On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2019. This rule also updates the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI, and finalizes changes to the ESRD Quality Incentive Program (QIP). Find the summary at https://www.cms.gov/newsroom/fact-sheets/cy19-esrddme-nprm-cms-1691-f-and-dmepos-competitive-bidding-program-temporary-gap-period
Emergency Disconnect Procedure for In-Center Hemodialysis Patients
The national Kidney Community Emergency Response Patient and Family Engagement Learning and Action Network (N-KPFE-LAN) is pleased to announce its new resource, Emergency Disconnect Procedure for In-Center Hemodialysis Patients. The one-page instruction sheet shows in-center hemodialysis patients how to disconnect from dialysis in three steps in an emergency situation. The resource can be downloaded and printed from the KCER website at: https://www.kcercoalition.com/contentassets/7202c26cb0ce40b9a098d3dbede5ccb9/emergencydisconnectdialysis508.pdf.
Annual Facility Surveys and IPRO ESRD Network Program Customer Support Portal
With Annual Facility Surveys around the corner, the IPRO ESRD Network program is encouraging use of the Freshdesk knowledgebase. Please click on the link to access Freshdesk. https://iproesrdnetwork.freshdesk.com/a/solutions/https://iproesrdnetwork.freshdesk.com/a/solutions/
Several articles are posted in Freshdesk to provide an easy-to-use and searchable knowledgebase on the 2744 survey process. The solutions in Freshdesk includes data clean up, instructions on creating the 2744, and how to complete the survey. Freshdesk allows facility staff to submit questions via the portal. Network staff will respond by email or phone. Facilities can also set up a webinar to complete surveys. For information, please send an email to support@IPRO.freshdesk.com or visit https://ipro.freshdesk.com/support/login.
Reset Passwords for DialysisData.org Website
The passwords to access the https://dialysisdata.org/ site are refreshed once a year around this time. All user accounts will be disabled. The Master Account Holder (MAH) password will be sent by the Network. Using MAH password, dialysis facility staff should “Enable users”, so they can access Dialysis Facility. This will prompt users to reset their passwords. These activities are performed at https://dialysisdata.org/. Please see more information on how to enable users at https://iproesrdnetwork.freshdesk.com/a/solutions/ or visit http://help.esrd.ipro.org/support/solutions/articles/9000155453-instructions-for-accessing-dialysis-facility-reports that gives instructions on how to enable users.
The New ESRD Patient Orientation Packet
All new ESRD patients receive the New ESRD Patient Orientation Packet (NEPOP) from the Centers for Medicare & Medicaid Services (CMS). This packet contains information that can assist new patients with understanding their disease and guide them to resources that can assist them with their care. The resources included in the NEPOP can be found on the ESRD National Coordinating Center’s website.
In order for these new ESRD patients to receive this education it is important that their contact information in CROWNWeb be accurate and up to date. The Network recommends reviewing and confirming contact information with new patients before the entry is made in CROWNWeb to ensure that they receive these educational resources.
Breaking through the Access to Care Barriers
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.
Assessing Treatment Adherence within the ESRD Population
As we all know, treatment of end stage renal disease (ESRD) is demanding, multifaceted and complex, requiring that patients strictly adhere to treatment protocols to achieve favorable health outcomes.
The American Kidney Fund surveyed more than 1,000 patients and nearly 400 renal professionals regarding patient treatment adherence.
Results were compiled and released this past March in the Barriers to Treatment Adherence for Dialysis Patients Adherence Survey report. Key findings indicate that 31% of patients admitted to terminating their treatment early and 18% cancel or skip a dialysis session. The most reported reason was not feeling well or conflicting medical appointments.
Network staff members are available to provide technical assistance and resources to help facilities improve patients’ adherence to maintaining the frequency and duration of their scheduled dialysis treatments.
In addition, based on the survey results, The American Kidney Fund has begun developing resources and educational tools designed to improve adherence. You can view the entire report at www.kidneyfund.org/adherencereport.
Fluid Restrictions During the Holidays
Dialysis patients deal with several issues that make compliance with fluid restriction difficult all year round; however, during holiday seasons these issues are often compounded, making it particularly difficult to follow guidelines related to fluid restrictions. In addition, there are other dietary considerations that need to be taken in consideration, like sodium restriction. Registered dietitians can help patients personalize fluid restriction goals and manage thirst; they can also offer patients tips to plan their holiday meals. Educating patients about appropriate serving sizes, seasonings and hidden fluid can also prepare them for their festivities. Talk to your patients to help them enjoy their holiday season while avoiding unwanted hospitalizations or other health complications. For more information, please visit https://www.kidney.org/atoz/content/fluid-overload-dialysis-patient.
Great American Smokeout® – November 15, 2018
“About 36.5 million Americans still smoke cigarettes, and tobacco use remains the single largest preventable cause of disease and premature death in the world,” as reported by the Centers for Disease Control and Prevention. Every year on the third Thursday of November, smokers across the nation take part in the American Cancer Society Great American Smokeout.
The Great American Smokeout is an opportunity for smokers to commit to healthy, smoke-free lives; not just for a day, but year round. Individuals, community groups, businesses, healthcare providers, and others can use this event to encourage people to make a plan to quit, or initiate a smoking cessation plan on the day of the event. The event also promotes the many tools and resources available through the American Cancer Society that people can use to help them quit and “stay quit.”
To learn about the available tools, click on the links below or call 1-800-227-2345.
- Benefits of Quitting Smoking Over Time: https://www.cancer.org/healthy/stay-away-from-tobacco/benefits-of-quitting-smoking-over-time.html
- Helping a Smoker Quit – Do’s and Don’ts: https://www.cancer.org/healthy/stay-away-from-tobacco/helping-a-smoker-quit.html
Monitor Missing Data in CROWNWeb for your Facility
The Centers for Medicare & Medicaid Services has published “Data Management Guidelines” for data submission in CROWNWeb. They have also set up data quality goals for 2017-2018. Please click here to see the goals set by the CMS.
The CROWNWeb facility dashboard provides easy identification of missing data.
Once a user logs in to CROWNWeb, the facility dashboard can be seen by entering facility CCN in the search box. The facility dashboard provides direct access to a comprehensive list of items requiring submission in CROWNWeb. It is important that facility administrators, medical directors and nurse managers look at the dashboard on monthly basis to ensure data are submitted according to CMS requirements. This is an easy way to monitor data submission.
The CMS ESRD QIP NHSN Reporting Measure Deadline and Data Quality Checks
Reporting to NHSN for the CMS ESRD QIP rule:
Facilities must follow NHSN Dialysis Event Surveillance Protocol and Reporting for calendar year 2018 (payment year 2020) for compliance with the ESRD QIP. The quarterly reporting deadline for April – June 2018 data is on or before September 30, 2018.
Data Quality Checks:
NHSN data should be completely and accurately reported according to the Dialysis Event Protocol. Determining whether or not the data are correct is your facility’s responsibility. Data quality checks should be performed before the data submission deadline for the quarter. For example, for April to June data, quality checks should be performed by September 30. For more information on how to perform data quality checks, please go to https://iproesrdnetwork.freshdesk.com/solution/articles/9000153404-how-to-perform-data-quality-checks- or https://iproesrdnetwork.freshdesk.com/support/solutions/folders/9000169529
“Welcome to Medicare” a Chance to Coordinate Care
If you have patients who are new to Medicare, encourage them to schedule their “Welcome to Medicare” physical exam. This is a FREE comprehensive screening that will ensure
- A record and evaluation of their medical and family history, current health conditions, and prescriptions.
- Baseline measures of blood pressure, vision, weight, and height.
- Review of preventive screenings and services, like cancer screenings and immunizations.
- Ordering of additional tests, if needed, depending on their general health and medical history.
After the visit, the doctor will give them a plan or checklist outlining free screenings and preventive services that they need. By collaborating with the physician/practice that performs the comprehensive review of the patient’s health status, the medical team at the dialysis clinic can be assured that the patient has an established resource for healthcare issues that are not specifically related to ESRD. This is a great opportunity to coordinate care for essential services like immunizations, diabetes management and cardiac related issues, just to name a few.
For more information, see: https://www.medicare.gov/people-like-me/new-to-medicare/welcome-to-medicare-visit.html