The Seven Step Journey Towards Kidney Transplant

The Centers for Medicare & Medicaid Services (CMS) has incorporated in the 2018 transplant quality improvement activity (QIA) a series of standardized steps toward transplant. According to the 2012 Clinical Journal of American Society of Nephrology article, “Impact of Navigators on Completion of Steps in the Kidney Transplant Process: A Randomized, Controlled Trial,” these steps were first defined and performed in 23 hemodialysis facilities in Ohio. The steps are: (1) Suitability for Referral to Transplant Center; (2) Interest in Transplant; (3) Referral Call to Transplant Center; (4) First Visit to Transplant Center; (5) Transplant Center Workup; (6) Successful Transplant Candidate; (7) On Waiting List or Evaluating Potential Living Donor.

Research has identified that the guidance offered by a transplant navigator –or mentor- helps patients move further and faster through the seven steps than they would without a navigator. If you are interested in starting a Peer Mentorship Program at your facility, contact the Network.

Update Admit/Discharge Records in CROWNWeb!

Patients should be admitted / discharged in CROWNWeb within 5 business days of their first treatment and within 5 business days of their last treatment at a Medicare-certified dialysis facility.

 

See Page 31 of the CROWNWeb Data Management Guidelines for details.

To send a help desk ticket to the Network: support@iproesrdnetwork.freshdesk.com

Looking for resources on depression and mental health?

The National Forum of ESRD Networks’ Kidney Patient Advisory Council (KPAC) has developed the Dialysis Patient Depression Toolkit. Created by patients for patients, with important contributions by professionals, this toolkit was is designed to help patients who feel that they may be experiencing depression. It also offers facility staff guidance in providing hope and assistance to patients with mental health concerns. The toolkit also addresses anxiety, sleepiness, substance abuse and more. It provides coping skills for patients, whether or not they are currently working with a professional in these areas of mental health, as well as resources and contact information for those individuals interested in more information about how to find help.

Cultural Competency in the ESRD Community

Cultural competence in healthcare describes the ability to provide care to patients with diverse values, beliefs and behaviors, including tailoring healthcare delivery to meet patients’ social, cultural and linguistic needs[1]

Dialysis facilities can improve their cultural competence by providing education about diverse populations to staff members.  This can assist to eliminate racial and ethnic disparities in care.

Some of the benefits of cultural competence include:
  • An increase mutual respect and understanding between patient and the organization
  • Increases participation and involvement in health issues
  • Reduces care disparities in the patient population
  • Reduces the number of missed treatments

[1] American Hospital Association and Institute for Diversity in Health Management. (2012, June). Diversity and Disparities: A Benchmark Study of U.S. Hospitals. Chicago: IL. Accessed at www.hpoe.org

 

Learn More About Network Publications

The IPRO ESRD Network Program offers educational content for patients through our Kidney Chronicles and PAC Speaks newsletters. Primarily distributed electronically, these newsletters focus on topics that involve patient engagement and education about ESRD, as well as updates on quality improvement activities and emergency response resources.

Here’s a quick look at what each newsletter has to offer!

Kidney Chronicles features educational information for patients, their care partners and family members. It is emailed to facility staff members with a request that they print and distribute copies to patients served by the facility. Network Patient Advisory Committee (PAC) members and Patient Subject Matter Experts (SME) also receive the newsletter via email.

The PAC Speaks newsletter is written by patients for patients about important issues for people living with end stage renal disease. This newsletter is also distributed to participants of the PAC and to patient SMEs, as well as dialysis facility staff.

Check out each Network website to read the latest editions of Kidney Chronicles and PAC Speaks!

ESRD QIP Corner

Don’t miss these important updates:

Facility DFC Data Updated:  The Centers for Medicare & Medicaid Services (CMS) has completed its April refresh of the facility data in Dialysis Facility Compare (DFC). Details about this update can be found at https://data.medicare.gov/data/dialysis-facility-compare.

The newly updated DFC database and current five-star facility ratings can be found at https://www.medicare.gov/dialysisfacilitycompare/.

ESRD QIP Measures Technical Specifications Updated: CMS also recently updated its web page on technical specifications for ESRD QIP Measures to include the CY2018 ESRD PPS Final Rule, and links to Technical Measure Specifications through PY2021.

Find this page at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/061_TechnicalSpecifications.html.

ESRD QIP Rule and NHSN Core Interventions:  The Centers for Disease Control and Prevention (CDC) recently updated its NHSN and CMS ESRD QIP Rule web page and its nine recommend Core Interventions for reducing BSI.

Find these updates at https://www.cdc.gov/nhsn/faqs/dialysis/faq-esrd-qip.html and https://www.cdc.gov/dialysis/prevention-tools/core-interventions.html.

What’s the current status of the ESRD QIP?

The ESRD QIP Current Status webpage can be found here: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/02_CurrentStatus.html

The ESRD QIP establishes incentives for dialysis facilities serving the ESRD population to meet performance standards established by CMS. The quality measures are improved every year via rulemaking. Facility evaluation and payment reductions in a given payment year (PY) are based on performance during a prior year.

Improved Patient Health Outcomes through Peer Mentors

Did you know that peer mentoring has been proven to be a successful strategy to educate patients about their options for treatment, including transplant? The Network has resources and tools available to help train patients who are interested in becoming peer mentors. Contact the Network today to sign up your facility for the Network’s new peer mentorship training program.

According to the National Kidney Foundation, peer support is reported to be effective in helping kidney patients adjust to kidney disease, long-term dialysis therapy and kidney transplantation. Peer support programs utilize someone who is living with the same disease to assist patients in managing their own health. This can be particularly effective when the patient is newly diagnosed or is having trouble coming to terms with the disease. In addition, peer support has become strongly linked with attempts to increase patients’ ability to self-manage their condition, and the drive to improve healthcare outcomes. Peer support works because patients are able to give each other something the clinician does not have, shared life experience.

A peer mentor empowers fellow patients to move forward with their lives after being diagnosed with ESRD. Peer mentoring provides support and increases the confidence that many new patients need, and offers patients access to someone who has been through the similar experiences and can understand their concerns. Peer mentors can come from all backgrounds. Mentors should be individuals with positive outlooks on managing kidney disease. Individuals who are succeeding at achieving their treatment goals can provide insight to help others successfully manage kidney disease.

 

For more information about peer mentorship visit, https://www.kidney.org/professionals/Peers

New Resources About Home Dialysis

Dispelling myths and providing concrete information regarding home modalities is often a challenge for in-center chairside dialysis practitioners. Another ESRD Network organization (HealthInsight ESRD Alliance Network 16 and 18) has created materials that help patients distinguish between myth and fact in an easy FAQ format. We hope these materials, which can be found at the links below, provide resources for you to offer your patients when they are considering whether home therapy is right for them.
My Choice, Home Dialysis – MYTH VS. REALITY

Review Your Facility Data By August 23, 2018

The PY2019 Preview Period for the ESRD QIP will begin on July 23, 2018, and end on August 23, 2018. The Preview Period provides an important opportunity for each facility to review and ask questions about its ESRD QIP scores and any potential payment reductions that may result. During the Preview Period, facilities will be able to access a Performance Score Report (PSR) to learn about how their estimated Total Performance Scores were calculated. CMS updated this year’s Preview PSR to provide more-streamlined reporting of facility performance.
On July 11, 2018 CMS will present a webinar on the PY2019 Preview Period to discuss how to access, review, and submit clarification questions and/or a formal inquiry about a facility’s estimated scores before the close of the Preview Period. Find details and register at https://register.gotowebinar.com/register/4774560365192234755.
In preparation for the PY 2019 Preview Period, CMS encourages all facilities to review and update their authorized users in accordance with the updated password requirements for Enterprise Identity Management (EIDM) accounts as applied to ESRD Quality Reporting System (EQRS); see
http://mycrownweb.org/2017/06/new-eidem-password-requirements/. Each facility also must designate a point of contact (POC) in EQRS; facilities without a POC will not be able to access their Preview PSRs, nor will they be able to submit clarification questions or a formal inquiry. If your facility has not established authorized users and a POC, CMS encourages you to do so as soon as possible.
For more information and tools, visit the QualityNet ESRD QIP Resources page athttps://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier3&cid=1228776130548.
Contact the QualityNet Help Desk with your questions or concerns about use of the ESRD QIP system at qnetsupport-esrd@hcqis.org, or 866-288-8912. Monday-Friday between 5 am and 5 pm PDT.

Extraordinary Circumstances Exception

A facility can request an exception or extension (if applicable) to various quality reporting requirements due to extraordinary circumstances beyond the control of the facility. Such circumstances may include (but are not limited to) natural disasters (such as a severe hurricane or flood), systemic problems with CMS data collection systems that directly affected the ability of facilities to submit data, or extreme circumstances preventing facilities from electronic clinical quality measure (eCQM) or electronic health record (EHR)-based reporting (e.g., extraordinary infrastructure challenges or vendor issues outside of the facility’s control). This also includes temporary closure of the facility. To request an exception or extension, facility administration must complete and submit the “ECE request form”, found here, to the ESRD QIP mailbox at ESRDQIP@cms.hhs.gov. In order for a facility to prevent loss of points under QIP this form must be submitted within 90 calendar days of the extraordinary circumstance following the end of the last reporting period.

Updating Notifications and Accretions in CROWNWeb

Notifications and Accretions must be updated monthly in CROWNWeb. The definitions for these records are:

Notification—a discrepancy in patient data between what CMS and the Social Security Administration (CMS/SSA) database has on record and what exists in CROWNWeb.

Accretion—a record that exists in a CMS/SSA database and believed to be ESRD, but has not been admitted into CROWNWeb as a patient. (An accretion may also occur for existing patients in CROWNWeb whose key identifiers are missing or incorrect.)

All corrections to the data must be made through CROWNWeb. When updating Notifications and Accretions in CROWNWeb:

  • All facilities (including batch submitting organizations) are responsible for correcting and maintaining their own data.
  •  New notifications and accretions should be resolved within 15 days and those that are under investigation are to be resolved within 30 days.
  • The Network is responsible for the oversight of notifications and accretions and will keep facilities informed as these issues arise for correction.
For a complete tutorial, please click here.

Considering the Best Practice of Patient Involvement in Quality Improvement

Ensuring patient involvement in every aspect of healthcare is paramount to positive health outcomes and is a best practice for improvement processes. According to the article, “Patient involvement in quality management: rationale and current status”, through involvement in their care, patients served as catalysts for broad change in the attitudes of staff by providing a motivation for wider organizational changes. These patients were able to adopt different roles across projects where they shared their experiences, helped to identify improvement priorities and developed potential solutions with the staff that had cared for them.
Click here to read more on best practices for involving patients in quality improvement.