ANNUAL REPORT 2013 - Amazon S3All ESRD Networks are required to submit an annual report to the Secretary of the U.S. Department of Health and Human Services. This report covers Northwest

i

ANNUAL REPORT

2013

Submitted to:

Department of Health and Human Services

Centers for Medicare & Medicaid Services

For: Contract Number HHSM-500-2013-NW016C

Submitted to CMS Project Officer

June 15, 2014

NORTHWEST RENAL NETWORK

Northwest Renal Network Annual Report 2013

CMS Contract # HHSM-500-2013-NW016C ii

TABLE OF CONTENTS I. PREFACE ......................................................................................................................... iii

A. Mission Statement ................................................................................................... iii B. Statement of the Chairperson ................................................................................... iv

II. INTRODUCTION ................................................................................................................ 1

A. Network Description ................................................................................................... 3

1. Geography and General Population Characteristics ............................................. 3 2. The Five Network States ...................................................................................... 4 3. ESRD Patient Population ..................................................................................... 5 4. Providers ........................................................................................................... 13 B. Network Structure .................................................................................................... 13

1. Staffing .............................................................................................................. 13 2. Boards and Committees ..................................................................................... 15 3. Network Council - Facility Representatives ........................................................ 16

III. CMS NATIONAL GOALS AND NETWORK ACTIVITIES ................................................ 17

A. AIM 1 – Better Care for Individual through Beneficiary and Family Centered Care .. 18

B. AIM 2 – Better Health for the ESRD Population ....................................................... 31

C. AIM 3 – Reduce Cost of ESRD Care by Improving Care .......................................... 31 IV. DATA TABLES ................................................................................................................ 35

1. ESRD Network 16 Incidence - One Year Statistics ............................................ 36

2. ESRD Network 16 Dialysis Prevalence - One Year Statistics ............................. 37 3. ESRD Network 16 Dialysis Patients Modality and Setting – In Home ................ 40 4. ESRD Network 16 Dialysis Patients Modality and Setting – In Center ................ 45 5. ESRD Network 16 Dialysis Renal Transplants by Network Transplant Center ... 50 6. ESRD Network 16 Renal Transplant Recipients ............................................... 51 7. ESRD Network 16 Dialysis Deaths .................................................................... 54 8. ESRD Network 16 Vocational Rehabilitation ...................................................... 56


CMS Contract # HHSM-500-2013-NW016C iii

I. PREFACE

MISSION STATEMENT

The mission of Northwest Renal Network is to promote

optimal dialysis and transplant care for kidney patients in

Alaska, Idaho, Montana, Oregon and Washington.


CMS Contract # HHSM-500-2013-NW016C iv

STATEMENT BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS

Northwest Renal Network (Network 16) Board of Directors and staff are pleased to submit the 2013 Annual Report to the Centers for Medicare & Medicaid Services (CMS). The activities of our Network support the CMS ESRD Network Program Strategic Goals outlined in a new Statement of Work that began in 2013 to improve ESRD patient outcomes.

Guided by three Aims, the focus of the new Statement of Work includes Better Care for the Individual through Beneficiary and Family Centered Care; Better Health for the ESRD Population and Reduce Costs of ESRD Care by Improving Care. This report summarizes the Network’s activities conducted towards these CMS goals in patient engagement, quality improvement, technical assistance, education, community collaboration, beneficiary protection and ESRD data system support and training activities. It also provides key data regarding patients and providers in Alaska, Idaho, Oregon, Montana and Washington. Highlights for 2013 include:

Quality Improvement The Network’s annual Quality Improvement projects addressed improving AVF maturation rates, reducing long-term catheter rates, increasing incident AVF placement, and assisting dialysis facilities with multiple opportunities for improvement. Additional QI activities included working with the Oregon Patient Safety Commission on the Oregon Blood Stream Infection Collaborative. The Network also continues to lead the nation in AV Fistula in-use rates and has documented a reduction in catheter (CVC) use.

Patient Engagement With a new focus on Patient Engagement, the Network instituted a new Patient Learning and Action Network (LAN) helping patients to become more involved with their care and with the development of Network activities. This LAN helped develop resources now available to patients and increased patient involvement at the facility level. The Network continued to promote and enhance its website resources for the community including additional tools for beneficiaries, emergency preparedness, and vocational rehabilitation.

Information Management Network 16 continued to provide technical expertise to dialysis and transplant facilities for the accurate completion of data required by CMS. Additionally we provided input on several national data committees helping to refine new data processes nationally.

The Board of Directors would like to thank Network 16’s consumers, clinical staff and provider facilities for their continued partnership and assistance toward reaching the Network and CMS goals. Specifically, we would like to thank the individuals who volunteer on the Network’s Board of Directors, Patient Advisory Committee and Medical Review Board. Their participation and knowledge is instrumental to the Network’s mission.

Katrina Russell, RN, CNN Chairperson, Board of Directors

NORTHWEST RENAL NETWORK


CMS Contract # HHSM-500-2013-NW016C 1

II. INTRODUCTION

Northwest Renal Network is a 501(c)3 non-profit corporation, established in March 1978 to provide End Stage Renal Disease (ESRD) quality of care monitoring services for the federal government. Under contract with the Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services, the Network provides services to promote optimal dialysis and transplant care for kidney patients in ESRD Network Area #16: Alaska, Idaho, Montana, Oregon and Washington. All ESRD Networks are required to submit an annual report to the Secretary of the U.S. Department of Health and Human Services. This report covers Northwest Renal Network activities conducted in calendar year 2013 under CMS Contract # HHSM-500-2013-NW016C. History of ESRD Networks In October 1972, passage of Section 2991 of Public Law 92-603 created the national ESRD Program that extended Medicare benefits to cover the high cost of medical care for most individuals suffering from end stage renal disease. Congress enacted modifications of the End Stage Renal Disease Program on June 13, 1978 (PL 95-292) to improve cost effectiveness, ensure quality of care, encourage kidney transplantation and home dialysis, and increase program accountability. This legislation amended Title XVIII of the Social Security Act, by adding Section 1881, which designated 32 ESRD Network areas and established Network organizations, consistent with criteria determined by the Secretary of the Department of Health and Human Services. To help achieve coordinated delivery of ESRD services, representatives of hospitals and health facilities serving dialysis and transplant patients in each area of the country were linked with patients, physicians, nurses, social workers, dietitians, and technicians into “Network Coordinating Councils.” In 1987, Networks were consolidated from 32 service areas into 18; the territory served by Northwest Renal Network (Network 16) was unchanged. The current configuration of ESRD Network Organizations nationwide is illustrated on the following page. Each Network includes representatives of the federally approved ESRD treatment facilities in its region, as well as patients and professionals involved in the delivery of ESRD services. The Network is responsible for conducting activities in the areas of quality improvement, community information and resources, administration, and information management. The function of the Network is to:

Provide an efficient organizational framework for improving quality of care

Identify opportunities to improve care, develop quality improvement interventions, and measure their effectiveness

Identify and address instances of substandard care including patient safety concerns, and refer to other agencies or organizations as appropriate

Investigate and resolve patient complaints and grievances

Coordinate the collection, analysis and reporting of data used in monitoring and evaluating quality of care and for beneficiary entitlement to Medicare coverage



End Stage Renal Disease Networks

ESRD Network No. 1 Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island

ESRD Network No. 2 New York

ESRD Network No. 3 New Jersey, Puerto Rico, U.S. Virgin Islands

ESRD Network No. 4 Pennsylvania, Delaware

ESRD Network No. 5 District of Columbia, Maryland, Virginia, West Virginia

ESRD Network No. 6 Georgia, North Carolina, South Carolina

ESRD Network No. 7 Florida

ESRD Network No. 8 Alabama, Mississippi, Tennessee

ESRD Network No. 9 Kentucky, Indiana, Ohio

ESRD Network No. 10 Illinois

ESRD Network No. 11 Michigan, Minnesota, Wisconsin, North Dakota, South Dakota

ESRD Network No. 12 Missouri, Iowa, Nebraska, Kansas

ESRD Network No. 13 Arkansas, Louisiana, Oklahoma

ESRD Network No. 14 Texas

ESRD Network No. 15 New Mexico, Colorado, Wyoming, Utah, Arizona, Nevada

ESRD Network No. 16 Alaska, Idaho, Montana, Oregon, Washington

ESRD Network No. 17 Northern California, Hawaii, Mariana Islands, Guam, American Samoa

ESRD Network No. 18 Southern California



A. NETWORK DESCRIPTION

1. Geography and General Population Characteristics

Northwest Renal Network serves the states of Alaska, Idaho, Montana, Oregon, and Washington, which span three time zones and almost one million square miles. The distance from Anchorage, Alaska to Billings, Montana is only a hundred miles less than the distance from Seattle, Washington to Atlanta, Georgia. Although the Network includes several metropolitan centers, a substantial portion of the general and ESRD population is dispersed in more remote, rural areas. While Washington has about the same population density as Texas, that’s 80 times the density in Alaska, and 15 times the density in Montana. Travel in many areas within the Network is challenging, as some regions have limited access roads and others are often impacted by severe weather events such as ice storms, high winds, and floods. In addition, natural disaster risks in the region include wildfires, earthquakes, tsunami, avalanches, and volcanic eruptions. The vast geographic size, varying population densities, and constraints on transportation found in this Network impact the size and location of ESRD facilities, and utilization of treatment modality options by ESRD patients. These factors also influence the methods utilized by the Network to disseminate information and conduct quality improvement activities. During 2012-2013, population growth in Alaska fell below the national average of 0.7%, while the rest of the Network grew faster than the US as a whole.

FIGURE 1

PERCENT CHANGE IN GENERAL POPULATION IN THE NETWORK AREA

STATE 2012 2013 %

CHANGE CHANGE

ALASKA 731,449 735,132 0.5% 1.2%

IDAHO 1,595,728 1,612,136 1.0% 0.9%

MONTANA 1,005,141 1,015,165 1.0% 0.7%

OREGON 3,899,353 3,930,065 0.8% 0.9%

WASHINGTON 6,897,012 6,971,406 1.1% 1.3%

NETWORK 16 14,128,683 14,263,904 1.0% 1.1%

US 313,914,040 316,128,839 0.7% 0.7%

Source: July 1, 2012 and 2013 Annual Population Estimates from the US Census Bureau at http://www.census.gov .

http://www.census.gov/



2. The Five Network States Alaska is the largest state in the US, with a land area of 571,951 square miles. Alaska depends on the lower 48 states for a number of specialized healthcare services, including renal transplantation. The

topography of Alaska includes 20,000-foot mountains, arctic tundra, glaciers, impassable rivers, and more than 6,000 miles of coastline, much of it mountainous. Travel between the more widely dispersed communities is primarily by air or sea. At the end of 2013 there were eight dialysis providers in Alaska dialyzing 512 non-transient prevalent patients, and 507 dialysis patients identified as living in Alaska.*

Idaho is the 14th largest state in the nation, with a land area of 82,747 square miles, much of which is mountain wilderness. Much of Idaho's population is distributed in small communities that may become quickly

isolated during the winter due to sudden and severe storms. Two thirds of Idaho is federal land, much of it forest and desert. At the end of 2013 there were 1,224 dialysis patients identified as living in Idaho, and 1,206 patients dialyzing at 26 providers, though one was temporarily closed for repairs.*

The 4th largest state in the nation, with a land area of 145,552 square miles, Montana is mostly rural. The Continental Divide bisects the state

into a milder, wetter, maritime but mountainous climate in the west and a harsher, drier continental climate in the eastern two thirds. Severe winters and summer forest fires, combined with the topography, frequently make travel difficult if not impossible. Many of the state's highways are closed during heavy snowfall, and air travel may also be restricted due to poor visibility. During the last week of 2013 there were 768 dialysis patients identified as living in Montana, and 779 patients dialyzing at twelve providers.*

Oregon is 80% rural and the 9th largest state, with a land area of 95,997 square miles. The maritime western third is mostly agricultural, while the

eastern two thirds is mostly desert. Eighty-seven percent of the population of Oregon lives in the western third. With its lumber and paper industries in decline and no other major export industries to replace them, Oregon is often one of the worst-hit states during recessions. At the end of 2013 there were 3,743 dialysis patients identified as living in Oregon and 3,868 patients dialyzing at 57 providers.*

Washington is the 18th largest state in the nation, with a land area of 66,544 square miles. Like Oregon, the state is divided by the Cascade

Mountain Range into a milder climate on the western side, and on the eastern side plateaus, deserts, and more sparsely populated agricultural areas irrigated by dams on the Columbia River. Three fourths of Washington counties are considered rural. When 2013 came to a close there were 6,467 dialysis patients identified as living in

Alaska - The Last Frontier

Idaho – The Gem State

Montana – The Treasure State

Oregon – The Beaver State

Washington – The Evergreen State



Washington and 6,484 patients dialyzing at eighty providers.* One of the eighty, however, is a children’s camp only open for two weeks of the year.

*While it’s possible that someone, a home patient for instance, could dialyze in Alaska and not live there, the discrepancy is probably due to a lag in updating patient address. Among the other four Network states, patients do cross state lines to dialyze. For instance, patients living in northern Wyoming, northern Utah, and northern California may dialyze in Montana, Idaho, or Oregon, respectively. And there are many places on the edges of Washington, Oregon, Idaho, and Montana where patients choose to dialyze in a bordering state. Delays in updating patient addresses also occur in those states.

3. The End Stage Renal Disease Patient Population Prevalence and Incidence The prevalence of a disease or other condition in a population is the number and proportion of people who have been diagnosed with the condition. Prevalence can be point prevalence, which identifies the number and proportion at a single point in time, or period prevalence, which is the number and proportion of people who had been diagnosed with the condition at any time during a specified time period. In this report, only point prevalence is utilized. It is traditional in this arena to measure the prevalence of people on dialysis. Incidence numbers apply to people newly acquiring a disease or other condition. Incidence always applies to a time period, not to a point in time. Here it is traditional to use ESRD incidence, or the incidence of permanent kidney failure. Patients new to ESRD either begin dialysis, or receive a transplant immediately without experiencing dialysis. ESRD incidence includes both. Rates of prevalence and incidence are often tallied not as percentages, but as the number of patients per million people in the general population. One percent would equate to 10,000 per million, for example. A summary comparing 2013 US Census population estimates for each of the five Network states with 2013 dialysis prevalence and ESRD incidence (initiating dialysis or receiving a transplant as first ESRD treatment modality), is presented in Figure 2.

FIGURE 2

DIALYSIS PREVALENCE AND ESRD INCIDENCE DATA

2013 NUMBER OF DIALYSIS NUMBER OF ESRD

GENERAL DIALYSIS PREVALENCE NEW ESRD INCIDENCE

STATE POPULATION PATIENTS per million PATIENTS per million

ALASKA 735,132 507 690 135 184

IDAHO 1,612,136 1,224 759 322 200

MONTANA 1,015,165 768 757 215 212

OREGON 3,930,065 3,743 952 936 238

WASHINGTON 6,971,406 6,467 928 1,660 238

NETWORK 14,263,904 12,842 900 3,337 234

Sources: Figure 1 above and Section IV: Data Tables in this report. Network totals include 133 prevalent dialysis patients and 69 new ESRD patients with residence reported to be in non-Network states. New ESRD patients includes 100 patients whose first modality was transplant.

Prevalent patients – According to CROWNWeb data, 12,842 dialysis patients were being treated by Network facilities as of December 31, 2013. Dialysis prevalence and prevalence rates continued to increase in all Network 16’s five states.



Incident patients – 3,337 patients were reported by Network facilities as beginning ESRD treatment in 2013, including 100 patients who began ESRD therapy with a transplant, and 37 patients receiving treatment at Veterans Administration facilities. ESRD incidence and incidence rates increased in every Network state except Montana. Figures 3 and 4 plot rates of dialysis prevalence and ESRD incidence over time for the US and the five Network 16 states. These two Figures do not include a time series for the Network as a whole, but since Washington makes up half of the Network population and Oregon an additional fourth, the Washington line, with a nod towards the Oregon line when they diverge, is a good surrogate for the Network trend.

FIGURE 3

400

600

800

1000

1200

1400

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Pre

va

len

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tsp

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Annual Rates of Dialysis Prevalence by State, 2004-2013

US

Washington

Oregon

Montana

Idaho

Alaska

Source: Figure 2 above and prior Northwest Renal Network Annual Reports.

FIGURE 4

100

150

200

250

300

350

400

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Incid

en

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Annual Rates of ESRD Incidence by State, 2004-2013

US

Washington

Oregon

Montana

Idaho

Alaska


Primary Renal Diagnosis Prevalent patients in the Northwest Renal Network area are 38% more likely to have a primary renal diagnosis (“PRD”) of glomerulonephritis than patients in the US as a whole. Prevalent patients in this Network are 41% less likely, and incident patients 30% less likely, to have a PRD of hypertension. The table in Figure 5 shows these differences, comparing the PRD distribution of Network patients to the PRD distribution of patients nationally.



FIGURE 5 Primary Renal Diagnosis

Treatment Modality A state-by-state comparison of the Network mix of dialysis modalities is presented in Figure 6. As Figure 7 illustrates, home dialysis continues to increase, reaching 15.8% in 2013, with Idaho and Alaska continuing to lead the way. Nationally, fewer than 10% of patients dialyze at home. This is the third year in a row that Network home rates have grown by half a percentage point. The total number of patients in the Modality table below differs slightly from the total number of prevalent patients in the previous tables because the two data series are derived from two different reports that use different retrieval criteria.

FIGURE 6

0%

5%

10%

15%

20%

25%

30%

35%

40%

NWRN AK ID MT OR WA

Pe

rce

nt

of

Pa

tien

ts

Dialysis Patient Modalitiesas of December 31, 2013, by State

In-CenterHemodialysis

HomeHemodialysis

HomePeritoneal

AK ID MT OR WA Total

Home Peritoneal 108 294 109 463 715 1689

21.1% 24.4% 14.0% 12.0% 11.0% 13.1%

Home Hemodialysis 6 21 17 85 214 343

1.2% 1.7% 2.2% 2.2% 3.3% 2.7%

Center Peritoneal 0 0 0 0 1 1

0% 0.0% 0.0% 0.0% 0.0% 0.0%

Center Hemodialysis

398 891 653 3320 5,554 10,816

77.7% 73.9% 83.8% 85.8% 85.7% 84.2%

Total 512 1206 779 3868 6,484 12,849

100% 100% 100% 100% 100% 100%

Source: Section IV: Data Tables in this report.

Hyper- Glomerulo-

Primary Renal Diagnosis Diabetes tension nephritis Other

Incident ESRD Patients 2013 NWRN 44.7% 19.3% 8.7% 27.3%

Incident ESRD Patients 2011 US 43.9% 27.5% 6.3% 22.3%

Prevalent Dialysis Patients 2013 NWRN 43.8% 16.7% 8.1% 31.4%

Prevalent Dialysis Patients 2011 US 44.2% 28.3% 9.0% 18.5%

Source: Section IV: Data Tables in this report, and NWRN 2012 Annual Report.



FIGURE 7

12%

13%

13%

14%

14%

15%

15%

16%

16%

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Perc

en

t o

f P

ati

en

ts

Percentage of Patients Dialyzing at Home, NWRN, 2004-2013


Transplantation Six hundred eight (608) transplants were performed at Network transplant centers during 2013. Of these, 434 or 71.5% were from deceased donors, 79 or 13.0% were from living related donors, and 94 or 15.5% were from living unrelated donors. One hundred incident ESRD patients received a transplant in this Network as their first ESRD treatment modality, without first receiving dialysis – 16.4% of all Network transplants and 3.0% of all incident patients.

FIGURE 8

0

1

2

3

4

5

6

7

8

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Tra

ns

pla

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pe

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ars

Transplants Performed at NWRN Centersper 100 Dialysis-Patient-Years, 2004-2013

Total Transplant Rate NWRN Total Transplant Rate US

Deceased Donor Transplant Rate NWRN Deceased Donor Transplant Rate US

Living Donor Transplant Rate NWRN Living Donor Transplant Rate US

Sources: Section IV: Data Tables in this report, prior NWRN Annual Reports, and USRDS 2013 Annual Data Report



Network transplant centers performed 18 more transplants during 2013 than they did in 2012. The number of deceased donor transplants grew by 22 (5.3%), the number of living related donor transplants grew by 1 (1.3%), and the number of living unrelated transplants fell by 6 (6.0%). While down slightly, the overall transplant rate continued to stabilize, as shown in Figure 8. The living donor rate continued to decline.

Age The average age of prevalent dialysis patients in treatment at Network facilities on December 31, 2013 fell again, to 61.0 years. The average age at incidence jumped sharply in 2013, to 62.2 years.

FIGURE 9

Race The racial categories referred to in this report are federally defined. New ESRD patients choose from the categories listed on the form used by Medicare to establish Medicare entitlement at the initiation of chronic treatment for ESRD (CMS Form 2728 - Medical Evidence Report). The general population of the Network's service area is predominantly white. Among dialysis patients, the largest racial minority group is in Montana, where American Indians and Alaska Natives comprise 24% of the prevalent dialysis population and 25% of the incident ESRD population. A broad mix of non-white patients make up almost half of Alaska’s dialysis patients, while Black/African American and Asian patients together comprise 21% of Washington dialysis patients. A comparison of the racial distributions of the general population, prevalent dialysis patient population, and incident ESRD population in each state is shown in Figure 10 below. Prevalent patients – The race distribution for prevalent dialysis patients in the Network at the end of 2013 was 79% White, 8% Black or African American, 6% Asian, 3% American Indian or Alaska Native, and 3% Native Hawaiian or other Pacific Islander. Ten percent of the Network population self-reported as Hispanic. Incident patients – The race distribution of incident ESRD in 2013 was 84% White, 6% Black or African American, 5% Asian, 3% American Indian or Alaska Native, and 2% Native Hawaiian or Other Pacific Islander. The likelihood of renal failure varies greatly between races and between states in the



Network. Figure 10 illustrates that the proportion of Black/African American patients in the prevalent dialysis population was three times the same proportion in the general Network population, and in the incident ESRD population twice as high. This disproportion spreads across most Network states, with Alaska, Oregon, and Washington all three times as high for prevalent patients. In Montana, the proportion of American Indian or Alaska Native patients in the prevalent dialysis population and in the incident ESRD population was almost four times the same proportion in the general Montana population. Though fewer patients are involved, disproportion is greatest among Native Hawaiians and Pacific Islanders. The prevalence of dialysis in this group was more than five times as high as the group’s representation in the general Network population, and the incidence of ESRD more than three times as high. This disproportion was particularly severe in Alaska, where Native Hawaiians and Pacific Islanders in the prevalent dialysis populations were ten times as common as the same peoples in the general population, and in the incident ESRD population almost six times as high. Gender Prevalent patients who are females continue to account for 43% of the Network’s prevalent dialysis patient population, and males 57%. For Incident patients, females accounted for 41% of the Network’s new ESRD patients in 2013 and males 59%.



FIGURE 10

Northwest Renal Network Race Distribution of General Population in Network Area

(estimate July 2013), of Network Point Prevalent Dialysis Population on 12/31/2013, and of

Network Incident ESRD Population during 2013, by State

Alaska Idaho Montana Oregon Washington Network

White

General Population 67.5% 93.8% 89.7% 88.3% 81.6% 84.7%

Dialysis Prevalence 53.6% 93.2% 73.2% 88.3% 73.7% 79.0%

ESRD Incidence 60.7% 95.3% 74.0% 93.8% 78.3% 83.5%

Black or African American



ESRD Incidence 9.6% 1.6% 0.5% 2.2% 9.9% 6.2%

American Indian and Alaska Native



ESRD Incidence 8.9% 1.6% 24.7% 0.6% 1.4% 3.0%

Asian



ESRD Incidence 13.3% 0.9% 0 2.8% 8.0% 5.4%

Native Hawaiian or Other Pacific

Islander



ESRD Incidence 6.7% 0.3% 0.9% 0.5% 2.3% 1.7%

More than one race selected



ESRD Incidence 0.7% 0.3% 0 0 0.2% 0.2%

Sources: Same as Figure 1, and Tables 1 and 2 in Section IV: Data Tables in this report.



Medicare Insured Status Medicare as a primary insurance covers most of the costs of dialysis treatment and transplant services for individuals, or the dependents of individuals, who meet requirements for Social Security Administration insured status. However, due to Medicare rules that require a patient’s employer group health insurance be primary for the first 30 months of Medicare eligibility, some patients are deferring enrolling in Medicare until the 30-month period has elapsed and Medicare has become the primary payer. Due to the change to facility based reporting of Medicare eligibility in CROWNWeb, the Network has seen a change in Medicare enrollment statuses. Facilities continue to report either Medicare or Non-Medicare with pending status being underreported for dialysis facilities. Medicare – Dialysis Patients The following graph (Figure 11) shows the Medicare enrollment status by each Network state as of December 31, 2013. More than 88% of Network dialysis patients are Medicare beneficiaries.

FIGURE 11

Source: 2013 Network Facility Surveys

Medicare – Transplant Patients

There were 607 patients in this Network who received transplants in 2013 including one individual who received 2 transplants during the year; 91.4% were enrolled in Medicare, 0.9% had applications for Medicare pending, and 6.8% were not enrolled in Medicare. Additional data on the patient population served by Northwest Renal Network facilities in 2013 is presented in data tables included in Section IV of this report.



4. Providers Figure 12 below shows the distribution of Network dialysis facilities by ownership (or management) category and profit status. LDO is the abbreviation for “Large Dialysis Organization.” CMS determines LDO/non-LDO status. As of December 31, 2013, there were 183 dialysis facilities and eight transplant centers in the Northwest Renal Network. Of the eight transplant centers, five were operated by non-profit hospitals, two by state universities, and one by the federal Veterans Administration. In the Network during 2013 ten new dialysis facilities opened, five in Oregon, four in Washington and one in Alaska. Six of the new facilities were opened by for-profit LDOs, one by a for-profit non-LDO, and three by regional non-profit non-LDOs. At the end of 2013, 68% of Network dialysis facilities were LDO facilities and 32% non-LDO. Almost three fourths (73%) of Network facilities were owned or managed by for-profit organizations and the remaining 27% by non-profit institutions, including the federal government. The latter operates two Veterans Administration dialysis facilities in the Network.

FIGURE 12

Source: Network Records

B. NETWORK STRUCTURE

1. Staffing Northwest Renal Network staff members are based in Seattle, Washington. Their responsibilities include administration, quality improvement, complaint and grievance investigation and resolution, data collection and analysis, patient and provider education, information dissemination, technical assistance, and collaborative activities with ESRD facilities, local, state and federal government agencies, and other organizations. Network staff as of December 31, 2013 included: Barbara Dommert-Breckler, BSN, RN - Quality Improvement Director and Interim Executive Director - The Quality Improvement Director (QID) is an experienced nephrology nurse. This position provides support to the Medical Review Board related to quality of care and quality improvement issues, and is responsible for the design and implementation of effective quality improvement projects. Responsibilities include providing technical assistance to individual Network facilities, developing patient and professional education materials for dissemination, developing presentations on special topics and contributing to the larger community in collaborative activities. The QI Director



is the clinical liaison with the renal community, CMS, State Survey Agency personnel and Quality Improvement Organizations. This position also collaborates with the Patient Services Coordinator to respond to clinical quality of care inquiries and assists in patient grievance resolution. Lisa Hall, MSSW, LICSW - Patient Services Director - The Patient Services Director (PSD) is the key contact person for patient and facility staff inquiries from the community regarding quality of care concerns, complaints and grievances, and general information needs such as rehabilitation, quality of life, and end of life planning. Technical assistance is provided in managing challenging situations and accessing resources. Concerns are trended and analyzed to develop targeted activities or educational resources for providers and patients. The PSD reports trends of concerns and grievances to the Medical Review Board and Board of Directors, and serves as a liaison to nephrology social workers at Network facilities. Additionally the PSD leads all Aim 1 Project and Campaign activities. Sharon Badger, RN - QI / Community Education Coordinator –The QI/CE Coordinator position supports multiple areas of Network activities to improve quality of care and clinical outcomes for people receiving treatment for ESRD. This position focuses on community outreach and collaboration activities of the Network. This position works closely with the Quality Improvement Director and the Patient Services Director. Duties include contributing to the development of quality improvement and community outreach activities, emergency preparedness for facilities/patients and materials for patients and providers, assistance with patient grievances and facility concerns, and collaborative partnership development. Donna Swenson - Data Manager - The Data Manager is responsible for oversight of Network data management activities. Responsibilities include managing the collection, processing, validation and security of confidential patient and facility-specific information. This position works closely with the Network’s Data/Information Systems Coordinator and administrative support staff involved in data processes. The Data Manager monitors timely and accurate submission of required CMS forms and data by Network dialysis facilities and transplant centers, provides education and technical assistance to facility Data Coordinators regarding CMS requirements to improve data reporting compliance. This position assists other Network departments with projects that require access to data files. The Data Manager was integral to activities related to the implementation phases of CROWNWeb in this reporting period. Leah Skrien - Data/Information Systems Coordinator - The Data/Information Systems Coordinator is responsible for oversight of the Network’s utilization of CMS-provided workstations and server, supervises installation of new hardware and/or software and troubleshoots Network hardware and/or software issues. This position monitors the security of the Network’s QualityNet Environment and adherence to CMS guidelines for security of data, provides staff training on security guidelines, and maintains the Business Contingency and Continuity Plan. This position assists the Data Manager in meeting requirements for data submission, maintenance of confidential information, and supervision of support staff involved in data processes. The Data/Information Systems Coordinator collaborates with other Network staff regarding data needs. The Data/Information Systems Coordinator also was integral to activities related to the implementation phases of CROWNWeb in this reporting period.

Faye Thibodeaux - Administrative and Project Assistant – Performs administrative and support activities for all Network staff members. Duties include administrative support to the Executive Director, general office operations, contract related project assistance and coordination of Administrative/Data Assistant activities.



Shanna Rodarte – Administrative Data Assistant - Provides support to the Network data department in obtaining and processing complete and timely data from facilities. This position also provides general administrative support for the Network’s operations.

2. Board of Directors, Committees and Network Council The Board of Directors (BOD) is the governing body of Northwest Renal Network, and includes the Officers of the Non-Profit Corporation, the Chairperson of the Medical Review Board, an Informed Consumer (ESRD patient) and four general members. The members of the Board are elected by the Network Council, and efforts are made to seek representation of each Network state. Specific functions of the Board include: acting as the administrative and governing body of the Network; liaison with the federal government; review and approval of any recommendations made by the Medical Review Board with respect to improving the quality of care provided by Network facilities; review and approval of criteria and clinical standards developed by the Medical Review Board; and final review and consideration of any action which will be taken with respect to reporting noncompliant facilities to CMS based upon the results of quality of care or patient grievance investigations. The 2013 Board of Directors Officers of the Corporation and Members-at-Large as of 12/31/13 included:

Officers: Katrina Russell, RN, CNN; Chairperson Faye Wong, RN; Vice-Chairperson Gwendolyn Pincomb, MD, PhD; Secretary-Treasurer

Members at Large:

John Stivelman, MD; Medical Review Board Chairperson (ex-officio) Troyce Crucchiola; PAC Liaison Jessie Pavlinac, MS, RD, CSR, LD; Medical Review Board Vice-Chair (ex-officio) Peggy Simpson, RN, MS, CNN Suzanne Watnick, MD Faye Wong, RN, CNN Raghav Wusirika, MD

The Medical Review Board (MRB) is an advisory committee to the Board of Directors, composed of individuals qualified to evaluate the quality and appropriateness of care delivered to ESRD patients, and to review patient concerns and grievances which are brought to the attention of the Network. Members of the Medical Review Board are appointed by the Board of Directors and include informed consumers (patients) and representatives from the clinical professions of internal medicine/nephrology, pediatric nephrology, renal transplantation, nephrology nursing, nephrology social work, renal

nutrition, and dialysis technology. Key functions of the MRB include development of the Network’s Quality Improvement Work Plan and Network Goals, as well as monitoring patient outcomes through evaluation of clinical data sets and patient complaints and grievances. Data sets reviewed for comparative performance of Network facilities include the ESRD Clinical Performance Measures, the Dialysis Facility Reports, and other data sources including the CMS Web-based data collection system CROWNWeb, and investigation of beneficiary complaints and grievances. The MRB may issue written recommendations to individual ESRD facilities in the Network to address quality of care concerns and request corrective action. It may refer quality of care concerns to the Board of Directors for consideration of recommending sanctions to CMS acting on behalf of the Secretary of the Department of Health and



Human Services (DHHS). The Network is also responsible for referral to the state Quality Improvement Organizations (QIO) or Office of Inspector General regarding any information collected while conducting activities that indicates that a physician may be failing to provide quality care or is involved in Medicare fraud. ESRD facility clinical care concerns may also be referred to the State Survey Agency. The 2013 members of Northwest Renal Network’s Medical Review Board as of 12/31/13 included:

John Stivelman MD, Chairperson Vickie Muchow Jessie Pavlinac, RD, MS, Vice-Chairperson Richard Parker, MD Suhail Ahmad, MD Nancy Pierce, BSN, RN, CNN Nancy Colobong Smith, MN, ARNP, CNN Michael Ryan, MD Mary Dittrich, MD Byron Roshto, CHT, EMT Rob Gordon, MSW Timothy J. Stevens, BSN, RN, CCTC Roger Gravgaard Jordan Symons, MD Michael Mace, MSW, LICSW Karen McEwen, RN

Katy Wilkens, RD, MS

The Patient Advisory Committee (PAC) is an advisory committee to the Network. The Network recognizes the essential role of patients in its mission to promote optimal dialysis and transplant care. Their experiences and perspective provide insight to the needs and challenges of the renal community. The primary role of the PAC is to inform the Network and its Board about the needs of patients, to facilitate patient centered-care, and to provide input into Network activities. The PAC consists of nine patient volunteers and two informed consumer members from the Board of Directors, who serve as liaison between the PAC and the Board. The Network promotes representation on the PAC that is a reflection of the Network’s region and population.

The 2013 members of Northwest Renal Network’s Patient Advisory Committee (PAC) as of 12/31/13 included:

Donna Ayers Elizabeth Kemble John Carter Erik Olsen Troyce Crucchiola (BOD liaison) Robert Phillips Patricia Danielson Quentin Schroeter Gordon Dutrisac Nancy Hewitt Spaeth Roger Gravgaard

In addition to the PAC, patients serve on the Network’s Board of Directors and Medical Review Board. These individuals provide essential feedback and input into the activities and operation of the Network. The patient perspective is critical in the development of effective quality improvement programs, technical assistance tools, patient educational materials, and other Network activities.

3. Network Council - Facility Representatives The Network Council is comprised of one Facility Representative for each Medicare Certified ESRD Facility or Transplant Center in the Network area. The Network Council provides input to Network activities and elects the Network’s Board of Directors. The Facility Representative is responsible to assure their facility participates in Network directed activities as required by the federal Conditions for Coverage (dialysis) and Conditions for Participation (transplant) regulations. The Informed Consumer/patient member of the Board of Directors is also a member of the Council. A list of facilities in operation in the Network area is available on the Network’s website at: www.nwrenalnetwork.org.

http://www.nwrenalnetwork.org/



The Northwest Renal Network (Network 16) is tasked with providing improvement in the care of individuals with ESRD as outlined in a new Statement of Work beginning in 2013. This new Statement of Work includes the following three Aims: Aim 1 – Better Care for the Individual through Beneficiary and Family Centered Care Under this Aim Network 16 is tasked with providing opportunities for meaningful patient engagement at the facility level. Additionally we have successfully created a Patient Learning and Action Network that has helped impact the care provided through the development of resources and increased patient involvement in all areas of care. The Northwest Renal Network engaged 10% of the patient base in our five states, developing best practices for engaging patients at the facility level, plan of care meetings, peer mentor programs, successful support groups and demonstrating patient engagement for state surveyors. A 23% improvement was achieved over the baseline. Patient Education and Orientation Campaign – Working with 20% of the NW16 patient population, the Network Learning and Action group developed resources on stress management, a checklist and library of resources for patients, and best practices for education and orientation. A 9.2% improvement was achieved over baseline. Patient Centeredness of Care Campaign – Working with 20% of the patient population, the Network Learning and Action developed resources to include staff training materials on patient centeredness, a booklet for patients on getting involved in their care, stress management resources and we demonstrated a 16% improvement over baseline. 2013 was a very successful year for Northwest Renal Network in terms of quality improvement projects. Our fistula rate maintained a rate of over 68%, ending the year with 69.11% a national high. The Network’s overall long term catheter rate was approximately 7%. In our facilities with a long term catheter rate of greater than 10%, the rate of long term catheters went from 15.86% to 12.17%. NWRN also spoke at the 2013 Annual Dialysis Conference on the topic of vascular access. With a focus on Healthcare Acquired Infections (HAI), we improved our Positive Blood Culture rates with a decline of 84%, Access Related Blood Stream Infection declined 94% and Local Access Site Infections declined 40% in our target HAI LAN facilities We also had success in our collaboration with the Oregon Patient Safety Commission and the 33 participating facilities. Starting in October 2012, the Northwest Dialysis Bloodstream Infection Prevention Collaborative had monthly meetings via conference calls, WebEx presentations, facility visits and live meetings to promote the CDC Core Interventions for Bloodstream Infection Prevention. The successes include improved compliance with cannulation/decannulation (58% to 97%) and hand hygiene practices (67% to 94%), also approximately 137 hospitalizations and 107 bloodstream infections were prevented. (Source: Oregon Patient Safety Commission) Aim 2 – Better Health for the ESRD Population Network 16 chose to focus on promoting appropriate home dialysis in qualified beneficiaries. Studies have shown that home dialysis overall has better outcomes for the ESRD population. In addition to being more convenient for the patient, it has also

III. CMS NATIONAL GOALS AND NETWORK ACTIVITIES 2013-15



improved quality of life. The Network began working with several collaborators to design a video series for patients with vignettes around the home dialysis experience. Aim 3 – Reduce Costs of ESRD Care by Improving Care Network 16 continued to be a resource for facilities to ensure that QIP measures were achieved in the acceptable range and assist those facilities who were struggling. General education on QIP was provided through Network Communications (i.e. newsletters) as well as provided in center. The Network tracked QIP results on an annual basis and provided assistance as needed to those who received scores below the acceptable range and are at risk for financial penalty. The Network provided ongoing support to the dialysis community to assist with each facility’s data submission in CROWNWeb. Staff served as a resource to individual dialysis facilities and batch submitters to provide assistance and expertise for facilities working with CROWNWeb and CROWNWeb data. The network focused on making the facilities experiences with CROWNWeb as efficient and streamlined as possible, and continued to work toward the goal of an accurate and complete data system for the ESRD community. The Network incorporates the Strategic Goals into the development of activities and projects. The following sections outline activities conducted by NWRN in 2013 to achieve the CMS Strategic Goals in the populations served by Network 16. Network 16 held an Annual Meeting in October to provide education to nurses, patient care technicians, renal dietician and social workers. The meeting was attended by over 100 facility staff. The topics included HAI, ICH-CAHPS, Teachable Moments, Transplant and Patient Engagement.

Patient and Family Engagement Facility Level Engagement In an effort to gather information about the current level of patient engagement in facility activities, all NW16 region facilities were surveyed. The survey focused on:

Percentage of patients who meet with the interdisciplinary team (IDT) in care plan meetings

Promotion of support groups

Establishment and support of patient mentor programs

Beneficiary attendance at QAPI

Beneficiary involvement in Governing Body Results of the patient engagement survey: with a maximum engagement score of 13, 16% of facilities scored zero (0), and 20% scored one (1). The breakdown of all facility scores is in the table below.

A. AIM 1 – Better Care for the Individual through Beneficiary and Family

Centered Care



FIGURE 13

Engagement Score Percentage of Facilities

0 16.1%

1 19.9%

2 12.4%

3 9.3%

4 6.8%

5 6.8%

6 3.7%

7 4.3%

8 1.2%

9 8.7%

10 5.6%

11 3.1%

12 1.2%

13 .6%

The Network utilized information learned from the patient engagement survey to develop and implement promotion of patient engagement. Top performers were identified, and the Network and representatives from the Patient LAN hosted a brainstorming session via conference call. Best practices and success stories were spread throughout the year through the Network’s blog, website, provider newsletter, regional patient and provider meetings and the Annual Network Conference. In addition to the activities above, the Network incorporated discussion, education, and evaluation of how facilities were implementing patient and family centered care during onsite visits. The Network presented on patient engagement at two conferences, with both patients and providers in attendance:

NWRN Annual Conference, October 2013 – Patient Engagement Panel

Alaska Kidney Patient Association Conference, November 2013 – Patient Engagement: Nothing About Me without Me Network Level Engagement

FIGURE 14 Under the direction of the PAC, NWRN conducted various activities in an effort to increase consumer awareness of the Network and its availability to help navigate their journey with kidney disease. Some examples:

Network participation in the NKF/Portland Kidney Group Conference

Distribution of monthly patient flyers/posters

Three (3) editions of the NWRN Consumer Newsletter in 2013



Mailing of postcards to new patients 6 months post-initiation of dialysis – Twenty-two percent (22%) of consumer calls to the Network in 2013 were attributed to patient receipt of a NWRN postcard.

Patient Involvement in CMS Meetings A patient representative from the Network’s LAN participated in the COR/Network monthly call on a quarterly basis, and was present at the Network’s annual CMS COR in person evaluation site visit. Patient Engagement Learning and Action Network (LAN) The Network convened its first Patient Engagement Learning and Action Network (LAN) in 2013, with 16 patient participants, 5 of whom are on the waiting list for a transplant. The full LAN met once in person, and 3 times via conference call. Additionally, individual LAN workgroups held monthly calls, and participated on facility focus group calls to enhance learning among both patients and focus group staff. A synthesis of NWRN 2013 Patient Engagement LAN activities is below.

FIGURE 15

Patient Engagement QI Project - Northwest Renal Network engaged 10% of the patient base in our five states, developing best practices for engaging patients at the facility level, plan of care meetings, peer mentor programs, successful support groups and demonstrating patient engagement for state surveyors. A 23% improvement was achieved over the baseline. An evaluation of the project was conducted with participating facilities in December. Results:

Communication from the Network was timely and effective – 89%

The monthly data submission was easy to complete – 89%

The staff time it took to participate was reasonable – 67%

Change package materials provided new information about patient engagement – 67%; the most utilized material was the Patient Engagement Practices Checklist

I made changes in our facility’s patient engagement activities due to the project – 67%



FIGURE 16

Patient Education and Orientation Campaign – Working with 20% of the NW16 patient population, the Network Learning and Action group developed resources on stress management, a checklist and library of resources for patients, and best practices for education and orientation. A 9.2% improvement was achieved over baseline. An evaluation of the campaign was conducted with participating facilities in December. Results:



The monthly patient surveys were easily accomplished – 32%


Change package materials provided new information about patient education and orientation – 40%; the most utilized material was the A-Z Library of Resources


Comments: “The patient surveys provided useful insight on patient education and perception of dialysis experiences, and a tool for facility selection of education topics to focus on.” “ Better education for our team and patient’s needs to be an ongoing priority.”

FIGURE 17

Patient Centeredness of Care Campaign – Working with 20% of the patient population, the Network Learning and Action developed resources to include staff training materials on patient centeredness, a booklet for patients on getting involved in their care, stress management resources and NWRN demonstrated a 16% improvement over baseline. An evaluation of the campaign was conducted with participating facilities in December. Results:





The monthly patient surveys were easily accomplished – 39%


Change package materials provided new information about patient centeredness of care – 70%; the most utilized material was the patient booklet How Can I Get Involved in My Care


Comments: “Our favorite aspect was the patient booklet! We are giving this to all new patients in all of our facilities – they actually read it and staff likes the content.” The Network also surveyed the LAN patient and SME participants in December. Results:

I received adequate orientation to prepare me for my role as a participant – 72%

I had the opportunity to provide as much input as I wanted in the design and implementation of Patient Engagement LAN activities – 79%

Communication from NWRN was timely and effective – 93%

The time commitment to participate in the LAN was reasonable – 100%

Change package materials provided new information that will serve to enhance patient engagement – 100%; favorite change package material was the Patient Engagement Practices Checklist

Comments: “I think we did amazing work.” “The change package materials can really make a difference in patient care.” “This is a step in the right direction to patients being more active in their care.” Information received from the LAN evaluations will be utilized to improve the Network’s 2014 Patient Engagement LAN activities. Patient Experience of Care Grievances The Network responded to 47 beneficiary/representative grievances in 2013, and conducted a focused audit of grievances in March 2013 and October 2013. For both audits the primary theme of the grievances was Treatment Related/Quality of Care. With the March 2013 audit, the most common thread for treatment related concerns was safety, and concerns about too much fluid being removed was the most common reported treatment related concern with the October 2013 audit. In addition to medical record review and working toward resolution with the grievant and facility staff, the Network identified 5 facilities as having the highest number of grievances related to safety, and required them to develop and implement an action plan aimed at reducing safety related grievances (May 2013). Tools were provided to assist in their efforts (QIA templates, NWRN Safety Webinar, and the National 5-Diamond Patient Safety Program). The Network monitored grievances received for these facilities each month, and there were no safety related grievances for any of the 5 facilities. Network PSD and/or QID participated in joint patient and IDT meetings in response to 4 grievances in 2013 (2 conference call mediations, 2 in person). ICH-CAHPS Beginning in May 2013, a letter was sent to all facility representatives explaining the premise of the Network method of verifying a facility administering the ICH-CAHPS during 2013. A 4-question survey was created on Survey Monkey which recorded the facility name and CMS Certification Number (CCN), which month the survey was done in, and the



facility’s comments. Each month the survey link was sent out to the facility representatives. As the facilities responded in the affirmative, their name was removed from the master list, to eliminate repeating the message. This routine was repeated through December of 2013. The majority of the facilities were not aware exactly when their ICH-CAHPS had been repeated, unless there was a mention of it or a question about it from a patient wondering why this was being done. The ICH-CAHPS survey was done at all qualifying facilities during 2013. A majority of surveys were sent and evaluated during the August to November 2013 timeframe. Sanctions During 2013 there was one facility in Oregon that was placed on a slow-track decertification in July, which was then rescinded by August. The Network worked closely with all state survey agencies in our area. While only one facility was on a track to decertification, it was removed prior to the decertification step. The Network developed, distributed and implemented a Cooperation with Network Projects procedure. This policy outlines the steps prior to recommending a facility for sanctions. During the course of the year all of the facilities were cooperative (post distribution) and did not require the use of the policy. State Survey Collaboration Using data gathered from state survey agencies, grievances and site visits, no facility in our Network has practices that required sanctions. During 2013 the Network met with Surveyors from all 5 of the Network states, and coordinated Network / State activities. Some key activities:

Shared information on grievances and IVDs received by the state and/or Network

Referred 2 grievances to the state agency in 2013

NWRN provided feedback to surveyors upon request prior to SSA site visits

Surveyors shared survey results with NWRN, and collaborated on follow up with facilities to aid in their corrective action planning

A state surveyor participated as subject matter expert on the Network’s Patient Engagement LAN

Conducted Webinar training for surveyors on QIP measures and on the Network’s new SOW and the 3 aims

Met with the WA state Department of Health on Certificate of Need rule revisions

Patient Appropriate Access to In-Center Dialysis Care Involuntary Discharges (IVDs) and Involuntary Transfers (IVTs) The Conditions for Coverage for End-stage Renal Disease Facilities require facilities to notify the Network and the State of involuntary discharges and transfers. CMS expects the Network and State to work collaboratively to ensure facilities follow the requirements and to protect the rights of beneficiaries. The Network’s document “Notifying the Network of Involuntary Discharges and Involuntary Transfers” is posted on the Network website and shared routinely as a key reference for dealing with possible IVD cases. This information is also included in the new facility packet. The Network also distributed and posted a patient flyer on “Patient Rights Related to Involuntary Discharge.” NWRN utilized the CMS data systems to track and trend involuntary discharges, and provided required IVD and Access to Care data in the monthly Network report to CMS. There were 18 IVD letters issued to patients the Network region for 2013, and 15 actual IVDs:

10 for Immediate Severe Threat



4 for Termination by Physician (3 of these were Averted)

4 for Disruptive/Abusive Behavior The Network received numerous contacts from facilities reporting patient/provider conflict that could result in patient discharge. Education on the following topics was provided to facilities across the country in 2013:

January 30th Heartland Kidney Conference – Conflict Be Cool

January 31st Heartland Kidney Conference – Professional Boundaries in the Chronic Dialysis Setting

February 17th – BONENT Seminar – Burnout: Running on Empty

October 3rd WebEx – Patient and Staff Safety

October 10th WebEx – Proactivity: Anticipating and Resolving Volatile Situations

October 20th Mid-Columbia Nephrology Seminar – Involuntary Discharge: Practical, Regulatory and Ethical Challenges

At Risk IVD/IVT and Failure to Place There were 33 notifications to the Network of patients At Risk for IVD. Of the 33, 30 were averted; one discontinued dialysis and one voluntarily transferred. At Risk reasons included: 21 Disruptive/Abusive Behavior; 7 Immediate Severe Threat; 5 Term by the physician; 4 Cannot Meet Medical Needs and 2 Non-payment. The Network received 6 reports of Failure to Place patients in 2013. A summary of the issues:

Patient with a tracheotomy

Undocumented / unfunded

Multiple IVDs / no nephrologist

Too medically complex for chronic outpatient

History of IVD for assault

Violent and unstable acute patient new on dialysis Vascular Access Management Improve Arteriovenous (AV) Fistula Rates for Prevalent Patients The Network maintained a prevalent patient arteriovenous fistula rate above 68% for the project year of October 2012 through October 2013. Since NWRN was at or above the target, there was not a specific project to increase arteriovenous fistulas. Through the project to reduce long term catheter rates, focus was placed on reducing catheters which naturally increases arteriovenous fistulas.

Reduce Catheter Rates for Prevalent Patients October 2012 is the base line for vascular access projects. At that time the Network had an overall central venous catheter rate of 14.8% at baseline. The CMS goal is long term catheters (in use for greater than 90 days) 10% or less. When we evaluated individual facility rates we had a list of 58 facilities with catheter in use for longer than 90 day rates ranging from 10.53% to 72.73%. The average long term catheter rate for these facilities was 15.86%. The target facilities were made aware of their required participation on the project. The facilities and the Network agreed on the root cause and mitigation requirements. The Network provided tools including meetings with the facility team, discussions with nephrologist and medical directors, and webinars on alternative vascular access. At the end of the project time line, October 2013, the average long term catheter rate for the target facilities dropped to 12.45%. The reduction of 3.41% exceeds the contract



requirement of a 2% reduction. The number of facilities with a greater than 10% long term catheter rate dropped to 40 from 58. Support Facility Vascular Access Reporting Both the Data and the Quality Department worked to support clinical data, including vascular access reporting. Missing clinical data reports were sent to the facilities including both general missing clinical numbers and UPI for specific patients with missing information. Approximately 371 calls were spent in direct calls to/from facilities in clinical data support. Spread Best Practices The Network Quality Improvement Director worked with both individual facilities and other Networks, as requested or as part of a project, to share best practices. Research was completed and a set of articles was made available to facilities and nephrologist to help with the reduction of long term catheters. In November the Network provided CE credits for a state wide provider meeting in Alaska that included catheter reduction and vascular access best practices.

Provide Technical Support in the Area of Vascular Access The Quality Improvement Director went to one facility in March to provide a class on the buttonhole technique. The availability of the Network to provide technical support was provided to all providers in the Network. Patient Safety: Healthcare The Network reviewed facilities Dialysis Facility Reports for 2012 and chose 19 facilities that had greater than expected infection, mortality and hospitalization rates. These facilities were informed that they would participate in the HAI LAN and then the remaining facilities were invited to join. We did not have any volunteer facilities most likely due to 33 of our facilities participating in the Northwest Dialysis Reduction of Bloodstream Infections Collaboration. In October 2012 Northwest Renal Network joined in a collaboration with Oregon Patient Safety Commission (OPSC) to reduce bloodstream infections in dialysis units. OPSC received a grant from the CDC for the second year for this project. The second grant was to expand the collaboration from just Oregon to Washington. Both groups used the CDC core interventions for Dialysis Bloodstream Infection Prevention, including the audit tools and holding monthly conference calls/webinars. The OPSC group also included two site visits and three live meetings. Once the facilities had completed at least one month of the audit tools, they developed AIM statements for their facility and used the PDSA cycles to achieve improvement. The results for both groups are below. Access-Related Blood-Stream Infections fell 76% at target facilities from 0.68 DE/month/facility in January to 0.16 DE in December, while facility average DE/month at non-target facilities fell 52%, from 0.31 to 0.15. Percentage reductions between the two groups differed significantly at p < 0.05. The linear fit for target facilities declined 4% per month (b = - 0.0039) and fit the data significantly at p < 0.05 (r2 = 0.565). A logarithmic fit increased r2 to 0.712 and significance to p < 0.01.



Nineteen Target Facilities versus All Other Network Facilities

FIGURE 18

Averag e Ac c es s -R elated B S I per F ac ility per Month

y = -0.2116L n(x) + 0.6094

R 2 = 0.7345

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

2013M012013M02

2013M032013M04

2013M052013M06

2013M072013M08

2013M092013M10

2013M112013M12

Other F acilities Target F acilities )L og. (Target F acilities

In the case of Local Access Site Infections (LASI), the difference between target and non-target facilities was smaller. In this measure, both groups spiked in July, with target facilities spiking by a relatively greater amount. Up until July, the target facility trend showed marked improvement, but as of December it was still trying to catch up with July. Overall, the slope of the linear fit for target facilities is very slightly positive (b = 0.002), and the correlation nil (r2 = 0.002). However, average target facility LASI did fall 22% over the course of the year, from 0.68 to 0.53 DE, while average non-target facility LASI actually rose 16%, from 0.56 to 0.65 DE. However, if you put your thumb over the January data, there is virtually no end-to-end yearly improvement – target facilities in February had DE numbers a little lower than other facilities, and ended the year the same way.

FIGURE 19

Ave. L oc al Ac c es s S ite Infec tions per F ac ility per Month

0.0

0.2

0.4

0.6

0.8

1.0

1.2

2013M012013M02

2013M032013M04

2013M052013M06

2013M072013M08

2013M092013M10

2013M112013M12

Other F acilities Target F acilities )L inear (Target F acilities



NW Dialysis Bloodstream Infection Prevention Collaborative Results The goal of the collaborative was to increase compliance with CDC audit tool procedures to 90%. CDC studies have shown that compliance with their core interventions for Dialysis Bloodstream Prevention reduced bloodstream infections. Reduction in bloodstream infections is both a cost savings and an improvement in patient quality of life.

FIGURE 20

FIGURE 21



FIGURE 22

FIGURE 23



FIGURE 24

FIGURE 25



FIGURE 26

Emergency Preparedness There were only a few instances of emergent conditions existing with our facilities during 2013. There were occasional facility shut-downs for 24 hours or less due to mechanical malfunction, but all patients were served by schedule manipulation or an agreement with a neighboring facility. Shutdowns due to weather were even less and handled in a short window of time with the same schedule manipulation and agreements. Outages of power or water were local in nature and efficiently handled. The Network participated in the national Kidney Community Emergency Response (KCER) emergency drill, and chaired KCER committees. The Network emergency plan was updated. The Network also conducted our verification of information drill with our back-up Network 18. This was conducted by fax. Network 18 faxed an announcement to the Network 16 facilities, who were instructed to send their answers back to Network 16 to verify the circuit was complete with regards to contact information provided. Network 16 did the same thing for the Network 18 facilities to verify the same information issues. The Network 16 facilities continued to receive monthly safety tips designed to keep the topic of preparedness in the forefront. These included flyers and topics that could be used with not only staff members, but also with the patients. Participation was maintained at monthly emergency preparedness meeting for both Pierce and King Counties.



Population Health Innovation Pilot Project

Promote Appropriate Home Dialysis in Qualified Beneficiaries

Network 16 in conjunction with Network 12 and the Medical Education Institute began work on this project after the initial CMS approval in April 2013. In the selected facilities the total patient population is 1,435 (12% of the network population). Twenty-five point seven percent of the population is dialyzing in a home modality. For the selected facilities 45% of the in-center patient population is non-white and only 33% of the home modality population is non-white. The African American population in the selected facilities is 364 with 85% treating in center and 15% treating with a home modality. For the white dialysis population in the target facilities, 70.5% of the white patients are treating in center and 29.5% treating in a home modality. A survey was developed and distributed to determine the needs and attitudes of in center staff to the home modalities. A consent form, script and filming occurred for home vignette videos. The vignettes were designed to spotlight the successful experiences of patients on different home modalities. In late summer CMS decided on a slow down for the AIM 2 project with the project needing new approval in September and the only evaluation being on the successful completion of the September submission.

Support for ESRD Quality Incentive Program (QIP) and Performance Improvement on QIP Measures In January the Network held an open webinar on the clinical year 2013 Quality Incentive Program (QIP) measures. For facilities that received a payment reduction in network 16, all but one had a reduction for adequacy. These facilities were required to attend a webinar on improving adequacy in February 2013. The one facility had a reduction due to high Hgb, but the previous year their reduction was for low Hgb. They had made a protocol change that caused the high Hgb and have made a revision. The Network was unable to get QIP data, except for anemia, NHSN and vascular access during 2013. For the data that was available, we worked with facilities to ensure six month consecutive entry into NHSN and the vascular access work previously mentioned. The facility request for information was handled on a unit by unit basis. During 2013 the Network kept the focus on the QIP by way of newsletters put out to patients and to facilities. The patients had the explanation of QIP, what it means to them and where to look for their facility scores. It was mentioned in a one page flyer in March and a little more in depth in the Consumer News in October 2013. For the facilities, NWRN utilized a monthly fax-blast Network News to remind via questions and deadline reminders in the June, July, October and December issues.

B. AIM 2 – Better Health for the ESRD Population

C. AIM 3 – Reduce Costs of ESRD Care by Improving Care



Technical Assistance to facilities to support the timely and accurate submission of data into CROWNWeb CROWNWeb (Consolidated Renal Operations in a Web Enabled Network) is the current CMS mandated web-based data collection system for Medicare Dialysis Facilities. The national release occurred in June of 2012. Since then, the ESRD community has been using CROWNWeb to submit patient and facility data, required CMS forms and clinical information. In support of this, Network staff continued to provide CROWNWeb technical support to dialysis facilities in 2013. This included training new and existing facility staff on CROWNWeb modules, assisting users with resolving data discrepancies and providing expertise on interpreting business rules and CMS requirements related to CROWNWeb. Staff also adapted a tool from Network 8 to identify and evaluate facility compliance with CROWNWeb activity. Through this tool, staff were able to evaluate facility CROWNWeb activity and provide intervention if the facility failed to perform its CROWNWeb tasks. 11 facilities were surveyed in 2013 regarding their understanding of CROWNWeb requirements and ability to perform the required CROWNWeb activities. Of these 11, 100% cited Network phone support as assisting them the most in understanding each CROWNWeb requirement. In 2013, Network staff spent over 470 hours on 2,971 calls from dialysis and transplant facilities regarding CROWNWeb technical assistance.

Figure 27

Collaboration on Report Development and CROWNWeb Enhancement Requests In 2013, data staff continued to evaluate and comment on CROWNWeb Reports. In 2012, in collaboration with all Network Data Managers, Quality Improvement Directors and Patient Service Coordinators, a gap analysis report was created analyzing contract requirements and identifying areas where the Networks could not meet deliverables due to the inability to extract information from CROWNWeb. In 2013, a data committee (the NCC Data Committee) was formed to review and prioritize reports identified by this document. Network 16 is one of eight networks working in this coalition of CMS and CMS contractors to provide guidance and subject matter expertise on generation of data extracts or reports currently not available that are needed in order to complete tasks



outlined in the Network Statement of Work. Through the NCC Data Committee, over 12 reports have been developed, tested, and released to the Network community. These reports range from a report identifying patients discharged from a dialysis facility without a corresponding new admission to a report identifying inaccurate treatment and admit dates. The data committee is still active, continuing to recommend new reports and prioritize and test existing reports. In addition, Network data staff also participated in a second NCC workgroup in 2013, the ESRD NCC Fistula First/Catheter Last (“FF/CL”) Data committee. This is a coalition of CMS and CMS Contractors in support of arteriovenous fistula (AVF) placement and maturation in hemodialysis patients while reducing long term catheter use. In this workgroup, staff tested and provided comments on accuracy and completeness of data for the transition to new FF/CL reports based on data now coming from CROWNWeb, determining useful future reports, and prioritizing items for release. In 2013, Network staff also identified CROWNWeb bugs and issues, and provided suggestions for CROWNWeb enhancements and change requests through tickets opened with the QualityNet Help Desk. Staff also responded to questions and outreach from CMS contractors for CROWNWeb development, and participated and offered input on monthly collaboration calls with CMS and CMS contractors. Communication and Education In 2013, Network staff provided important communications to facilities about CROWNWeb through the Network Blog, E-mail announcements and Newsletters. Network staff also worked with CMS contractors to obtain accurate data extracts to distribute to facilities regarding missing clinical data for facilities prior to CROWNWeb closure of clinical months, missing 2728 and 2746 forms, and potential erroneous data needing investigation in CROWNWeb. These were reviewed and distributed to facilities to ensure accuracy, timeliness and completeness of data submission in CROWNWeb. Data staff notified users about all upcoming WebEx sessions, meetings and upcoming trainings for CROWNWeb and distributed Project CROWNWeb and QualityNet Identity Management System (QIMS) registration links. Summaries of meetings were provided upon request for those users unable to attend. Staff also developed, updated and distributed documents about QIMS and CROWNWeb user roles, required CROWNWeb tasks, and other CROWNWeb guides including a series addressing the annual facility survey. Development of Tools and Education To assist with understanding and validating CROWNWeb data, Network staff refined Access and Excel queries and tools to assist in review and distribution of data. This involved developing tools to extract CROWNWeb data to assist with several Network 16 projects and requirements including the Network publication of Zip Code/Modality reports and a project involving outreach to new ESRD patients. Annual Facility Survey The network provided technical support to assist in 100% data submission and completion of the CMS-2744 Annual ESRD Facility Survey, which was completed in CROWNWeb for the first time in 2013. The network participated in conference calls with CMS and CMS contractors along with the other ESRD Networks to discuss CROWNWeb bugs and development of data cleanup tools and queries specific to the CMS-2744 in the CROWNWeb environment. As a result of these calls, additional reports not available in CROWNWeb were created to assist in identifying and resolving CROWNWeb data issues. Nationwide data problems were identified and global solutions were applied for issues affecting the survey, such as removing duplicate identical treatments submitted in CROWNWeb. The network also developed and distributed CMS-2744 guides and FAQs to facilities, and spent January-April of 2013



providing phone support to ensure all facilities submitted a complete and accurate CMS-2744 in CROWNWeb before the June 2013 due date. Additional Support The Network also offered support to facilities not using CROWNWeb. This included manually processing and reviewing CMS forms, and admissions and discharges reported by transplant facilities and Veterans facilities. Documentation of Network required CROWNWeb and data activity for 2013 was provided in each monthly report to CMS.



IV. DATA TABLES

The tables that follow were generated by CROWNWeb

Tables 1, 2, 6, and 7 reflect data based upon patients’ state of residence. Tables 3, 4, 5 and 8 reflect data based upon the state within which a provider operates. Northwest Renal Network also posts periodic updates on its website at: www.nwrenalnetwork.org. With the national release of CROWNWeb, the responsibility for verifying, correcting and updating patient data changed from Networks to the Medicare Certified dialysis facilities. The 2013 data tables were extracted from a snapshot of CROWNWeb after the verification and finalization of the 2013 CMS-2744 Annual Facility Surveys. As data in CROWNWeb can be updated by facilities through the single user interface (SUI) or batch submission at any time, these numbers may not match what was extracted on earlier or later dates. Therefore, ESRD Network 16 cannot attest to the accuracy of the data contained within the Annual Report Tables.

http://www.nwrenalnetwork.org/



Table #1: ESRD Network 16 Incidence - One Year Statistics Calendar Year 2013 (01/01/2013 - 12/31/2013)

Newly Diagnosed Chronic ESRD Patients by State of Residence, Age, Gender, Race and Primary Diagnosis

Age Group AK ID MT OR WA Other Total

00-04 0 2 0 3 7 0 12

05-09 0 0 0 2 1 0 3

10-14 0 1 1 1 6 0 9

15-19 0 2 1 4 8 0 15

20-24 1 1 1 8 20 1 32

25-29 3 3 6 12 26 1 51

30-34 3 6 5 23 46 2 85

35-39 2 9 10 32 57 2 112

40-44 10 16 8 37 58 0 129

45-49 9 17 13 46 81 4 170

50-54 13 27 14 77 153 9 293

55-59 20 32 24 123 178 8 385

60-64 16 41 25 111 182 15 390

65-69 21 42 34 132 227 7 463

70-74 15 39 32 105 211 8 410

75-79 12 41 16 102 179 4 354

80-84 8 24 13 69 121 6 241

>=85 2 19 12 49 99 2 183

Total 135 322 215 936 1,660 69 3,337

Gender AK ID MT OR WA Other Total

Female 52 135 91 371 695 25 1,369

Male 83 187 124 565 965 44 1,968

Not Specified 0 0 0 0 0 0 0

Total 135 322 215 936 1,660 69 3,337

Race AK ID MT OR WA Other Total

American Indian/Alaska Native 12 5 53 6 23 2 101

Asian 18 3 0 26 132 1 180

Black or African American 13 5 1 21 164 2 206

Multiracial 1 1 0 0 3 0 5

Native Hawaiian or Other Pacific Islander 9 1 2 5 38 3 58

White 82 306 159 878 1,296 61 2,782


Total 135 322 215 936 1,660 69 3,337

Primary Diagnosis AK ID MT OR WA Other Total

Cystic/Hereditary/Congenital Diseases 11 15 9 51 84 4 174

Diabetes 60 148 99 434 712 38 1,491

Glomerulonephritis 16 37 18 64 151 3 289

Hypertension/Large Vessel Disease 30 77 29 165 337 7 645

Interstitial Nephritis/Pyelonephritis 6 11 8 43 76 6 150

Miscellaneous Conditions 6 17 32 115 165 8 343

Neoplasms/Tumors 3 9 5 30 74 0 121

Secondary GN/Vasculitis 3 7 15 29 44 3 101


Total 135 322 215 936 1,660 69 3,337

Source of Information: CROWNWeb

Race: The categories are from the CMS-2728 Form. Diagnosis: The categories are from the CMS 2728 Form.

This table cannot be compared to the CMS facility survey because the CMS Facility Survey is limited to dialysis patients receiving outpatient services from Medicare approved dialysis facilities.

This table includes 100 patients with transplant therapy as an initial treatment.

This table includes 37 patients receiving treatment at VA facilities.



TABLE #2: ESRD Network 16 Dialysis Prevalence - One Year Statistics All active Dialysis Patients by state of residence, age, race, gender and primary diagnosis as of 12/31/2013


00-04 0 2 1 4 9 0 16

05-09 0 0 0 2 4 0 6

10-14 0 2 0 2 3 0 7

15-19 3 3 3 11 15 1 36

20-24 4 11 10 49 73 3 150

25-29 10 19 17 64 114 1 225

30-34 15 37 12 108 183 3 358

35-39 18 50 36 136 259 3 502

40-44 34 54 38 181 318 3 628

45-49 32 78 44 225 409 11 799

50-54 56 111 71 321 606 19 1,184

55-59 66 144 94 436 748 19 1,507

60-64 76 151 91 492 847 21 1,678

65-69 67 154 109 533 876 10 1,749

70-74 51 154 104 423 696 13 1,441

75-79 36 124 63 315 601 13 1,152

80-84 26 77 46 254 422 8 833

>=85 13 53 29 187 284 5 571

Total 507 1,224 768 3,743 6,467 133 12,842


Female 230 507 318 1,592 2,849 54 5,550

Male 277 717 450 2,151 3,618 79 7,292

Total 507 1,224 768 3,743 6,467 133 12,842

Ethnicity AK ID MT OR WA Other Total

Hispanic or Latino 15 164 12 384 703 7 1,285

Not Hispanic or Latino 492 1,059 756 3,359 5,759 126 11,551


Total 507 1,224 768 3,743 6,467 133 12,842



Asian 69 10 8 127 600 5 819

Black or African American 54 22 6 220 777 16 1,095

More than one race selected 2 1 1 3 6 0 13


White 272 1,140 562 3,306 4,764 98 10,142


Total 507 1,224 768 3,743 6,467 133 12,842


Acquired obstructive uropathy 10 26 9 61 61 3 170

Acute interstitial nephritis 0 1 1 5 12 0 19

AIDS nephropathy 3 0 0 5 8 0 16

Amyloidosis 1 1 1 8 57 0 68

Analgesic abuse 2 0 2 12 13 1 30



Cholesterol emboli, renal emboli 2 4 4 9 17 1 37

Chronic interstitial nephritis 3 13 3 33 64 2 118

Chronic pyelonephritis, reflux nephropathy 3 13 5 21 41 1 84

Complications of transplanted bone marrow 0 1 1 0 0 0 2

Complications of transplanted heart 0 3 0 2 8 0 13

Complications of transplanted kidney 15 41 14 79 177 2 328

Complications of transplanted liver 0 2 1 1 7 1 12

Complications of transplanted lung 0 0 0 1 1 0 2

Complications of transplanted organ unspecified 0 1 0 1 5 0 7

Congenital nephrotic syndrome 0 0 0 3 2 0 5

Congenital obstruction of ureterpelvic junction 0 5 6 2 12 1 26

Congenital obstruction of uretrovesical junction 0 1 0 1 3 0 5

Cystinosis 0 0 1 2 2 0 5

Dense deposit disease, MPGN type 2 0 1 1 2 0 0 4

Diabetes with renal manifestations Type 1 24 70 52 175 307 8 636

Diabetes with renal manifestations Type 2 205 460 313 1,401 2,564 47 4,990

Drash syndrome, mesangial sclerosis 0 1 0 4 5 0 10

Etiology uncertain 7 17 47 239 291 5 606

Fabry's disease 0 0 1 0 2 1 4

Focal Glomerulonephritis, focal sclerosing GN 20 34 23 110 264 6 457

Glomerulonephritis (GN) (histologically not examined) 30 57 27 193 265 6 578

Goodpasture's syndrome 1 6 5 11 16 0 39

Gouty nephropathy 2 0 0 1 6 0 9

Hemolytic uremic syndrome 0 2 3 11 12 0 28

Henoch-Schonlein syndrome 1 1 1 6 2 0 11

Hepatorenal syndrome 0 2 3 6 10 0 21

Hereditary nephritis, Alport's syndrome 1 4 3 12 16 0 36

Hypertension: Unspecified with renal failure 98 243 74 622 1,083 24 2,144

IgA nephropathy, Berger's disease (proven by immunofluorescence)

11 28 17 72 109 2 239

IgM nephropathy (proven by immunofluorescence) 1 0 1 5 6 0 13

Lead nephropathy 0 0 0 0 1 0 1

Lupus erythematosus, (SLE nephritis) 5 8 7 43 61 3 127

Lymphoma of kidneys 0 0 0 2 0 0 2

Medullary cystic disease, including nephronophthisis 1 3 0 8 8 0 20

Membranoproliferative GN type 1, diffuse MPGN 4 7 5 25 36 1 78

Membranous nephropathy 5 8 8 35 35 0 91

Multiple myeloma 3 10 4 19 36 0 72

Nephrolithiasis 0 2 0 6 20 0 28

Nephropathy caused by other agents 4 8 6 31 39 2 90

Nephropathy due to heroin abuse and related drugs 0 0 0 1 12 0 13

Other (congenital malformation syndromes) 2 4 4 10 8 0 28

Other Congenital obstructive uropathy 1 2 4 10 16 0 33

Other disorders of calcium metabolism 0 2 0 1 5 0 8

Other immuno proliferative neoplasms (including light chain nephropathy)

1 8 3 8 7 1 28

Other proliferative GN 2 11 7 12 31 2 65

Other renal disorders 7 6 10 53 92 1 169

Other Vasculitis and its derivatives 1 2 4 16 21 0 44

Polyarteritis 0 0 1 2 3 0 6



Polycystic kidneys, adult type (dominant) 15 35 33 149 235 5 472

Polycystic, infantile (recessive) 0 0 0 2 6 0 8

Post infectious GN, SBE 0 3 3 5 7 0 18

Post partum renal failure 0 0 0 0 1 0 1

Primary oxalosis 0 0 0 0 1 0 1

Prune belly syndrome 0 0 0 3 1 0 4

Radiation nephritis 0 1 0 1 6 0 8

Renal artery occlusion 1 4 1 6 11 1 24

Renal artery stenosis 2 5 6 28 56 0 97

Renal hypoplasia, dysplasia, oligonephronia 2 4 1 10 13 1 31

Renal tumor (benign) 0 1 0 1 1 0 3

Renal tumor (malignant) 2 8 4 18 41 0 73

Renal tumor (unspecified) 0 0 1 2 0 0 3

Scleroderma 1 0 2 2 5 0 10

Secondary GN, other 1 0 5 6 14 1 27

Sickle cell disease/anemia 0 0 0 0 1 0 1

Traumatic or surgical loss of kidney(s) 0 1 1 2 6 0 10

Tuberous sclerosis 0 1 0 4 2 0 7

Tubular necrosis (no recovery) 0 17 12 63 100 2 194

Urinary tract tumor (benign) 0 1 0 3 1 0 5

Urinary tract tumor (malignant) 0 1 0 3 9 0 13

Urinary tract tumor (unspecified) 0 1 0 0 3 0 4

Urolithiasis 0 0 2 3 3 0 8

Wegener's granulomatosis 5 12 11 17 23 0 68

With lesion of rapidly progressive GN 2 9 4 9 23 0 47


Total 507 1,224 768 3,743 6,467 133 12,842

When a category count = 0, the category may not be displayed on the report.



Table #3: ESRD Network 16 Dialysis Patients Modality and Setting - In Home

Number of Living Patients by Modality By Dialysis Facility, SELF-CARE SETTINGS-HOME As of December 31, 2012 and December 31, 2013

State: AK

Hemo CAPD CCPD Other Total

Facility CCN 2012 2013 2012 2013 2012 2013 2012 2013 2012 2013

022500 0 0 4 7 20 13 0 0 24 20

022502 0 0 0 0 4 4 0 0 4 4

022503 0 0 0 0 7 5 0 0 7 5

022504 0 0 0 0 0 6 0 0 0 6

022506 4 6 1 0 50 61 0 0 55 67

022507 0 0 3 0 13 11 0 0 16 11

022508 0 0 0 0 0 0 0 0 0 0

022509 0 0 0 0 0 1 0 0 0 1

AK Totals 4 6 8 7 94 101 0 0 106 114

State: ID


Facility CCN 2012 2013 2012 2013 2012 2013 2012 2013 2012 2013

131316 0 0 0 0 0 0 0 0 0 0

132500 3 4 0 1 4 3 0 0 7 8

132501 0 0 5 6 5 14 0 0 10 20

132502 3 3 13 13 35 39 0 0 51 55

132503 0 0 2 2 7 4 0 0 9 6

132505 9 8 5 1 15 14 0 0 29 23

132506 0 0 0 0 2 3 0 0 2 3

132507 0 0 0 0 0 0 0 0 0 0

132508 0 0 1 3 2 8 0 0 3 11

132509 0 1 2 2 9 9 0 0 11 12

132510 0 0 0 0 0 0 0 0 0 0

132511 3 1 6 5 24 26 0 0 33 32

132512 4 3 9 14 22 25 0 0 35 42

132513 0 0 6 1 9 5 0 0 15 6

132514 2 0 6 2 16 25 0 0 24 27

132515 0 0 0 0 0 0 0 0 0 0

132516 0 0 0 0 0 0 0 0 0 0

132517 0 0 1 0 0 0 0 0 1 0

132518 0 0 1 0 4 0 0 0 5 0

132519 0 0 2 2 17 22 0 0 19 24

132520 0 0 1 0 2 1 0 0 3 1

132521 1 1 0 0 2 2 0 0 3 3

132522 2 0 1 2 9 8 0 0 12 10

132523 0 0 7 18 13 13 0 0 20 31

132524 0 0 2 0 2 1 0 0 4 1

132525 0 0 1 0 6 0 0 0 7 0

ID Totals 27 21 71 72 205 222 0 0 303 315



State: MT


Facility CCN 2012 2013 2012 2013 2012 2013 2012 2013 2012 2013

270003 0 2 1 2 3 4 0 0 4 8

270004 0 0 13 13 4 5 0 0 17 18

270013 9 7 1 1 28 31 0 0 38 39

270032 0 0 0 0 0 0 0 0 0 0

272500 0 0 0 0 0 0 0 0 0 0

272502 5 5 3 3 11 20 0 0 19 28

272503 0 0 0 0 0 0 0 0 0 0

272504 0 0 0 0 0 0 0 0 0 0

272505 0 0 0 0 0 1 0 0 0 1

272506 3 3 13 11 8 9 0 0 24 23

272507 0 0 6 9 1 0 0 0 7 9

272508 0 0 0 0 0 0 0 0 0 0

273501# 0 0 0 0 0 0 0 0 0 0

MT Totals 17 17 37 39 55 70 0 0 109 126

State: OR


Facility CCN 2012 2013 2012 2013 2012 2013 2012 2013 2012 2013

380006 0 0 3 3 2 2 0 0 5 5

38003F 0 0 0 0 0 0 0 0 0 0

380061# 0 0 0 0 0 0 0 0 0 0

382500 0 0 0 0 0 0 0 0 0 0

382502 9 8 6 6 34 39 0 0 49 53

382505 6 6 7 6 34 34 0 0 47 46

382507 1 6 3 2 3 3 0 0 7 11

382508 0 0 0 0 0 0 0 0 0 0

382509 10 7 18 14 45 45 0 0 73 66

382510 0 0 3 2 7 5 0 0 10 7

382511 0 0 0 0 0 0 0 0 0 0

382512 5 5 18 20 11 9 0 0 34 34

382513 0 0 0 0 0 0 0 0 0 0

382514 0 0 0 1 18 14 0 0 18 15

382515 0 0 7 7 21 23 0 0 28 30

382516 0 0 0 0 0 0 0 0 0 0

382518 13 10 11 9 26 29 0 0 50 48

382519 6 3 0 1 11 16 0 0 17 20

382520 0 0 0 0 0 0 0 0 0 0

382521 0 0 0 0 0 0 0 0 0 0

382522 0 0 0 0 0 0 0 0 0 0

382523 0 0 0 0 0 0 0 0 0 0

382524 0 0 0 0 0 0 0 0 0 0

382525 0 0 0 0 0 0 0 0 0 0

382526 0 0 0 3 1 10 0 0 1 13

382527 0 0 0 0 0 0 0 0 0 0

382529 0 0 1 1 12 13 0 0 13 14

382530 0 0 0 0 0 0 0 0 0 0

382531 0 0 2 1 6 6 0 0 8 7

382532 0 0 2 1 5 4 0 0 7 5



382534 0 0 0 0 0 0 0 0 0 0

382535 0 0 0 0 0 0 0 0 0 0

382536 3 5 3 10 5 11 0 0 11 26

382537 0 0 0 0 0 0 0 0 0 0

382538 0 0 0 0 0 0 0 0 0 0

382540 19 20 11 10 28 29 0 0 58 59

382543 0 0 0 0 0 0 0 0 0 0

382544 0 0 0 2 10 8 0 0 10 10

382545 0 0 0 0 0 0 0 0 0 0

382546 0 0 0 0 0 0 0 0 0 0

382547 13 12 10 4 12 7 0 0 35 23

382548 0 0 0 0 0 0 0 0 0 0

382549 4 3 3 4 9 14 0 0 16 21

382550 0 0 2 2 2 2 0 0 4 4

382551 0 0 0 0 0 0 0 0 0 0

382553 0 0 0 0 0 0 0 0 0 0

382554 0 0 0 0 0 4 0 0 0 4

382555 0 0 0 0 0 0 0 0 0 0

382556 0 0 0 0 0 0 0 0 0 0

382557 0 0 0 0 0 0 0 0 0 0

382558 0 0 3 4 9 13 0 0 12 17

382559 0 0 0 0 0 0 0 0 0 0

382560 0 0 0 0 0 0 0 0 0 0

382561^ 0 0 0 0 0 0 0 0 0 0

382562^ 0 0 0 1 0 5 0 0 0 6

382563^ 0 0 0 1 0 2 0 0 0 3

382564^ 0 0 0 0 0 1 0 0 0 1

382565^ 0 0 0 0 0 0 0 0 0 0

OR Totals 89 85 113 115 311 348 0 0 513 548

State: WA


Facility CCN 2012 2013 2012 2013 2012 2013 2012 2013 2012 2013

500016# 0 0 0 0 0 0 0 0 0 0

500041 0 0 3 4 13 16 0 0 16 20

500057 3 3 0 0 1 0 0 0 4 3

500108 7 10 10 5 10 12 0 0 27 27

50010F 1 1 2 5 8 13 0 0 11 19

502500 51 45 37 33 135 161 0 0 223 239

502501 14 13 5 3 9 9 0 0 28 25

502502 3 2 4 3 6 17 0 0 13 22

502503 2 2 1 2 6 12 0 0 9 16

502504 10 8 2 2 15 18 0 0 27 28

502505 0 0 0 0 0 0 0 0 0 0

502507 0 0 0 0 0 0 0 0 0 0

502508 1 0 1 0 0 0 0 0 2 0

502509 0 0 0 0 0 0 0 0 0 0

502510 0 0 1 3 7 7 0 0 8 10

502511 0 0 0 0 0 0 0 0 0 0

502513 23 23 1 1 12 15 0 0 36 39

502514 0 0 0 0 0 0 0 0 0 0

502516 0 0 0 0 0 0 0 0 0 0



502517 0 0 6 2 22 19 0 0 28 21

502518 0 1 2 0 9 9 0 0 11 10

502519 6 6 1 1 14 12 0 0 21 19

502520 0 0 0 0 0 0 0 0 0 0

502521 12 8 1 1 6 9 0 0 19 18

502522 7 7 5 7 10 21 0 0 22 35

502523 0 0 0 0 0 0 0 0 0 0

502524 0 0 0 0 0 0 0 0 0 0

502525 1 3 2 3 7 10 0 0 10 16

502526 0 0 1 0 7 7 0 0 8 7

502527 16 14 5 2 21 25 0 0 42 41

502528 0 0 0 0 0 0 0 0 0 0

502529 0 0 0 0 0 0 0 0 0 0

502530 0 0 6 3 20 22 0 0 26 25

502531 0 0 0 0 0 0 0 0 0 0

502532 0 0 0 0 0 0 0 0 0 0

502533 0 0 1 1 2 1 0 0 3 2

502534 0 0 0 5 8 9 0 0 8 14

502535 0 0 0 0 0 0 0 0 0 0

502536 0 0 0 0 0 0 0 0 0 0

502537 0 0 0 0 0 0 0 0 0 0

502538 7 9 2 2 9 17 0 0 18 28

502539 0 0 0 0 0 0 0 0 0 0

502540 0 0 0 0 0 0 0 0 0 0

502541 5 8 0 0 0 0 0 0 5 8

502542 0 0 3 2 7 10 0 0 10 12

502543 0 0 2 4 41 50 0 0 43 54

502544 0 0 0 0 0 0 0 0 0 0

502545 2 2 0 0 1 2 0 0 3 4

502546 8 9 1 1 12 7 0 0 21 17

502547 0 0 0 0 0 0 0 0 0 0

502548 0 0 0 0 0 0 0 0 0 0

502549 0 0 0 0 0 0 0 0 0 0

502550 0 0 1 1 5 6 0 0 6 7

502551 1 7 1 1 4 2 0 0 6 10

502552 0 0 0 0 0 0 0 0 0 0

502553 0 0 0 0 0 0 0 0 0 0

502554 0 0 0 0 0 0 0 0 0 0

502555 13 18 2 0 13 10 0 0 28 28

502556 0 0 0 0 0 0 0 0 0 0

502557 0 0 0 0 0 0 0 0 0 0

502558 0 0 0 1 2 3 0 0 2 4

502559 0 0 0 0 0 0 0 0 0 0

502560 12 10 1 3 12 12 0 0 25 25

502561 0 0 0 0 11 3 0 0 11 3

502562 0 0 0 0 2 2 0 0 2 2

502563 0 0 0 0 0 0 0 0 0 0

502564 0 0 0 0 2 5 0 0 2 5

502565 0 0 2 1 1 3 0 0 3 4

502566 0 0 0 0 0 0 0 0 0 0

502567 0 0 0 0 0 0 0 0 0 0

502568 0 0 0 0 0 0 0 0 0 0



502569 0 4 5 3 10 15 0 0 15 22

502570^ 0 0 0 0 0 0 0 0 0 0

502571^ 0 0 0 0 0 0 0 0 0 0

503300 1 1 0 0 16 16 0 0 17 17

503505 0 0 2 1 26 22 0 0 28 23

503507 0 0 0 0 0 0 0 0 0 0

503510 0 0 0 0 0 0 0 0 0 0

503511 0 0 0 0 0 0 0 0 0 0

503512^ 0 0 0 0 0 0 0 0 0 0

503700 0 0 0 0 0 0 0 0 0 0

WA Totals 206 214 119 106 522 609 0 0 847 929

Network


2012 2013 2012 2013 2012 2013 2012 2013 2012 2013

Network Totals 343 343 348 339 1,187 1,350 0 0 1,878 2,032

Source of Information: Facility Survey (CMS 2744) and CROWNWeb

This table includes 11 Veterans Affairs Facility patients for 2012 and 19 Veterans Affairs Facility patients for 2013

^ Facility not operational in 2012

# Facility not operational in 2013

* Facility does not have a generated 2744 in 2013



Table #4: ESRD Network 16 Dialysis Patients Modality and Setting – In Center

Number of Living Patients by Modality By Dialysis Facility, IN-CENTER SETTINGS AND TOTALS

As of December 31, 2012 and December 31, 2013

State: AK

Hemo PD Total Total In-Center & Home

1

Facility CCN 2012 2013 2012 2013 2012 2013 2012 2013

022500 163 140 0 0 163 140 187 160

022502 47 47 0 0 47 47 51 51

022503 18 24 0 0 18 24 25 29

022504 11 13 0 0 11 13 11 19

022506 69 70 0 0 69 70 124 137

022507 44 41 0 0 44 41 60 52

022508 20 23 0 0 20 23 20 23

022509 2 40 0 0 2 40 2 41

AK Totals 374 398 0 0 374 398 480 512

State: ID


1

Facility CCN 2012 2013 2012 2013 2012 2013 2012 2013

131316 8 8 0 0 8 8 8 8

132500 34 27 0 0 34 27 41 35

132501 23 23 0 0 23 23 33 43

132502 102 97 0 0 102 97 153 152

132503 29 19 0 0 29 19 38 25

132505 74 90 0 0 74 90 103 113

132506 14 15 0 0 14 15 16 18

132507 49 59 0 0 49 59 49 59

132508 32 32 0 0 32 32 35 43

132509 33 23 0 0 33 23 44 35

132510 21 23 0 0 21 23 21 23

132511 51 56 0 0 51 56 84 88

132512 49 50 0 0 49 50 84 92

132513 26 35 0 0 26 35 41 41

132514 68 77 0 0 68 77 92 104

132515 23 19 0 0 23 19 23 19

132516 44 50 0 0 44 50 44 50

132517 22 18 0 0 22 18 23 18

132518 36 35 0 0 36 35 41 35

132519 50 48 0 0 50 48 69 72

132520 12 16 0 0 12 16 15 17

132521 9 9 0 0 9 9 12 12

132522 18 22 0 0 18 22 30 32

132523 33 37 0 0 33 37 53 68

132524 4 3 0 0 4 3 8 4

132525 16 0 0 0 16 0 23 0

ID Totals 880 891 0 0 880 891 1,183 1,206



State: MT


1

Facility CCN 2012 2013 2012 2013 2012 2013 2012 2013

270003 44 40 0 0 44 40 48 48

270004 91 94 0 0 91 94 108 112

270013 81 79 0 0 81 79 119 118

270032 20 23 0 0 20 23 20 23

272500 38 41 0 0 38 41 38 41

272502 87 86 0 0 87 86 106 114

272503 36 34 0 0 36 34 36 34

272504 32 35 0 0 32 35 32 35

272505 11 13 0 0 11 13 11 14

272506 62 70 0 0 62 70 86 93

272507 92 104 0 0 92 104 99 113

272508 32 34 0 0 32 34 32 34

273501# 0 0 0 0 0 0 0 0

MT Totals 626 653 0 0 626 653 735 779

State: OR


1

Facility CCN 2012 2013 2012 2013 2012 2013 2012 2013

380006 47 32 0 0 47 32 52 37

38003F 38 35 0 0 38 35 38 35

380061# 0 0 0 0 0 0 0 0

382500 98 91 0 0 98 91 98 91

382502 69 79 0 0 69 79 118 132

382505 172 184 0 0 172 184 219 230

382507 59 56 0 0 59 56 66 67

382508 125 126 0 0 125 126 125 126

382509 0 0 0 0 0 0 73 66

382510 96 79 0 0 96 79 106 86

382511 60 62 0 0 60 62 60 62

382512 120 130 0 0 120 130 154 164

382513 69 64 0 0 69 64 69 64

382514 90 85 0 0 90 85 108 100

382515 118 129 0 0 118 129 146 159

382516 60 67 0 0 60 67 60 67

382518 64 72 0 0 64 72 114 120

382519 47 51 0 0 47 51 64 71

382520 38 42 0 0 38 42 38 42

382521 126 130 0 0 126 130 126 130

382522 128 119 0 0 128 119 128 119

382523 7 7 0 0 7 7 7 7

382524 86 95 0 0 86 95 86 95

382525 66 77 0 0 66 77 66 77

382526 78 88 0 0 78 88 79 101

382527 144 118 0 0 144 118 144 118

382529 41 37 1 0 42 37 55 51



382530 55 58 0 0 55 58 55 58

382531 16 17 0 0 16 17 24 24

382532 47 56 0 0 47 56 54 61

382534 112 113 0 0 112 113 112 113

382535 43 40 0 0 43 40 43 40

382536 54 56 0 0 54 56 65 82

382537 45 41 0 0 45 41 45 41

382538 63 85 0 0 63 85 63 85

382540 99 98 0 0 99 98 157 157

382543 89 80 0 0 89 80 89 80

382544 24 31 0 0 24 31 34 41

382545 16 16 0 0 16 16 16 16

382546 17 23 0 0 17 23 17 23

382547 0 0 0 0 0 0 35 23

382548 19 19 0 0 19 19 19 19

382549 46 51 0 0 46 51 62 72

382550 14 12 0 0 14 12 18 16

382551 76 76 0 0 76 76 76 76

382553 14 19 0 0 14 19 14 19

382554 17 17 0 0 17 17 17 21

382555 26 31 0 0 26 31 26 31

382556 28 33 0 0 28 33 28 33

382557 54 55 0 0 54 55 54 55

382558 29 38 0 0 29 38 41 55

382559 34 46 0 0 34 46 34 46

382560 32 38 0 0 32 38 32 38

382561^ 0 46 0 0 0 46 0 46

382562^ 0 14 0 0 0 14 0 20

382563^ 0 19 0 0 0 19 0 22

382564^ 0 18 0 0 0 18 0 19

382565^ 0 19 0 0 0 19 0 19

OR Totals 3,115 3,320 1 0 3,116 3,320 3,629 3,868

State: WA


1

Facility CCN 2012 2013 2012 2013 2012 2013 2012 2013

500016# 0 0 0 0 0 0 0 0

500041 122 119 1 0 123 119 139 139

500057 51 56 0 0 51 56 55 59

500108 238 97 0 0 238 97 265 124

50010F 28 7 0 0 28 7 39 26

502500 156 145 0 1 156 146 379 385

502501 120 115 0 0 120 115 148 140

502502 104 104 0 0 104 104 117 126

502503 168 156 0 0 168 156 177 172

502504 80 83 2 0 82 83 109 111

502505 79 76 0 0 79 76 79 76

502507 115 124 0 0 115 124 115 124

502508 142 146 0 0 142 146 144 146

502509 136 153 0 0 136 153 136 153

502510 34 26 0 0 34 26 42 36

502511 101 100 0 0 101 100 101 100



502513 118 122 0 0 118 122 154 161

502514 87 83 0 0 87 83 87 83

502516 77 70 0 0 77 70 77 70

502517 60 49 0 0 60 49 88 70

502518 75 81 0 0 75 81 86 91

502519 113 115 0 0 113 115 134 134

502520 114 110 0 0 114 110 114 110

502521 146 147 0 0 146 147 165 165

502522 164 170 0 0 164 170 186 205

502523 87 76 0 0 87 76 87 76

502524 125 104 0 0 125 104 125 104

502525 62 58 0 0 62 58 72 74

502526 69 72 0 0 69 72 77 79

502527 75 79 0 0 75 79 117 120

502528 71 75 0 0 71 75 71 75

502529 91 86 0 0 91 86 91 86

502530 126 137 0 0 126 137 152 162

502531 58 61 0 0 58 61 58 61

502532 51 55 0 0 51 55 51 55

502533 41 47 0 0 41 47 44 49

502534 97 98 0 0 97 98 105 112

502535 61 69 0 0 61 69 61 69

502536 58 68 0 0 58 68 58 68

502537 65 58 0 0 65 58 65 58

502538 66 74 0 0 66 74 84 102

502539 50 57 0 0 50 57 50 57

502540 21 22 0 0 21 22 21 22

502541 107 107 0 0 107 107 112 115

502542 40 44 0 0 40 44 50 56

502543 49 44 0 0 49 44 92 98

502544 39 46 0 0 39 46 39 46

502545 29 28 0 0 29 28 32 32

502546 114 97 0 0 114 97 135 114

502547 44 52 0 0 44 52 44 52

502548 29 30 0 0 29 30 29 30

502549 38 36 0 0 38 36 38 36

502550 70 77 0 0 70 77 76 84

502551 73 75 0 0 73 75 79 85

502552 15 18 0 0 15 18 15 18

502553 87 104 0 0 87 104 87 104

502554 44 47 0 0 44 47 44 47

502555 35 33 0 0 35 33 63 61

502556 45 63 0 0 45 63 45 63

502557 27 30 0 0 27 30 27 30

502558 13 16 0 0 13 16 15 20

502559 42 47 0 0 42 47 42 47

502560 50 63 0 0 50 63 75 88

502561 19 35 0 0 19 35 30 38

502562 15 14 0 0 15 14 17 16

502563 10 8 0 0 10 8 10 8

502564 27 24 0 0 27 24 29 29

502565 9 11 0 0 9 11 12 15



502566 68 94 0 0 68 94 68 94

502567 18 20 0 0 18 20 18 20

502568 64 68 0 0 64 68 64 68

502569 13 11 0 0 13 11 28 33

502570^ 0 22 0 0 0 22 0 22

502571^ 0 4 0 0 0 4 0 4

503300 10 11 0 0 10 11 27 28

503505 118 126 0 0 118 126 146 149

503507 64 62 0 0 64 62 64 62

503510 51 54 0 0 51 54 51 54

503511 33 78 0 0 33 78 33 78

503512^ 0 105 0 0 0 105 0 105

503700 0 0 0 0 0 0 0 0

WA Totals 5,411 5,554 3 1 5,414 5,555 6,261 6,484

Network


1

2012 2013 2012 2013 2012 2013 2012 2013

Network Totals

10,406 10,816 4 1 10,410 10,817 12,288 12,849

Source of Information: Facility Survey (CMS 2744) and CROWNWeb 1 The last column of the report displays the total from Table #3 plus total from Table #4

This table includes 66 Veterans Affairs Facility patients for 2012 and 42 Veterans Affairs Facility patients for 2013

^ Facility not operational in 2012

# Facility not operational in 2013

* Facility does not have a generated 2744 in 2013



Table #5: ESRD Network 16 Renal Transplants by Transplant Center

Number of Transplants Performed By Transplant Center Calendar Year 2012 and Calendar Year 2013

Total Transplants Performed Patients Awaiting Transplant

Transplant Center 2012 2013 2012 2013

380009 105 90 360 326

380017 58 63 150 178

38003F 35 56 239 221

OR Total 198 209 749 725

500005 110 115 188 182

500008 118 119 261 252

500027 93 85 350 385

500054 47 57 254 278

503300 24 23 18 16

WA Total 392 399 1,071 1,113

Network Total 590 608* 1,820 1,838

*One individual received two transplants during the year (2013)



Table #6: ESRD Network 16 Renal Transplant Recipients

01/01/2013 - 12/31/2013

RENAL TRANSPLANT RECIPIENTS FOR TRANSPLANT CENTERS WITHIN THE NETWORK AREA

Renal Transplant Recipients By Transplant Type, Age, Gender, Race And Primary Diagnosis For Calendar Year 2013.

Age Group

Transplant Type

Total Deceased

Living Related

Living Unrelated

Unknown

00-04 2 4 0 0 6

05-09 3 0 1 0 4

10-14 5 4 1 0 10

15-19 8 2 3 0 13

20-24 5 2 0 0 7

25-29 11 1 7 0 19

30-34 20 10 4 0 34

35-39 22 7 7 0 36

40-44 26 4 7 0 37

45-49 49 2 12 0 63

50-54 35 8 15 0 58

55-59 55 12 14 0 81

60-64 71 8 13 0 92

65-69 63 8 6 0 77

70-74 45 6 2 0 53

75-79 12 1 2 0 15

80-84 2 0 0 0 2

>=85 0 0 0 0 0

Total 434 79 94 0 607

Gender

Transplant Type

Total Deceased

Living Related

Living Unrelated

Unknown

Female 148 30 29 0 207

Male 286 49 65 0 400

Total 434 79 94 0 607

Race

Transplant Type

Total Deceased

Living Related

Living Unrelated

Unknown

American Indian/Alaska Native 2 0 1 0 3

Asian 44 5 7 0 56

Black or African American 48 0 5 0 53

Multiracial 1 1 1 0 3

Native Hawaiian or Other Pacific Islander 7 1 2 0 10

White 332 72 78 0 482

Not Specified 0 0 0 0 0

Total 434 79 94 0 607

Primary Diagnosis

Transplant Type

Total Deceased

Living Related

Living Unrelated

Unknown

Acquired obstructive uropathy 4 1 0 0 5

Acute interstitial nephritis 1 0 0 0 1

AIDS nephropathy 1 0 0 0 1

Amyloidosis 0 0 0 0 0



Analgesic abuse 1 0 0 0 1

Cholesterol emboli, renal emboli 1 0 0 0 1

Chronic interstitial nephritis 1 4 0 0 5

Chronic pyelonephritis, reflux nephropathy 3 6 1 0 10

Complications of other specified transplanted organ 0 0 0 0 0

Complications of transplanted bone marrow 0 0 0 0 0

Complications of transplanted heart 1 1 0 0 2

Complications of transplanted intestine 0 0 0 0 0

Complications of transplanted kidney 20 0 2 0 22

Complications of transplanted liver 1 0 0 0 1

Complications of transplanted lung 1 0 0 0 1

Complications of transplanted organ unspecified 0 0 0 0 0

Complications of transplanted pancreas 0 0 0 0 0

Congenital nephrotic syndrome 1 0 0 0 1

Congenital obstruction of ureterpelvic junction 0 0 0 0 0

Congenital obstruction of uretrovesical junction 0 0 0 0 0

Cystinosis 0 0 0 0 0

Dense deposit disease, MPGN type 2 0 0 0 0 0

Diabetes with renal manifestations Type 1 34 3 3 0 40

Diabetes with renal manifestations Type 2 85 12 11 0 108

Drash syndrome, mesangial sclerosis 0 0 0 0 0

Etiology uncertain 23 0 6 0 29

Fabry's disease 0 0 1 0 1

Focal Glomerulonephritis, focal sclerosing GN 30 4 10 0 44

Glomerulonephritis (GN) (histologically not examined) 25 9 2 0 36

Goodpasture's syndrome 4 0 0 0 4

Gouty nephropathy 0 0 0 0 0

Hemolytic uremic syndrome 2 1 1 0 4

Henoch-Schonlein syndrome 1 0 0 0 1

Hepatorenal syndrome 3 0 0 0 3

Hereditary nephritis, Alport's syndrome 4 0 1 0 5

Hypertension: Unspecified with renal failure 42 10 13 0 65

IgA nephropathy, Berger's disease (proven by immunofluorescence)

15 5 6 0 26

IgM nephropathy (proven by immunofluorescence) 0 0 2 0 2

Lead nephropathy 0 0 0 0 0

Lupus erythematosus, (SLE nephritis) 6 5 3 0 14

Lymphoma of kidneys 0 0 0 0 0

Medullary cystic disease, including nephronophthisis 4 1 0 0 5

Membranoproliferative GN type 1, diffuse MPGN 4 0 0 0 4

Membranous nephropathy 3 0 1 0 4

Multiple myeloma 0 0 0 0 0

Nephrolithiasis 0 0 1 0 1

Nephropathy caused by other agents 2 1 1 0 4

Nephropathy due to heroin abuse and related drugs 0 0 0 0 0

Other (congenital malformation syndromes) 1 0 2 0 3

Other Congenital obstructive uropathy 3 3 3 0 9

Other disorders of calcium metabolism 0 0 0 0 0

Other immuno proliferative neoplasms (including light chain nephropathy)

1 0 0 0 1

Other proliferative GN 4 0 0 0 4

Other renal disorders 10 1 0 0 11

Other Vasculitis and its derivatives 2 1 0 0 3



Polyarteritis 0 0 0 0 0

Polycystic kidneys, adult type (dominant) 55 6 22 0 83

Polycystic, infantile (recessive) 1 1 0 0 2

Post infectious GN, SBE 1 0 0 0 1

Post partum renal failure 0 0 0 0 0

Primary oxalosis 1 0 0 0 1

Prune belly syndrome 1 0 0 0 1

Radiation nephritis 0 0 0 0 0

Renal artery occlusion 0 0 0 0 0

Renal artery stenosis 2 0 0 0 2

Renal hypoplasia, dysplasia, oligonephronia 4 0 1 0 5

Renal tumor (benign) 0 0 0 0 0

Renal tumor (malignant) 2 0 0 0 2

Renal tumor (unspecified) 0 1 0 0 1

Scleroderma 0 0 0 0 0

Secondary GN, other 1 0 1 0 2

Sickle cell disease/anemia 0 0 0 0 0

Sickle cell trait and other sickle cell (HbS/Hb other) 0 0 0 0 0

Traumatic or surgical loss of kidney(s) 1 0 0 0 1

Tuberous sclerosis 1 0 0 0 1

Tubular necrosis (no recovery) 6 1 0 0 7

Urinary tract tumor (benign) 0 0 0 0 0

Urinary tract tumor (malignant) 0 0 0 0 0

Urinary tract tumor (unspecified) 0 0 0 0 0

Urolithiasis 2 0 0 0 2

Wegener's granulomatosis 3 1 0 0 4

With lesion of rapidly progressive GN 3 1 0 0 4

Not Specified 6 0 0 0 6

Total 434 79 94 0 607*

*One individual received two transplants during the year



Table #7: ESRD Network 16 Dialysis Deaths

As of 01/01/2013 - 12/31/2013

Deaths of dialysis patients by state of residence, age, race, gender, primary diagnosis and cause of death for calendar year 2013


00-04 0 0 0 0 0 0 0

05-09 0 0 0 0 0 0 0

10-14 0 0 0 0 0 0 0

15-19 0 0 0 0 0 0 0

20-24 1 1 0 0 0 0 2

25-29 0 0 0 0 5 0 5

30-34 0 1 3 5 10 0 19

35-39 0 4 4 5 11 0 24

40-44 0 6 2 11 27 0 46

45-49 2 5 6 15 32 2 62

50-54 4 8 11 33 56 1 113

55-59 10 8 16 42 93 2 171

60-64 14 31 17 84 135 2 283

65-69 10 40 18 88 157 1 314

70-74 7 39 15 99 154 1 315

75-79 15 34 19 94 161 1 324

80-84 13 30 13 68 139 3 266

>=85 12 32 15 85 155 3 302

Total 88 239 139 629 1,135 16 2,246


Female 34 87 59 253 500 4 937

Male 54 152 80 376 635 12 1,309


Total 88 239 139 629 1,135 16 2,246



Asian 9 3 0 15 85 0 112

Black or African American 16 1 2 30 102 2 153

Multiracial 0 0 0 0 3 0 3


White 48 230 104 577 902 14 1,875


Total 88 239 139 629 1,135 16 2,246


Cystic/Hereditary/Congenital Diseases 1 2 3 17 23 0 46

Diabetes 39 108 72 273 576 6 1,074

Glomerulonephritis 9 21 10 48 70 2 160

Hypertension/Large Vessel Disease 26 64 15 137 234 5 481

Interstitial Nephritis/Pyelonephritis 0 9 9 32 42 0 92

Miscellaneous Conditions 4 16 20 83 108 2 233

Neoplasms/Tumors 8 16 7 24 54 1 110

Secondary GN/Vasculitis 1 3 3 14 24 0 45


Total 88 239 139 629 1,135 16 2,246



Primary Cause of Death AK ID MT OR WA Other Total

Cardiac 21 95 57 210 373 7 763

Gastro-Intestinal 1 3 1 2 10 0 17

Infection 12 15 14 61 101 1 204

Liver Disease 1 5 0 6 2 0 14

Other 32 82 48 200 403 7 772

Unknown 17 24 11 114 172 1 339

Vascular 4 14 6 20 53 0 97


Total 88 239 139 629 1,135 16 2,246

Source of Information: CROWNWeb

Race: The categories are from the CMS-2728 Form

Diagnosis: The categories are from the CMS-2728 Form

This table cannot be compared to the CMS Facility Survey because the CMS Facility Survey is limited to those deaths reported by only Medicare-approved facilities.

This table includes 18 Patients receiving treatment at VA facilities.



Table #8: ESRD Network 16 Vocational Rehabilitation

Vocational Rehabilitation By Dialysis Facility for 01/01/2013 - 12/31/2013

Patients Age 18 – 54 as of 12/31/2013

AK

Facility CCN Aged 18 through 54 Patients Receiving

Services from Voc Rehab Patients Employed Full-

Time or Part-Time Patients Attending School

Full-Time or Part-Time

022500 59 0 8 2

022502 20 0 6 2

022504 8 1 4 0

022503 9 0 1 0

022506 37 0 13 1

022507 15 1 6 0

022508 6 1 1 0

022509 17 0 4 0

AK Total 171 3 43 5

ID





131316 1 0 0 0

132500 8 1 2 1

132501 16 0 3 0

132502 52 4 7 3

132503 6 0 0 0

132505 26 1 6 2

132506 10 1 1 1

132507 15 1 2 0

132508 10 0 3 0

132509 6 0 2 0

132510 3 0 1 0

132511 29 2 2 2

132512 32 0 6 1

132513 13 0 3 0

132514 28 0 6 0

132515 4 0 1 0

132516 17 0 3 0

132517 5 0 1 0

132518 10 0 2 0

132519 19 1 2 0

132520 8 0 2 0

132521 4 0 0 0

132522 7 0 0 0

132523 27 1 6 2

132524 0 0 0 0

132525 0 0 0 0

ID Total 356 12 61 12

MT







270003 8 2 3 0

270004 34 1 6 1

270013 34 2 8 0

270032 6 1 1 0

272500 22 1 3 1

272502 41 3 10 3

272503 8 0 4 0

272504 10 0 0 0

272505 4 0 0 0

272506 22 1 6 1

272507 32 1 10 1

272508 12 0 0 0

MT Total 233 12 51 7

OR





380006 9 1 2 0

382500 23 0 4 0

382502 45 1 10 2

382505 62 1 21 3

382507 19 0 1 1

382508 35 2 4 2

382509 30 5 16 6

382510 19 0 0 1

382511 20 0 1 0

382512 42 0 13 0

382513 18 0 2 0

382514 16 1 2 0

382515 50 0 10 3

382516 24 0 4 0

382518 39 0 7 4

382519 23 0 4 1

382520 12 0 3 0

382521 35 0 12 0

382522 38 1 10 5

382523 2 0 0 2

382524 37 1 17 1

382525 24 0 8 0

382526 28 0 5 1

382527 41 1 5 3

382529 12 0 1 1

382530 24 0 2 0

382531 8 0 3 0

382532 17 0 0 0

382534 41 0 16 1

382535 7 0 2 0

382536 19 0 5 0

382537 6 0 1 0

382538 20 0 7 0



382540 54 0 19 0

382543 25 0 6 2

382544 12 0 0 0

382545 5 0 2 0

382546 7 0 2 1

382547 7 0 4 1

382548 4 0 0 0

382549 21 0 9 2

382550 4 0 0 0

382551 24 3 5 0

382553 5 0 0 0

382554 8 1 3 1

382555 8 0 2 0

382556 8 0 1 0

382557 20 0 2 0

382558 13 0 1 0

382559 12 0 3 1

382560 9 2 1 0

382561 11 0 1 0

382562 9 0 5 0

382563 3 0 0 0

382564 4 0 0 0

382565 5 0 0 0

38003F 4 0 0 0

OR Total 1,127 20 264 45

WA





500041 29 0 2 1

500057 15 0 2 0

500108 35 0 5 0

502500 145 9 52 11

502501 36 1 6 4

502502 48 0 10 0

502503 48 1 12 3

502504 34 0 14 1

502505 27 2 11 0

502507 36 1 12 0

502508 51 3 11 2

502509 54 1 5 1

502510 13 0 2 0

502511 45 3 6 3

502513 64 1 19 3

502514 35 0 8 0

502516 21 0 7 0

502517 18 0 9 3

502518 40 0 6 0

502519 35 0 10 1

502520 35 2 7 1



502521 37 1 10 1

502522 62 2 18 1

502523 20 1 7 0

502524 31 1 5 0

502525 18 0 8 1

502526 27 6 5 0

502527 38 0 12 2

502528 12 0 5 0

502529 28 0 3 0

502530 46 1 10 3

502531 19 0 4 1

502532 10 0 0 0

502533 15 0 3 0

502534 37 0 14 1

502535 21 0 4 0

502536 12 0 1 0

502537 11 0 3 0

502538 36 1 7 1

502539 15 0 6 0

502540 4 0 1 0

502541 54 3 14 3

502542 12 1 5 1

502543 31 3 12 1

502544 14 1 4 1

502545 6 0 1 0

502546 28 0 3 0

502547 12 0 1 0

502548 9 0 0 0

502549 8 0 4 0

502550 19 0 5 1

502551 27 1 4 0

502552 7 1 2 1

502553 39 1 6 1

502554 18 0 4 2

502555 26 0 9 3

502556 19 1 3 0

502557 3 0 1 0

502558 9 0 1 0

502559 13 0 2 0

502560 24 0 3 0

502561 10 0 6 0

502562 3 0 0 0

502563 1 0 0 0

502564 4 0 1 0

502565 3 0 0 0

502566 30 5 2 0

502567 2 0 0 0

502568 15 1 6 1

502569 14 0 3 0



502570 10 0 5 0

502571 0 0 0 0

503300 7 0 0 3

503505 45 2 15 3

503507 22 0 2 0

503510 6 0 3 0

503511 26 0 4 0

503512 39 0 8 0

503700 0 0 0 0

50010F 6 0 3 0

WA Total 1,984 57 484 66

Network Total 3,871 104 903 135

Documents

ANNUAL REPORT 2013 - Amazon S3All ESRD Networks are required to submit an annual report to the Secretary of the U.S. Department of Health and Human Services. This report covers Northwest