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JENNA KRISHEREXECUTIVE DIRECTOR
SOUTHEASTERN KIDNEY COUNCIL
Patient Centered Care in the ESRD Network System
Who’s Who in the Network System
Congress
ESRD Networks
CONTRACT
CMS
SOW
HHS/CMS
Network 6
Patients
Congress
1972: Extended Medicare coverage to Persons with ESRD
1977: Amended Social Security Act (The Act) to establish ESRD Network Program
1986: Amended the Act to expand Network responsibilities, add language to fund Networks at 50 cents per dialysis treatment
Congress’ List of Network Responsibilities
Encourage use of treatment settings most compatible with rehabilitation of the patient and the participation of patients, providers of services, in vocational rehabilitation programs
Develop criteria and standards relating to the quality and appropriateness of patient care and with respect to working with encouraging participation in vocational rehabilitation programs;
Develop Network goals with respect to the placement of patients in home therapies, and in-center self-care settings and undergoing or preparing for transplantation
Evaluate the procedure by which facilities assess the appropriateness of patients for proposed treatment modalities
Implement a procedure for evaluating and resolving patient grievances
Conduct on-site reviews of facilities as necessary, utilizing standards of care established by the Network to assure proper medical care
Congress’ List of Network Responsibilities
Collect, validate, and analyze such data as are necessary to assure the maintenance of the registry
Identify facilities and providers not cooperating toward meeting Network goals and assist such facilities and providers in developing appropriate plans for correction and reporting to the Secretary on facilities that are not providing appropriate medical care
Submit an annual report to the Secretary on July 1 of each year which shall include a full statement of the Network’s goals, data on the Network’s performance in meeting its goals including data on the comparative performance of facilities and providers, identification of those facilities that have consistently failed to cooperate with Network goals, and recommendations with respect to the need for additional or alternative services or facilities in the Network area in order to meet the Network goals, including self-dialysis training, transplantation, and organ procurement facilities.
§ 405.2112 ESRD network organizations.
(a) Developing network goals for placing patients in settings for selfcare and transplantation.
(b) Encouraging the use of medically appropriate treatment settings most compatible with patient rehabilitation and the participation of patients, providers of services, and renal disease facilities in vocational rehabilitation programs
(c) Developing criteria and standards relating to the quality and appropriateness of patient are and, with respect to working with patients, facilities, and providers of services, for encouraging participation in vocational rehabilitation programs.
(d) Evaluating the procedures used by facilities in the network in assessing patients for placement in appropriatetreatment modalities.
(e) Making recommendations to member facilities as needed to achieve network goals.
(f) On or before July 1 of each year, submitting to CMS an annual report that contains the following information:
ESRD Network Contract
Improve the quality and safety of dialysis-related services provided for individuals with ESRD.
Improve the independence, quality of life, and rehabilitation (to the extent possible) of individuals with ESRD through support for transplantation, use of self-care, and in-center self-care, as medically appropriate, through the end of life.
Improve patient perception of care and experience of care, and resolve patients’ complaints and grievances.
Improve collaboration with providers and facilities to ensure achievement of goals 1 through 3 through the most efficient and effective means possible, with recognition of the differences among providers and the associated possibilities/capabilities.
Improve the collection, reliability, timeliness, and use of data to measure processes of care and outcomes; to maintain a patient registry; and to support the goals of the ESRD Network Program.
CONTRACT
SOW
Don Berwick Triple Aims
Better care for individuals Safe Effective Patient-centered Timely Efficient Equitable
Better health for populations, by attacking upstream causes such as poor nutrition physical inactivity substance abuse.
Reducing per-capita costs by improving Quality
CONTRACT
SOW
18 ESRD Networks
Each entity contracts with CMS All have the same Statement of Work and
GoalsCurrent contract through June 2012Most are small, non-profit companiesOur area is ESRD Network area #6
Non-profit organization, based in Raleigh, NCHold the contract with CMS for ESRD
Network 6Volunteer, multi-disciplinary Board of
Directors Consumer Committee Medical Review Board Finance Committee Nominating Committee
14 paid staff members
The Patients We Serve
3 States38,500 people on dialysis11,000 people with a transplant10% of the US ESRD Population68% African American/30% WhiteAverage age: 59 years72% dialyzing in-center8% at home20% with a transplant
The Patients we Serve
590 FacilitiesFMC: 34%DaVita: 33%All others: 33%10% of all facilities nationally
Network Contract by the Numbers
5 Tasks Task 1: Quality Improvement Task 2: Outreach and Patient Services Task 3: Administration Task 4: Information Management Task 5: CROWN Web
Funding CMS collects 50 Cents per treatment SKC receives 26 Cents per treatment
14 SKC Staff members
CONTRACT
SOW
TO IMPROVE THE LIVES OF PEOPLE WITH OR AT RISK FOR END STAGE RENAL DISEASE BY PROMOTING AND
ADVANCING QUALITY OF CARE.
Quality of Care Commitment
Each Facility agrees to…Cooperate with the Network, participate in Network
activities and pursue Network goals to fulfill the terms of the current Network Statement of Work.
Identify a Governing body that receives and acts upon Network recommendations.
Provide the highest quality of care to every patient we treat by striving to meet Network Quality Goals using a data-driven quality assessment and performance improvement plan.
Provide timely and accurate data and information to support the national ESRD registry, to facilitate measurement and improvement of care and to resolve patient complaints.
Quality of Care Commitment
Cooperate with the Network Medical Review Board (MRB) on all QI activities including QI Projects and Focused Review, including submission of information and responding to MRB recommendations.
Cooperate with the Network in prevention and resolution of patient concerns, complaints and grievances. This includes educating patients on the Network’s role in complaint and grievance resolution, posting the Network address and phone number and notifying the Network at least 30 days prior to involuntarily discharging a patient.
Share educational information with patients as requested by the Network and helps educate patients on the role and services of the Network.
Follow all CMS/HIPAA rules for secure transmission of data.
Quality of Care Commitment
Southeastern Kidney Council agrees to… Provide educational resources and technical assistance to
facilities and to patients to help improve the quality of care.
Provide comparative feedback reports that facilities can incorporate into local QI projects.
Provide education, tools and technical assistance to assist facilities and patients to: Prevent and resolve conflict between patients and providers Improve the quality of care Ensure data submission is accurate and timely
Oversee all Network activities through the multidisciplinary Board of Directors and its committees to ensure projects are effective, reasonable and appropriate for patients and providers in the Network 6 area and that activities are conducted in an environment free from conflict of interest.
Task 1: Quality Improvement
Increase fistula useDecrease catheter useImprove anemia managementImprove adequacyIncrease immunizationsReduce health care infections
Task 1 by the Numbers
52.8% of Patients Dialyzing via AV Fistula7.2% of Patients Dialyzing via Catheter > 90
Days28% of Patients Dialyzing via AV Graft
Vascular Access in Network 6 Area
Catheter Use By Network Dec 2010
AVF Use by Network Dec 2010
Facility AVF Rates Dec 2010
66%
51-65%
25546%
41-50%
16430%
<40%
6211%
7113%
Opportunity to Improve - QAPI
Improving AVF Rates for Better Care
All Facilities Resources Technical Assistance Workshops/Education Data Feedback
Improving AVF Rates for Better Care
66%: Great job!51-65%: Include in your QAPI; call us for
help<50%: Complete box and return
We reviewed this report at our QI meeting on __/__/__Signed: Medical Director _________________ Nurse Manager ___________________
We (Check one) ___ Confirmed data is correct ___ Corrected the data in the corporate systems and with the Network
We (check one) ___ Have an AVF QAPI ___ Do not have an AVF QAPIWe plan to increase the # of AVFs each month as follows: _____in 30 days ___ in 60 days ___
in 90 days
• <40%: Focused Review
Focused Review to Improve Care
Letter to Medical Director and Clinical Manager with Agreement of Expectations Data-driven QAPI Send us your progress data SKC will help with tools and feedback
Training manual Educational materials Sample templates
MRB reviews data and provides feedbackPossible site visitsWhen facility hits goal, released and asked to
share best practices
Focused Review to Improve Care
Focused Review to Improve Care
Using March 2010 vascular access data, ranked all providers by catheter use (all catheters)
Selected the 15 facilities with at least 40 patients that had the highest catheter rates
Selected the 5 facilities with < 40 patients with the highest catheter rates
8 Facilities continued from last year
Focused Review to Improve Care
Increasing Immunizations for Better Care
9% 100%
53% >90%
Increasing Immunizations for Better Care
Increasing Immunizations for Better Care
Decreasing Anemia for Better Care
Increasing Adequacy for Better Care
Quality Improvement on the Horizon
Healthcare Acquired InfectionsTransplant
Formed a coalition to study and remove barriers to transplant
Increased patient / provider education Collaboration of transplant centers Increase donors May include transplant measures in future screening
Quality Improvement on the Horizon
377 (82%) Facilities had fewer Transplants than Expected
81 (18%) had more than Expected
Better Care
1,256 more AV Fistulas in use571 fewer catheters in use322 fewer long-term catheters in use1,125 more patients receiving adequate
dialysis2,680 more patients with anemia managed
Educating Patients for Better Care
New Patients receive NEPOP Introduce CMS, Network, State Surveyors Educational materials
All Patients receive newslettersAll Patients receive annual Calendar
Developed by Consumer Committee Each month, facility receives supporting packet
Educating Patients for Better Care
39,665 Calendars mailed in December 2009Survey/analysis conducted in June 201029% of respondents knew ”Network 6”82% knew “Southeastern Kidney Council”When asked for future education topics
Nutrition – 31% Treatment Options – 26% Emergency Preparedness – 12%
When asked how Video – 34% Facility distribution – 27% Mail materials to home – 25% Workshop/meeting – 13%
Educating Providers for Better Care
Network Annual ReportRegional and National patterns of careInformation on Network QI projectsInformation on the importance of
immunizationCQI MaterialsDialysis Facility ReportVISION, CROWN information
Assisting Patients/Providers for Better Care
Identify providers for transient dialysisAssist users with Dialysis Facility CompareAssist with procedures to assess patients for
treatment modalitiesAssist providers in developing rehabilitation
goalsQI Plans / QAPIsAssist in disaster planning and recoveryAssist with community education programsHelp patients and providers resolve issues
Resolving Issues For Better Care
287 complaints in 20109% of all the complaints in the US5.06 complaints per 1000 patientsOther calls
101 Beneficiary inquiries 191 Facility concerns 451 Facility inquiries 1,720 Calls regarding
Resolving Issues For Better Care
Resolving Issues For Better Care
37 Involuntary Discharges in 201032 Averted
Resolving Issues For Better Care
What to do if SKC calls you with a complaint Think positive: you’ve done a good job educating
patients to call us Keep an open mind Send us documentation that helps us understand the
situation Know the conditions for coverage If IVD – 30 day notice and complete IVD packet Keep the patient central to your actions
Maintaining the Registry for Better Care
11,000 CMS 2728 Forms entered in 2010 1,760 had to be returned for correction 88% on time, accurate
7,700 CMS 2746 Forms entered in 2010 230 had to be returned for correction 94% on time, accurate
6,732 NPAR forms with 47,124 events enteredClinical Data
Fistula First – monthly Elab – annual Immunization – annual
Maintaining the Registry for Better Care
Medicare uses data to determine eligibilityClinical indicators profiled to identify trends
in care to be addressedRegistry allows us to know where patients
are dialyzing and help with placement in emergencies
Data analyzed and reported in journals to improve the science of care
Descriptive / demographics help us understand the population served
Questions?