Category: All Networks

A Snapshot of the 2018 ESRD Network Statement of Work – What it Means to Your Facility

In October 2017 ESRD Networks received a new statement of work (SOW) from the Centers for Medicare & Medicaid Services (CMS). This document outlines the quality improvement activities (QIAs) that each Network is required to implement within its service area during 2018. This new SOW includes many changes to the requirements of the previous SOW. While the number of QIAs reduced from eight to four, the scope of the QIAs expanded significantly:

The number of facilities required to participate in QIAs has increased; this increase, in turn, significantly expands the number of patients that will benefit from the quality improvement activities being conducted. Any facility that is working with the Network on a QIA will be required to participate in national Learning & Action Network (LAN) webinars, hosted by the ESRD National Coordinating Council (NCC) on behalf of CMS (See article in this issue, “Facility Involvement in Learning & Action Networks: A 2018 CMS Requirement”). The QIAs are patient centered, and each participating facility is encouraged to have patients work hand-in-hand with management and the facility’s QAPI teams to ensure the success of the QIA’s goals. A brief description of each QIA, its scope, and the CMS goals follow.

Reduce Rates of Bloodstream Infections (BSI)
Fifty percent of the Network’s facilities, those with the lowest semi-annual pooled mean rates of BSI, will participate in the BSI QIA. Staff at these facilities will receive education and training on implementation of the CDC Core interventions and will be invited to the NCC LAN BSI events. Those facilities selected for participation in this QIA will be subdivided into three intervention cohorts, each of which will have different focused goals, activities, and measures of success.  Network staff will work with each of these cohorts on specific quality improvement measures to achieve the goals of the QIA.

The graphic to the right identifies the three cohorts and the following lists the goal for each cohort:

  • Each facility in the BSI cohort will work to reduce its semi-annual pooled mean rate of BSI by 20%.
  • Facilities in the Long-term Catheter (LTC) cohort will work to reduce the LTC count by two percentage points.
  • Facilities in the Health Information Exchange (HIE) cohort will work to participate in an HIE or in some other evidence-based effective information transfer system.

Improve Transplant Coordination
This year Network staff will work with 30% of the facilities in our service area to increase, by 10 percentage points over baseline, the number of eligible patients on the transplant waitlist.  Network staff will work with transplant centers and in-center facilities to meet this goal. Network staff will work with facilities to monitor patient progress using the Seven Steps to Waitlist Process outlined in the table to the right.

Promote Appropriate Home Dialysis
The Network staff will work with 30% of the facilities in its service area to increase the number of patients trained in a home modality.   The goal is to increase the initiation of home training by 10 percentage points over baseline.  In collaboration with physicians and in-center staff, Network staff will work to create a culture of “home first.”  Network staff will work with facilities to monitor patient progress toward the goal of initiating home training using the Seven Steps to Home Modality Training as outlined in the table to the right.

Population Health Focused Pilot QIA (PHFPQ): Vocational Rehabilitation
For the PHFP QIA, the Network will focus on supporting ESRD patients in attaining gainful employment through vocational rehabilitation. Working with 10% of the dialysis facilities in its service area, the Network will seek to increase referrals to approved vocational rehabilitation programs by 5%, with the ultimate goal of increasing in enrollment in vocational rehabilitation services by 2% from baseline to re-measure. Additionally, Network staff will identify a disparity within the target facilities and work with the targeted population to decrease the gap in services.

Strategies for Preventing Catheter-Related Bloodstream Infections in Hemodialysis Patients

A 2016 article in the International Journal of Nephrology and Renovascular Disease evaluates management strategies for preventing catheter-related bloodstream infections, with recognition that many patients begin hemodialysis (HD) with a catheter. The authors conclude that “Early efforts must be directed toward preventative care emphasizing placement of other vascular accesses or initiating an alternative dialysis modality, such as timely peritoneal dialysis (PD) to avert HD catheter placement before it becomes necessary.”

Findings include:

  • “Urgent start PD” programs are a safe alternative to HD in patients without an established AV fistula or graft.
  • Should no options exist outside of catheter placement, proper catheter care and infection control procedures implemented through educating and auditing dialysis unit staff as well as patients, are the first step in preventing infections.
  • In high-risk groups for whom all other conservative measures to prevent infection have failed, the authors recommend consideration of antimicrobial lock (AML) therapy.

“Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies,”Int J Nephrol Renovasc Dis. 2016; 9: 95-103. Published online 2016 Apr 18. doi: 10.2147/IJNRD.S76826

Posting of Payment Year 2018 Performance Score Certificates

CMS regulations state that each facility’s Payment Year (PY) 2018 Performance Score Certificate (PSC) must be printed and posted in a prominent patient area within 15 business days of its availability. PSCs are expected to be available on or about December 15, 2017.

Click on the link for instructions to download and print the certificate.
http://help.esrd.ipro.org/solution/articles/9000114744-esrd-qip-payment-year-2018-guide.

For information on how ESRD QIP affects patients, please visit:
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/03_PatientImpact.html.

If you have any questions or concerns, please contact the ESRD-QIP team at esrdqip@cms.hhs.gov. If you have any questions for the Network staff, please send an email to support@iproesrdnetwork.freshdesk.com.

News for Your Patients: CMS Announces Improved Access to High-Quality Health Coverage Choices; Decreased Premiums for 2018

The Centers for Medicare & Medicaid Services (CMS) recently released 2018 benefit and premium information as well as Star Ratings for Medicare health and drug plans. Changes announced represent more health coverage choices, improved access to high-quality health choices, and decreased premiums in 2018. “Medicare’s top priority is to ensure that beneficiaries have choices for affordable, high-quality care that fit their needs,” said CMS Administrator Seema Verma.

The following resources have been created to assist patients with understanding health coverage options:

For more information about the CMS health coverage announcement, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-10-11.html

For information on proposed policy changes and updates for Medicare Advantage and the Prescription Drug Benefit Program for 2019, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-16.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending

The Grievance Process: Do You Know Your Facility’s Responsibilities?

Dialysis facilities are required to ensure a process has been implemented for patients to express concerns about their care without reprisal or denial of services.

According to CMS, a grievance is defined as “a written or oral communication from an ESRD patient, and/or an individual representing an ESRD patient, and/or another party, alleging that an ESRD service received from a Medicare-certified provider did not meet the grievant’s expectations with respect to safety, civility, patient rights, and/or clinical standards of care.” The grievant is not required to explicitly state that the care did not meet professionally recognized standards.

Federal regulations at 42 CFR §405.2112(g) specify “evaluating and resolving patient grievances” as one of the Network’s functions. The Network’s case review responsibilities include investigating grievances filed with the Network and addressing non-grievance access to care cases. However, some concerns do not fall under the jurisdiction of the Network; in these cases patients would be referred to a more appropriate agency, such as the state health department.

The following resources provided by the Network can help educate staff and patients about grievances:

For more information, or assistance with patient grievances, please contact the Patient Services Director in your Network.

Empower Your Patients: With your help, we can make a difference!

Have any of your patients or their caregivers/family members shared with you their feelings about not being heard?

Has a patient ever shared an idea they felt would be useful for others with ESRD?

If so, we know you’ll understand the value of engaging such individuals in efforts to improve patient care. We need your help!

The Network has convened a group of Patient Subject Matter Experts (SMEs) to provide patient perspective and feedback to the Network on educational materials, quality improvement projects and other issues that relate to our work in improving care to ESRD patients. Please consider nominating patients, transplant recipients, and family members/care partners who are interested in sharing their talents and ideas with other SMEs in the Network.

What do SMEs do? Ultimately, they help Network staff understand what is important to patients, share useful ideas and experiences, and foster Network initiatives at their own dialysis facility and transplant center. Their efforts focus on providing feedback on Network quality improvement activities related to infection prevention, transplant referrals, home dialysis training, vocational rehabilitation, and patient engagement.

For more information, please contact your local Network.

How Does the ESRD Network Partner with Facilities to Improve Patient Care?

Under contract with CMS, ESRD Networks are charged with achieving healthcare transformation, promoting the National Quality Strategy, and supporting the Health and Human Services Secretary’s priorities, by working with dialysis providers, government agencies, ESRD stakeholders, patients, family members and care partners to reach CMS set goals. The Network strives to achieve these goals through activities that include:

  • conducting directed quality improvement activities focused on patient care,
  • maintaining a patient registry,
  • assisting with emergencies,
  • providing educational materials, and
  • investigating patient grievances.

On December 1, 2017, all 18 ESRD Networks across the country began a new contract year.

Do you want to learn more about the work of the Network?

Medicare Part D: Time to Review

Medicare offers prescription drug coverage to everyone with Medicare. If your patients decide not to get Medicare drug coverage when they are first eligible, they may be asked to pay a late enrollment penalty unless they have other creditable prescription drug coverage or are receiving Medicare’s Extra Help.

Every year, Medicare’s open enrollment period is October 15 – December 7. Medicare health and drug plans can make changes each year. These changes could affect the cost, coverage, and the providers and pharmacies in their networks. You can assist your patients by discussing their Medicare Part D coverage and timelines for the ESRD coordination of benefits period to ensure that they are prepared for the year to come.

To research Medicare drug plans use the Medicare Plan finder at: https://www.medicare.gov/find-a-plan/questions/home.aspx

ESRD PPS: Updates to Policies and Payment Rates

CMS issued a final rule that updates payment policies and rates under the ESRD Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2018. In addition, this rule finalizes updates to the acute kidney injury dialysis payment rate for renal dialysis services, as well as updates to the ESRD Quality Incentive Program for payment years 2019, 2020, and 2021. CMS projects that the updates for Calendar Year (CY) 2018 will increase the total payments to all ESRD facilities by 0.5 percent compared with CY 2017. For hospital-based ESRD facilities, CMS projects an increase in total payments of 0.7 percent, while for freestanding facilities, the projected increase in total payments is 0.5 percent.

The final rule also includes:

  • Update to the ESRD PPS base rate
  • Annual update to the wage index and wage index floor
  • Update to the outlier policy

See the full text of this excerpted CMS Fact Sheet (issued October 27).

Why Facility Data Reports Should Be Checked

CMS established the ESRD Quality Incentive Program (QIP) as part of its ongoing efforts to improve the quality of dialysis care provided to ESRD patients.

Annual Dialysis Facility Reports (DFRs) and Quarterly Dialysis Facility Compare (QDFC) Reports are made available to facilities, State Survey Agencies, and Regional Offices online at dialysisdata.org. Only authorized users can access the reports.

Facilities can use the DFR and QDFC reports to assist in their quality improvement efforts; state surveyors use the DFR data when deciding which facilities to survey. Facilities are given a chance to preview and comment on these reports. The quality measures from the reports are posted on the Dialysis Facility Compare website, which is used by patients to review and compare characteristics and quality information on approximately 6,500 dialysis facilities in the United States.

Dialysis facility staff are encouraged to review the facility’s data reports on a regular basis. For information on how to access these reports, visit the IPRO ESRD Network Program help portal.

New Priorities and Goals Planned for ESRD Stakeholders

The Department of Health and Human Services (HHS) National Quality Strategy (NQS) is a national effort to align public- and private-sector stakeholders to achieve better health and healthcare for all Americans. It was developed “through a transparent and collaborative process with input from a range of stakeholders. More than 300 groups, organizations, and individuals, representing all sectors of the health care industry and the general public, provided comments.”

The Centers for Medicare & Medicaid Services (CMS) contracts with End Stage Renal Disease (ESRD) Networks to implement the NQS principles and HHS Secretary’s priorities in the ESRD community. Starting in December 2017, Networks will launch a set of new quality improvement activities, data reporting requirements, and educational programs that reflect updated priorities and goals.

HHS Secretary’s Priorities

  1. Reform, Strengthen, and Modernize the Nation’s Health Care System
  2. Protect the Health of Americans Where They Live, Learn, Work, and Play
  3. Strengthen the Economic and Social Well-Being of Americans Across the Lifespan
  4. Foster Sound, Sustained Advances in the Sciences
  5. Promote Effective and Efficient Management and Stewardship

CMS Goals

  1. Empower patients to make decisions about their health care
  2. Usher in a new era of state flexibility and local leadership
  3. Support innovative approaches to improve quality, accessibility, and affordability
  4. Improve the CMS customer experience

November is American Diabetes Month

According to the Centers for Disease Control and Prevention (CDC), more than 30 million children and adults in the United States are living with diabetes. At least 1 out of 3 people will develop diabetes in their lifetime. The American Diabetes Association has selected the month of November to raise awareness of the disease and its serious complications. The following resources can be helpful for dialysis staff and patients to discuss the importance of diabetes prevention and control: