risks to our patient population.
The Network can provide guidance to facilities as they support patients through any one of these processes. Facilities can then take preventative measures to minimize the potential for patients to encounter access to care issues. Facilities should also closely review their own policies in working with these patients and some national resources like the Kidney Patient Advisory Council (KPAC) Grievance Toolkit found at esrdnetworks.org, as well as the CMS Conditions for Coverage.
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): http://esrd.ipro.org/wpcontent/uploads/2017/08/InterpretiveGuidelines.pdfÂ
For more information on the regulations on plans of care, see the CMS Conditions for Coverage for end-stage renal disease facilities. Subpart C – Patient Care: https://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol5/xml/CFR-2011-title42-vol5-sec494-90.xml
In 2016, the IPRO ESRD Network of New York introduced an innovative program to help facilities accept patients who had been previously involuntarily discharged from their dialysis facility. As reported in the April 6, 2016 issue of Nephrology News and Issues, through the program prospective dialysis units are offered a 30-day trial period during which they may accept a patient for treatment as if he or she is a “transient” patient. The unit accepts the patient with the understanding that there is no commitment to continue treatment after 30 days; should the patient cause excessive disruption to the unit or exhibit threatening or violent outbursts. Participating units agree that if the patient refrains from these behaviors, the unit will accept the patient as permanent after the 30th day or the 12th treatment. In 2017 the program continues to help patients who have been involuntarily discharged from their dialysis facility, with five patients being accepted permanently in a new dialysis facility, to date. This program helps those patients who have been involuntarily discharged from their unit receive a second chance. Through this second chance, the patient and facility get to know one another and the patient has an opportunity to gain a sense of stability and reliable access to the treatments needed to stay healthy and to survive.
Click here, to read the complete article, An innovative approach in addressing dialysis patient placement challenges.