2009 Dialysis Facility Report - DialysisData.org · for patient age, sex, race, ethnicity, diabetes...
Transcript of 2009 Dialysis Facility Report - DialysisData.org · for patient age, sex, race, ethnicity, diabetes...
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
2009 Dialysis Facility Report
Purpose of the Report
SAMPLEEnclosed is the 2009 Dialysis Facility Report (DFR) for this facility based on data from the Centers for Medicare amp Medicaid Services (CMS)
This DFR includes data specific to provider number(s) 999999
These data could be useful in quality improvement and assurance activities The information contained in this report facilitates comparisons of patient characteristics treatment patterns transplantation rates hospitalization rates and mortality rates to local and national averages Some of these comparisons account for the patient mix at this facility including age sex race and diabetic status This report is provided as a resource for characterizing selected aspects of clinical experience at this facility relative to other caregivers in this state ESRD Network and across the United States
In October 2009 each states surveyors will receive the DFR for all dialysis facilities in their state
This report also provides you with advance notice of the updated quality measures (urea reduction ratio hemoglobin and patient survival) for your facility that will be reported on the Dialysis Facility Compare (DFC) website in November 2009 (wwwmedicaregov)
Collaborators
CMS has contracted with the University of Michigan Kidney Epidemiology and Cost Center (UM-KECC) and Arbor Research Collaborative for Health to produce the 2009 Dialysis Facility Reports
How to Submit Comments
Between September 30 2009 and October 15 2009 you may submit comments for CMS on the three DFC measures for your state surveyor or for UM-KECC Please visit wwwDialysisReportsorg log on to view your report and click Comments
Dialysis Facility Compare Comment on the three DFC measures (see page 2) which will be reported on the DFC public website in November 2009 The comment period begins September 30 2009 and ends October 15 2009 Your comments will not appear on the DFC website
State Surveyor Comment on your DFR for the state surveyors The state surveyors will receive a copy of your DFR in October 2009 with your comments
UM-KECC Submit questions about your DFR to UM-KECC You can also submit your suggestions to improve the DFR
IMPORTANT Please note that any comments posted during the original comment period will not change It is not necessary to comment during the new comment period unless you have new comments on the SMR or would like to change your original comments
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 118
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
Dear Dialysis Facility Director
SAMPLEThis report has been prepared for this facility by the University of Michigan Kidney Epidemiology and Cost Center (UM-KECC) with funding from the Centers for Medicare amp Medicaid Services (CMS) It is the fourteenth in a series of annual reports This is one of 5507 reports that have been sent to the ESRD Networks for distribution to ESRD providers in the US Your state survey agency will receive this report in September 2009 Selected highlights from this report are given here The information specific to this facility is printed in bold type for easy identification
Whats New This Year As part of a continuing effort to improve the quality and relevance of this report for your facility the following changes have been incorporated into your 2009 DFR The percent of cardiac related deaths has been added to Table 1 First year mortality statistics for new dialysis patients who started dialysis between January 1 2005 and December 31 2007 are calculated and reported in the second half of Table 1 Please refer to the section entitled Whats New in Section I of the Guide to the 2009 Dialysis Facility Reports for greater detail on these changes
Dialysis Facility Compare Anemia management is reported as two measures the percent of patients with hemoglobin values of less than 10 gdL and the percent of patients with hemoglobin values greater than 12 gdL The URR and hemoglobin measures were calculated for Medicare approved dialysis facilities operating at any time during 2008 The hemoglobin measures were calculated only for patients treated with erythropoiesis stimulating agents (ESA) The patient survival measure was calculated for Medicare approved dialysis facilities operating at any time from 2005 through 2008 The following measures for this facility will appear on the DFC website
Measure Name This Facility
1 The percentage of Medicare hemodialysis patients treated in this facility during 2008 with URR ge 65 92
Number of patients included in calculation 113
2 The percentage of Medicare patients treated in this facility during 2008 with ESA-treated hemoglobin lt10 gdL 16 with ESA-treated hemoglobin gt12 gdL 3 Number of patients included in calculation 110
3 Patient survival reported as as expected better than expected or worse than expected for the time period 2005-2008 for this facility As Expected
Standardized Mortality Ratio (SMR) 105 P-value 062
Please see Table 5 for more information on URR and ESA-treated hemoglobin for this facility URR and ESA-treated hemoglobin measures based on 10 or fewer patients will be reported as not available on DFC Table 1 provides additional information on patient survival If the Standardized Mortality Ratio (SMR) is less than 100 and statistically significant (plt005) the patient survival classification is Better than Expected on DFC If the facility SMR is greater than 100 and statistically significant (plt005) the patient survival classification is Worse than Expected on DFC Otherwise the patient survival classification is As Expected on DFC Please note that the classification is not reported for a facility if the SMR is based on 3 or fewer expected deaths
Overview This report includes summaries of patient characteristics treatment patterns and patient outcomes for chronic dialysis patients who were treated in this facility between January 2005 and December 2008 Mortality hospitalization and transplantation statistics are reported for a three- or four-year period Regional and national averages are included to allow for comparisons Several of the summaries of patient mortality
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 218
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
hospitalization and transplantation are adjusted to account for the characteristics of the patient mix at this facility including age sex race ethnicity and diabetes as a cause of ESRD Unless otherwise specified data refer to hemodialysis and peritoneal dialysis patients combined
Summary data about the percent of patients with URR of 65 or higher and with central catheters are included as suggested by Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines Summary data about the percent of patients with hemoglobin from 10 gdL to 12 gdL are also reported These practice pattern measures are strongly correlated with the mortality and hospitalization measures found in these reports Note that elevated mortality or hospitalization rates may be due to a variety of causes unrelated to clinical practices so it may not always be possible to identify clinical practices that explain those rates
SAMPLEMortality Mortality summaries are provided in Table 1 A Standardized Mortality Ratio (SMR) is calculated for each facility Although mortality statistics can vary substantially from year to year they are reported here as a key outcome for dialysis patients The SMR compares the observed death rate in this facility to the death rate that would be expected based on national death rates for patients with the characteristics of the patients at this facility Time at risk and deaths within 60 days after transfer out of this facility are attributed to this facility Time at risk and deaths after transplantation are excluded from the analysis The SMR is adjusted for patient age sex race ethnicity diabetes as a cause of ESRD duration of ESRD nursing home status BMI at incidence and comorbidities at incidence as well as state population death rates The rate of withdrawal from dialysis and the percentage of deaths due to infection and cardiac related deaths are reported in the table to help in the interpretation of the mortality outcomes
There was a 23 annual observed death rate among the patients treated at this facility during 2005-2008 while a rate of 22 would be expected based on the age sex race ethnicity diabetes as cause of ESRD duration of ESRD nursing home status BMI at incidence comorbidities at incidence and state population death rates The SMR of observed to expected deaths is 105 which is not far (5) above the national reference value of 100
First Year Mortality Mortality summaries for new dialysis patients are also provided in Table 1 The first year SMR compares the observed death rate in this facility to the death rate that would be expected based on national death rates for new dialysis patients with the characteristics of the patients at this facility Similar to the mortality of all patients the SMR for new dialysis patients is adjusted for patient age sex race ethnicity diabetes as a cause of ESRD nursing home status BMI at incidence and comorbidities at incidence as well as state population death rates The rate of withdrawal from dialysis and the percentage of deaths due to infection and cardiac related deaths are also reported to facilitate the interpretation of the mortality outcomes
There was a 36 annual observed first year death rate among the patients starting dialysis at this facility during 2005-2007 while a rate of 26 would be expected based on the age sex race ethnicity diabetes as cause of ESRD nursing home status BMI at incidence comorbidities at incidence and state population death rates The first year SMR of observed to expected deaths is 140 which is 40 more deaths than expected at this facility This difference is not statistically significant (pgt005) so this higher mortality could plausibly be just a chance occurrence
Hospitalization Hospitalization summaries are reported for Medicare patients in Table 2 The table includes information on the number of days hospitalized the number of hospital admissions and the diagnoses present at admission for patients at this facility The Standardized Hospitalization Ratio (SHR) for Days compares the observed number of days hospitalized to the number of days that would be expected based on national hospitalization rates for patients with the characteristics of the patients at this facility The Standardized Hospitalization Ratio (SHR) for Admissions compares the observed number of admissions to the number of admissions that would be expected based on national hospitalization rates for patients with the characteristics of the patients at this facility Both measures are adjusted for age race ethnicity sex diabetes duration of ESRD nursing home status and BMI As in the mortality calculation time at risk and
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 318
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
hospitalizations within 60 days after transfer out of this facility are attributed to this facility Time at risk and hospitalizations starting 3 days before transplantation are excluded from the analysis
The SHR (days) of observed to expected number of days hospitalized at this facility during 2005-2007 is 090 which is 10 lower than expected The SHR (admissions) of observed to expected number of admissions for patients at this facility during 2005-2007 is 090 which is 10 lower than expected
Infection Information on hospitalizations for septicemia is reported on Table 2 The information in Table 2 is based on Medicare patient claims
SAMPLEThe percentage of Medicare dialysis patients at this facility hospitalized with septicemia during 2005-2007 was 17 compared to 12 nationally
Transplantation Transplantation summaries are reported in Table 3 The Standardized Transplantation Ratio (STR) represents relative first transplantation rates (observedexpected) for patients at this facility adjusting for patient age Patients who are 70 or older as well as those with a prior kidney transplant are excluded As in the mortality and hospitalization calculations time at risk and transplants within 60 days after transfer out of this facility are attributed to this facility
Of the patients under age 70 treated at this facility during 2005-2008 who had not previously received a transplant 7 were transplanted annually while a rate of 5 would be expected for these patients The STR of observed to expected number of patients transplanted for this facility is 126 which is 26 higher than expected for this facility This difference is not statistically significant (pgt005) and could plausibly be due to random chance
Transplant Waitlist Table 4 summarizes waitlist information for patients under age 70 being treated at this facility at the end of each year Unlike the mortality hospitalization and transplantation statistics the waitlist statistics do not include patients who transferred out of the facility
Among the 93 dialysis patients under age 70 treated at this facility on December 31 2008 25 were on the kidney transplant waitlist compared to 21 nationally This difference is not statistically significant (pgt005) and is plausibly due to random chance
Practice Patterns Table 5 summarizes the dialytic modality hemoglobin and URR for patients treated at this facility during each year These data are derived from CMS Medicare paid dialysis claim data Vascular access data for prevalent and incident patients as reported by the CMS Fistula First project are summarized in Table 6
Among the 110 ESA-treated dialysis patients included in the analysis of Medicare claims data of hemoglobin for 2008 at this facility 81 had hemoglobin between 10-12 gdL compared to 71 nationally Among the 113 hemodialysis patients in this facility included in the analysis of Medicare claims data of URR in 2008 92 had URR above the KDOQI minimum value for URR (URR ge 65) compared to 96 nationally
At this facility in 2008 an average of 39 of incident patients had AV fistulae in place compared to 31 nationally Also at this facility in 2008 an average of 51 of prevalent patients had AV fistulae in place compared to 58 nationally Of the prevalent patients receiving hemodialysis treatment at this facility in 2008 10 had a catheter which had been in place for more than 90 days as their only vascular access compared to 11 nationally See Tables 5 and 6 for more information about practice patterns
Patient Characteristics Characteristics of patients starting dialysis during 2005-2008 are reported in Table 7 Table 8 gives summaries for all dialysis patients being treated at the end of each year 2005-2008 Comorbidities are reported in Table 9 for Medicare dialysis patients being treated at the end of each year 2005-2007
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
There were 11 patients with Medical Evidence Forms (CMS-2728) which indicated that they started treatment at this facility during 2008 The average number of comorbidities reported for new patients is 35 which is higher than the average of 31 reported nationally Also 9 of these patients were not under the care of a nephrologist before starting dialysis compared to 31 nationally Furthermore 64 of these patients were informed of their transplant options compared to 72 nationally The average serum albumin calculated for these patients (before first dialysis) is 33 gdl which is higher than the national average value of 31 gdl The average residual renal function (GFR) calculated for these patients from serum creatinine (before first dialysis) and other parameters was 140 mlmin which is higher than the national average value of 110 mlmin
SAMPLEAmong patients treated at this facility on December 31 2008 6 were treated in a nursing home during the year which is lower than the national average value of 13 The average number of comorbidities reported on Medicare claims in 2007 for Medicare patients in this facility on December 31 2007 is 37 which is lower than the national average value of 41
Facility Information General information about this facility is provided in Tables 11 12 and 13 Table 11 provides counts of patients treated Medicare eligibility treatment modality and staffing from the Annual Facility Survey (Form CMS-2744) Table 12 reports survey and certification activity Table 13 includes services provided by this facility as well as information on ownership
This facility reported having 28 staff members to care for 140 patients at the end of 2008 This facility reported having 21 stations available as of March 31 2009 This facility offers both hemodialysis and peritoneal dialysis services Additional information regarding patient counts patient modality and facility staffing is available in Table 11
Sources of Patient Data This report is based primarily on Medicare claims and data collected for CMS Patients were assigned to this facility based on the Standard Information Management System (SIMS) database Medicare claims and Medical Evidence Forms (Form CMS-2728) Network 99 has a list of the patients included in the mortality analyses for this facility Table 9 reports comorbidities reported on Medicare claims Table 10 reports the number of patients placed in this facility for analyses in Tables 1 2 3 8 and 9 of this report Table 10 also provides information on patient status at the end of the year both for patients who remain in this facility until the end of each year and for those who transfer out of this facility receive a transplant or die during the year
These are just a few highlights of the statistics you will find in this report based on the data for this facility We hope that this report is of interest to you and that you will discuss it with your staff We welcome any questions or comments you might have about the content of the current report or any suggestions you might have for future reports Comments or suggestions can be submitted at the secure site available at wwwDialysisReportsorg until October 15 2009 If you have questions after the comment period is over please contact us directly at keccdfrumichedu or (734) 998-9823
For a complete description of the methods used to calculate the statistics in this report please see the Guide to the 2009 Dialysis Facility Reports The Guide is available from ESRD Network 99 and is also on the UM-KECC web site at wwwDialysisReportsorg
Prepared by The University of Michigan Kidney Epidemiology and Cost Center (UM-KECC) under contract with the Centers for Medicare amp Medicaid Services
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 1 Mortality Summary for All Dialysis Patients (2005-08) amp New Dialysis Patients (2005-07)1
Regional Averages2 This Facility per Year 2005-2008
Measure Name 2005 2006 2007 2008 2005-2008 State Network US
SAMPLEAll Patients Death Rates 1a Patients (n=number) 205 184 166 177 7327 965 700 901
1b Patient years (PY) at risk (n) 1486 1265 1249 1262 52627 670 479 606
1c Deaths (n) 35 37 20 30 1227 146 108 127
1d Expected deaths (n) 322 264 280 296 1167 150 118 127
1e Death rate per 100 PY ( of 1b) 236 292 160 238 232 218 225 210
1f Expected death rate per 100 PY ( of 1b) 216 209 225 235 221 225 246 210
All Patients Categories of Death 1g Withdrawal from dialysis prior to death ( of 1c) 286 378 300 200 295 275 341 238
1h Death due to Infections ( of 1c) 286 243 200 200 238 173 180 175
Cardiac causes ( of 1c) 429 324 600 267 385 311 303 273
1i Dialysis unrelated deaths3 (n excluded from SMR) 0 0 1 2 37 01 01 01
All Patients Standardized Mortality Ratio (SMR)
1j SMR4 109 140 071 101 105 097 091 100
1k P-value5 066 006 014 099 062 na na na
1l Confidence interval for SMR6
High (95 limit) 151 193 110 145 125 na na na
Low (5 limit) 076 099 044 068 087 na na na
All Patients SMR Percentiles for this Facility (ie percent of facilities with lower mortality rates) 1m In this State 62 88 18 64 65
1n In this Network 69 89 31 69 76
1o In the US 53 82 21 60 59
Regional Averages New Patients First Year Death Rates 2005 2006 2007 2005-2007 Per Year 2005-20072
1p New Patients (n=number) 53 12 10 757 237 189 202
1q Patient years (PY) at risk (n) 422 96 92 6117 199 158 171
1r Deaths (n) 16 4 2 227 59 46 48
1s Expected deaths (n) 102 24 31 1577 62 51 48
1t Death rate per 100 PY 379 415 216 360 295 289 281
1u Expected death rate per 100 PY 242 247 338 257 309 321 281
New Patients Categories of Deaths 1v Withdrawal from dialysis prior to death ( of 1r) 250 750 100 409 343 429 322
1w Death due to Infections ( of 1r) 375 00 00 273 212 228 231
Cardiac causes ( of 1r) 250 750 00 318 336 362 331
New Patients First Year Standardized Mortality Ratio (SMR)
1x SMR4 157 168 064 140 095 090 100
1y P-value5 011 044 079 015 na na na
1z Confidence interval for SMR6
High (95 limit) 255 430 231 212 na na na
Low (5 limit) 090 046 008 088 na na na
na = not applicable [1] See Guide Section IV [2] Values are shown for the average facility annualized [3] Defined as deaths due to street drugs and accidents unrelated to treatment [4] Calculated as a ratio of deaths (1c to 1d for all patients 1r to 1s for new patients) to expected deaths not shown if there are too few expected deaths [5] A p-value less than or equal to 005 indicates that the difference between the actual and expected mortality is probably real and is not due to random
chance alone while a p-value greater than 005 indicates that the difference could plausibly be due to random chance [6] The confidence interval range represents uncertainty in the value of the SMR due to random variation [7] Sum of 4 years (all patients) or 3 years (new patients) used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 2 Hospitalization Summary for Medicare Dialysis Patients1 2005-2007
Regional Averages2 This Facility per Year 2005-2007
Measure Name 2005 2006 2007 2005-2007 State Network US Medicare Dialysis Patients
2a Medicare dialysis patients (n) 160 154 141 4555 791 572 674
2b Patient years (PY) at risk (n) 1136 1037 1037 32105 543 387 445
Days Hospitalized Statistics
2c Total days hospitalized (n) 1692 1758 924 43745 869 542 658
2d Expected total days hospitalized (n) 18024 15891 14855 487705 8082 5799 6580
2e Days hospitalized per PY 149 170 89 136 160 140 148
2f Expected days hospitalized per PY 159 153 143 152 149 150 148
2g Standardized Hospitalization Ratio (Days)3 094 111 062 090 107 093 100
Admission Statistics
2h Total admissions (n) 226 193 140 5595 115 77 84
2i Expected total admissions (n) 2287 2023 1919 62305 1039 747 844
2j Admissions per PY 20 19 13 17 21 20 19
2k Expected admissions per PY 20 20 19 19 19 19 19
2l Standardized Hospitalization Ratio (Admissions)4 099 095 073 090 111 103 100
Diagnoses Present at Admission ( of 2a) 2m Septicemia 188 169 142 167 153 128 123
2n Acute myocardial infarction 69 58 21 51 60 52 42
2o Congestive heart failure 288 208 191 231 309 281 252
2p Cardiac dysrhythmia 163 110 121 132 166 168 146
2q Cardiac arrest 31 13 28 24 22 18 17
Length of Stay 2r One day admissions ( of 2h) 186 155 229 186 124 144 136
2s Average length of stay (days per admission 2c2h) 75 91 66 78 75 70 78
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer see Guide Section V [2] Values are shown for the average facility annualized [3] Standardized Hospitalization Ratio (Days) calculated as ratio of actual (2c) to expected (2d) hospitalized days [4] Standardized Hospitalization Ratio (Admissions) calculated as ratio of actual (2h) to expected (2i) total admissions [5] Sum of 3 years used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 3 Transplantation Summary for Dialysis Patients under Age 70 2005-2008
Regional Averages2 This Facility per Year 2005-2008
Measure Name 2005 2006 2007 2008 2005-2008 State Network US
3a Eligible patients1 (n) 147 121 110 112 4909 636 437 616
3b Transplants (n) 8 7 7 3 259 30 25 25
3c Donor type (sums to 3b3)
Living Donor (n) 2 1 0 1 49 10 10 08
Deceased Donor (n) 6 6 7 2 219 20 16 17
Patients who have not Previously Received a Transplant
3d Eligible patients1 (n) 134 106 100 104 4449 575 389 550
3e Patient years (PY) at risk (n) 967 768 761 776 32739 404 268 378
3f 1st transplants4 (n) 7 6 6 3 229 27 22 21
3g Expected 1st transplants (n) 53 44 39 39 1759 22 15 21
3h 1st transplant rate per 100 PY 72 78 79 39 67 66 82 56
3i Expected 1st transplant rate per 100 PY 55 57 51 50 53 56 55 56
3j Donor type (sums to 3f5)
Living Donor (n) 2 0 0 1 39 09 08 06
Deceased Donor (n) 5 6 6 2 199 18 14 15
Standardized 1st Transplantation Ratio (STR)
3k STR6 131 136 154 078 126 119 149 100
3l P-value7 058 056 040 092 034 na na na
3m 95 Confidence interval for STR8
Upper limit 270 297 334 227 190 na na na
Lower limit 053 050 056 016 079 na na na
STR Percentiles for this Facility (ie percent of facilities with lower transplantation rates) 3n In this State 56 59 69 41 53
3o In this Network 47 49 55 35 40
3p In the US 67 69 76 48 67
SAMPLE na = not applicable [1] See Guide Section VI [2] Values are shown for the average facility annualized [3] Values may not sum to 3b due to unknown donor type [4] Among first transplants that occurred after the start of dialysis from 2005-2008 42 of transplants in the US were not included because the transplant
occurred less than 90 days after the start of ESRD and 02 were not included because the patient was not assigned to a facility at time of transplant [5] Values may not sum to 3f due to unknown donor type [6] Standardized Transplantation Ratio calculated as ratio of actual (3f) to expected (3g) Not shown if 3g is too small [7] A p-value less than or equal to 005 indicates that the difference between the actual and expected transplants is probably real and is not due to random
chance while a p-value greater than 005 indicates that the difference is plausibly due to random chance [8] The confidence interval range represents uncertainty in the value of the STR due to random variation [9] Sum of 4 years used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 4 Waitlist Summary for Dialysis Patients under Age 70 Treated as of December 31st of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
4a
4b
4c
4d
Eligible patients on 12311 (n)
Patients on the waitlist ( of 4a)
P-value 3 (compared to US value)
Patients on the waitlist by subgroup ( of corresponding value in 4e)
Age lt 40
Age 40-69
96
344
lt01
600
296
87
333
002
600
278
83
337
002
500
320
93
247
025
250
247
502
215
na
364
193
344
222
na
363
199
464
214
na
320
198
Male 327 333 349 239 221 223 220
Female 362 333 325 255 209 219 207
African American 392 308 277 200 197 202 200
AsianPacific Islander
Native American
00
100
284
313
372
220
326
172
White Hispanic
White Non-Hispanic
Otherunknown race
00
310
500
364
500
412
00
308
194
237
86
185
233
136
238
206
261
Diabetes 286 289 356 216 167 173 163
Non-diabetes 404 381 316 286 250 259 255
Previous kidney transplant
No previous kidney transplant
545
318
556
308
429
329
429
233
429
192
430
195
437
192
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
326
333
379
324
320
357
414
240
345
108
367
308
120
287
263
129
286
279
111
268
292
4e Eligible patients in 4a by subgroup (n)
Age lt 40
Age 40-69
15
81
15
72
8
75
8
85
66
435
46
298
63
400
Male 49 45 43 46 286 197 261
Female 47 42 40 47 216 148 202
African American 51 52 47 50 259 137 194
AsianPacific Islander
Native American
0
1
0
0
0
0
1
0
06
03
09
13
22
08
White Hispanic
White Non-Hispanic
Otherunknown race
2
42
0
2
33
0
2
34
0
3
39
0
15
216
02
14
169
02
70
164
06
Diabetes 49 45 45 51 210 148 204
Non-diabetes 47 42 38 42 292 196 259
Previous kidney transplant
No previous kidney transplant
11
85
9
78
7
76
7
86
50
451
39
306
42
422
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
43
24
29
34
25
28
29
25
29
37
30
26
195
164
143
137
110
97
180
145
139
SAMPLE
na = not applicable [1] See Guide Section VII [2] Values are shown for the average facility [3] Facility waitlist percentage is compared to the US waitlist percentage for that year 226 (2005) 230 (2006) 237 (2007) 214 (2008)
A p-value greater than 005 indicates that the difference between percent of patients waitlisted at the facility and national percentage is plausibly due to random chance
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 918
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 5 Facility Modality Hemoglobin and Urea Reduction Ratio for Medicare Dialysis Patients1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Modality (among all dialysis patients with ESRD for 90+ days and 1+ claim at this facility)
5a Patients treated during year1 (n) 163 162 152 153 843 661 771
5b Modality ( of 5a sums to 100)
Hemodialysis 840 858 862 869 891 896 895
CAPDCCPD 129 80 132 98 47 50 56
Other dialysis3 31 62 07 33 62 54 48
Hemoglobin (among ESA-treated dialysis patients with ESRD for 90+ days and 4+ Hemoglobin claims at this facility)
5c Eligible patients1 (n) 123 119 107 110 571 420 496
5d Average hemoglobin (gdL) 126 119 118 106 116 116 116
5e Hemoglobin categories ( of 5c sums to 100)
lt 10 gdL 16 25 19 164 26 24 23
10-12 gdL 187 429 617 809 684 727 713
gt 12 gdL 797 546 364 27 290 249 264
5f Hemoglobin 10-12 gdL ( of HD pts) 170 416 630 840 682 724 711
Hemoglobin 10-12 gdL ( of PD pts) 286 667 429 00 649 679 689
5g Hemoglobin percentiles for this facility4
In this State 7 48 79 72
In this Network 7 38 61 59
In the US 6 37 62 69
Urea Reduction Ratio (URR among HD patients with ESRD for 183+ days and 4+ URR claims at this facility)6
5h Eligible patients1(n) 95 100 97 113 521 384 454
5i URR categories ( of 5h sums to 100)
lt 600 74 50 31 09 17 19 15
600-649 126 140 52 71 25 30 27
650-699 474 480 515 265 113 130 110
700-749 295 250 309 469 391 391 360
75+ 32 80 93 186 454 430 488
5j URR 65+ ( of 5h meets a KDOQI guideline) 800 810 918 920 958 951 958
5k URR percentiles for this facility5
In this State 4 2 13 17
In this Network 4 2 18 21
In the US 3 3 16 16SAMPLE
na = not applicable [1] See Guide Section VIII [2] Counts are shown for the average facility [3] Other dialysis includes patients who switch between HD and PD during the year and patients for whom modality is unknown [4] Percent of facilities with a smaller percentage of patients with hemoglobin 10-12 gdl [5] Percent of facilities with a smaller percentage of patients with URR 65+ [6] Patients identified in the Standard Information Management System (SIMS) as having dialyzed five or more times per week were excluded from the URR
calculations Among eligible patients in the US 044 were excluded due to frequent dialysis in 2008
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1018
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 6 Vascular Access Information1 (CMS Fistula First) 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Vascular Access
6a Prevalent hemodialysis patient months3 1709 1454 1424 1446
6b Vascular access type in use ( of 6a sums to 100)
Arteriovenous fistula 263 352 410 427 465 483 502
Arteriovenous graft 420 384 361 315 271 214 227
Catheter 314 259 228 258 261 300 267
OtherMissing 03 04 01 00 03 03 04
6c Arteriovenous fistulae in place4 ( of 6a) 317 422 492 512 541 573 581
6d Catheter only ge 90 days5 ( of 6a) 142 94 103 95 116 137 115
Vascular Access at First Treatment 6e Incident hemodialysis patients (n) 26 0 12 23 189 148 173
6f Vascular access type in use6 ( of 6e sums to 100)
Arteriovenous fistula 154 417 217 146 149 158
Arteriovenous graft 115 83 43 53 45 68
Catheter 538 500 739 777 792 749
OtherMissing 192 00 00 23 13 25
6g Arteriovenous fistulae in place4 ( of 6e) 231 583 391 253 288 308
SAMPLE na = not applicable [1] See Guide Section IX [2] Values are shown for the average facility [3] Patients may be counted up to 12 times per year [4] Includes all patients with fistulae regardless of whether or not they received their hemodialysis treatments using their fistulae [5] Catheter was used for treatment and has been in place for 90 days or more prior to treatment Patient does not have an fistula or graft in place Catheter is
only access Port access devices are reported as catheters for this project [6] Patients listed as graft or catheter may have had fistulae in place for future use but they actually received their treatment through a graft or catheter
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1118
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patient Characteristics3
7a Total number of patients with forms (n) 53 12 10 11 350 304 319
7b Average age (years [0-95]) 632 658 732 612 643 648 633
7c Female ( of 7a) 434 500 400 455 448 442 440
7d Race4 ( of 7a sums to 100)
African-American 358 167 100 364 335 233 284
AsianPacific Islander 00 00 00 00 11 18 42
Native American 00 00 00 00 05 24 11
White 642 833 900 636 641 717 658
OtherUnknownMissing 00 00 00 00 08 08 05
7e Hispanic ( of 7a) 19 00 00 91 30 32 134
7f Primary cause of ESRD ( of 7a sums to 100)
Diabetes 509 417 300 545 408 403 451
Hypertension 189 167 400 364 304 272 287
Primary Glomerulonephritis 132 167 200 91 63 67 64
OtherMissing 170 250 100 00 226 258 199
7g Medical coverage ( of 7a sums to 100)
Employer group only 38 333 100 182 178 162 161
Medicare only 113 00 100 91 162 163 204
Medicaid only 75 00 00 91 103 100 114
Medicare and Medicaid only 226 00 00 91 112 102 126
Medicare and Other 377 500 800 455 360 370 238
OtherUnknown 151 167 00 91 40 60 86
None 19 00 00 00 46 43 71
7h Body Mass Index5
Male 287 242 281 227 268 269 266
Female 261 335 276 328 288 287 280
7i Employment6
Six months prior to ESRD treatment 190 667 333 400 348 387 362
At first ESRD treatment 95 667 333 400 181 225 220
7j Primary modality7 ( of 7a sums to 100)
Hemodialysis 500 444 500 944 945 939
CAPDCCPD 500 556 500 56 55 61
OtherUnknownMissing 00 00 00 00 00 00
7k Number of incident hemodialysis patients7 (n) 6 4 5 332 286 298
7l Access used at first outpatient dialysis7 ( of 7k sums to 100)
Arteriovenous fistula 00 500 00 127 141 136
Arteriovenous graft 00 00 00 29 27 33
Catheter 100 500 100 843 832 819
OtherUnknownMissing 00 00 00 01 00 12
7m Arteriovenous fistulae placed7 ( of 7k) 167 750 00 229 270 292
Average Lab Values Prior to Dialysis3
7n Hemoglobin (gdL [3-18]) 105 112 120 105 99 100 99
7o Serum Albumin (gdL [08-60]) 32 35 36 33 32 32 31
SAMPLE
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1218
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 (cont) Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Average Lab Values Prior to Dialysis3
7p Serum Creatinine (mgdL [2-33]) 70 50 54 51 58 58 63
7q GFR (mLmin [0-60]) 103 124 119 140 119 118 110
Care Prior to ESRD Therapy 7r Received ESA prior to ESRD ( of 7a) 472 333 700 364 261 295 263
7s Pre-ESRD nephrologist care7 ( of 7a sums to 100)
No 250 200 91 330 321 310
Yes lt 6 months 00 00 00 38 48 116
Yes 6-12 months 417 300 545 201 215 208
Yes gt 12 months 333 500 364 328 341 242
Unknown 00 00 00 103 76 124
7t Informed of transplant options7 ( of 7a) 917 900 636 690 710 724
7u Patients not informed of transplant options7 (n) 1 0 3 102 87 92
7v Reason not informed7 ( of 7u may not sum to 100)
Medically unfit 00 100 384 439 309
Unsuitable due to age 00 00 334 320 239
Psychologically unfit 00 00 21 30 28
Patient declined information 00 00 13 12 13
Patient has not been assessed 100 00 332 294 449
Comorbid Conditions 7w Pre-existing Comorbidity ( yes of 7a)
Congestive heart failure 566 250 400 273 415 374 328
Atherosclerotic heart disease8 340 417 400 364 268 268 210
Other cardiac disorder8 00 00 100 00 198 197 171
CVD CVA TIA 57 00 00 182 107 103 95
Peripheral vascular disease 189 333 100 182 154 155 140
History of hypertension 981 917 100 909 861 845 847
Diabetes8 566 417 300 636 574 560 578
Diabetes on insulin 170 250 300 455 383 380 363
COPD 57 333 00 182 130 123 93
Current smoker 57 00 00 91 82 77 62
Cancer 00 00 00 182 112 109 74
Alcohol dependence 00 00 00 00 21 23 16
Drug dependence 00 00 00 00 18 15 13
Inability to ambulate 00 00 00 91 88 75 69
Inability to transfer 00 00 00 00 51 38 35
7x Average number of comorbid conditions 30 29 26 35 35 33 31 SAMPLE
na= not applicable [1] See Guide Section X [2] Values are shown for the average facility [3] For continuous variables summaries include only responses in range indicated in brackets [4] Asian includes Indian sub-continent Native American includes Alaskan Native White includes Middle Eastern and Arabian [5] The median BMI is computed for adult patients at least 20 years old [6] Full-time part-time or student ( of 18-60 year olds) [7] Data collection for these items began mid-year 2005 Summaries for these items shown starting in 2006 [8] AHD includes ischemic heart disease (coronary artery disease) and myocardial infarction Other cardiac disorder includes cardiac arrest cardiac
dysrhythmia and pericarditis Diabetes includes patients with diabetes as the primary cause of ESRD
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1318
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 8 Summaries for All Dialysis Patients Treated as of December 31 of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
8a
8b
8c
Patients treated on 1231 (n)
Average age (years)
Age ( of 8a sums to 100)
lt 20
141
601
07
123
616
00
127
636
00
130
627
00
712
616
05
523
626
05
652
609
05
20-64 574 593 551 585 549 513 562
65+ 418 407 449 415 446 481 433
8d Female ( of 8a) 489 472 512 515 454 449 453
8e Race ( of 8a sums to 100)
African American 447 553 543 554 452 327 374
AsianPacific Islander
Native American
00
07
00
00
00
00
08
00
13
05
24
30
48
15
White 546 447 457 438 526 615 551
OtherUnknownMissing 00 00 00 00 04 05 12
8f Ethnicity ( of 8a sums to 100)
Hispanic
Non-Hispanic
Unknown
21
950
28
24
943
33
24
953
24
23
962
15
33
953
14
38
950
12
153
827
19
8g Cause of ESRD ( of 8a sums to 100)
Diabetes 475 472 480 538 410 415 437
Hypertension
Glomerulonephritis
OtherUnknown
Missing
199
163
135
28
220
154
114
41
252
118
118
31
215
115
108
23
298
100
168
23
267
106
190
22
277
102
173
11
8h Average duration of ESRD (years) 45 48 47 43 43 42 43
8i Years since start of ESRD ( of 8a sums to 100)
lt 1 220 163 134 123 185 191 181
1-2 255 211 189 269 186 189 187
2-3 106 187 142 154 153 158 149
3-6 206 187 291 208 265 258 259
6+ 213 252 244 246 211 204 224
8j Nursing home patients3 ( of 8a) 64 130 87 62 142 162 133
8k Modality ( of 8a sums to 100)
In-center hemodialysis
In-center self hemodialysis
Home hemodialysis
Continuous ambulatory peritoneal dialysis
Continuous cycling peritoneal dialysis
Other modality4
837
00
00
142
14
07
902
00
00
73
16
08
858
00
00
110
31
00
869
00
00
38
92
00
909
00
15
38
32
07
908
00
15
34
37
07
906
00
11
27
49
07SAMPLE
na = not applicable [1] See Guide Section XI [2] Values are shown for the average facility [3] Includes patients who were also treated by a nursing facility at any time during the year The source of nursing facility history of patients is the Nursing
Home Minimum Dataset [4] Other modality includes other dialysis uncertain modality and patients not on dialysis but still temporarily assigned to the facility (discontinued dialysis
recovered renal function and lost to follow up)
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 9 Comorbidities Reported on Medicare Claims for Medicare Dialysis Patients Treated as of December 31 of Each Year1 2005-2007
This Facility Regional Averages2 2007 Measure Name 2005 2006 2007 State Network US
9a Medicare dialysis patients on 1231 (n) 112 103 107 556 401 473
9b Comorbidity ( yes of 9a)
AIDSHIV positive 00 00 09 12 10 18
Alcohol dependence 36 29 19 24 27 22
Anemia 54 49 37 98 79 73
Cancer 125 107 103 121 119 107
Cardiac arrest 09 10 19 15 14 15
Cardiac dysrhythmia 241 233 224 434 416 351
Cerebrovascular disease 259 252 262 309 274 273
Chronic obstructive pulmonary disease 232 282 243 359 328 296
Congestive heart failure 438 417 495 576 542 518
Diabetes 554 573 636 632 621 623
Drug dependence 00 10 00 24 26 19
Gastrointestinal tract bleeding 36 68 09 34 32 29
Hepatitis B 09 10 09 13 10 12
Hepatitis other 45 29 28 46 36 38
Hyperparathyroidism 63 58 75 80 132 88
Infection 563 476 477 554 506 511
Ischemic heart disease 527 495 495 597 562 510
Myocardial infarction 54 117 37 115 98 85
Peripheral vascular disease3 536 447 533 498 476 465
Pneumonia 63 29 19 55 50 53
9c Average number of comorbid conditions 38 37 37 46 44 41
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer on 1231 each year See Guide Section XII [2] Values are shown for the average facility [3] Peripheral vascular disease includes both venous and arterial diseases
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 10 How Patients Were Assigned to This Facility and End of Year Patient Status1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
10a Number of patients placed in facility1 (n) 205 184 166 177 1015 749 911
10b Initial patient placement for the year in this facility
( of 10a sums to 100)
Continuing at facility on 0101 698 766 741 718 686 679 691
Incident (new to ESRD) 263 163 133 51 199 206 199
Transferred into facility 39 71 127 232 115 114 110
10c Patient status at end of year ( of 10a sums to 100)
Alive in this facility on 1231 688 668 765 734 702 698 716
Alive in another facility on 1231 93 65 36 34 86 85 82
Received a transplant 29 33 42 23 31 35 28
Died death attributed to this facility 171 201 120 169 150 152 142
Died death attributed to another facility 10 27 06 11 16 15 14
Other3 10 05 30 28 15 16 18
SAMPLE[1] Patient assignment for Tables 1238 and 9 only See Guide Section XIII [2] Values are shown for the average facility [3] Includes patients who recovered renal function discontinued dialysis or were lost to follow-up Also includes dialysis unrelated deaths Dialysis
unrelated deaths are not attributed to any facility for the purposes of the mortality calculations in this report
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
Dear Dialysis Facility Director
SAMPLEThis report has been prepared for this facility by the University of Michigan Kidney Epidemiology and Cost Center (UM-KECC) with funding from the Centers for Medicare amp Medicaid Services (CMS) It is the fourteenth in a series of annual reports This is one of 5507 reports that have been sent to the ESRD Networks for distribution to ESRD providers in the US Your state survey agency will receive this report in September 2009 Selected highlights from this report are given here The information specific to this facility is printed in bold type for easy identification
Whats New This Year As part of a continuing effort to improve the quality and relevance of this report for your facility the following changes have been incorporated into your 2009 DFR The percent of cardiac related deaths has been added to Table 1 First year mortality statistics for new dialysis patients who started dialysis between January 1 2005 and December 31 2007 are calculated and reported in the second half of Table 1 Please refer to the section entitled Whats New in Section I of the Guide to the 2009 Dialysis Facility Reports for greater detail on these changes
Dialysis Facility Compare Anemia management is reported as two measures the percent of patients with hemoglobin values of less than 10 gdL and the percent of patients with hemoglobin values greater than 12 gdL The URR and hemoglobin measures were calculated for Medicare approved dialysis facilities operating at any time during 2008 The hemoglobin measures were calculated only for patients treated with erythropoiesis stimulating agents (ESA) The patient survival measure was calculated for Medicare approved dialysis facilities operating at any time from 2005 through 2008 The following measures for this facility will appear on the DFC website
Measure Name This Facility
1 The percentage of Medicare hemodialysis patients treated in this facility during 2008 with URR ge 65 92
Number of patients included in calculation 113
2 The percentage of Medicare patients treated in this facility during 2008 with ESA-treated hemoglobin lt10 gdL 16 with ESA-treated hemoglobin gt12 gdL 3 Number of patients included in calculation 110
3 Patient survival reported as as expected better than expected or worse than expected for the time period 2005-2008 for this facility As Expected
Standardized Mortality Ratio (SMR) 105 P-value 062
Please see Table 5 for more information on URR and ESA-treated hemoglobin for this facility URR and ESA-treated hemoglobin measures based on 10 or fewer patients will be reported as not available on DFC Table 1 provides additional information on patient survival If the Standardized Mortality Ratio (SMR) is less than 100 and statistically significant (plt005) the patient survival classification is Better than Expected on DFC If the facility SMR is greater than 100 and statistically significant (plt005) the patient survival classification is Worse than Expected on DFC Otherwise the patient survival classification is As Expected on DFC Please note that the classification is not reported for a facility if the SMR is based on 3 or fewer expected deaths
Overview This report includes summaries of patient characteristics treatment patterns and patient outcomes for chronic dialysis patients who were treated in this facility between January 2005 and December 2008 Mortality hospitalization and transplantation statistics are reported for a three- or four-year period Regional and national averages are included to allow for comparisons Several of the summaries of patient mortality
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 218
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
hospitalization and transplantation are adjusted to account for the characteristics of the patient mix at this facility including age sex race ethnicity and diabetes as a cause of ESRD Unless otherwise specified data refer to hemodialysis and peritoneal dialysis patients combined
Summary data about the percent of patients with URR of 65 or higher and with central catheters are included as suggested by Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines Summary data about the percent of patients with hemoglobin from 10 gdL to 12 gdL are also reported These practice pattern measures are strongly correlated with the mortality and hospitalization measures found in these reports Note that elevated mortality or hospitalization rates may be due to a variety of causes unrelated to clinical practices so it may not always be possible to identify clinical practices that explain those rates
SAMPLEMortality Mortality summaries are provided in Table 1 A Standardized Mortality Ratio (SMR) is calculated for each facility Although mortality statistics can vary substantially from year to year they are reported here as a key outcome for dialysis patients The SMR compares the observed death rate in this facility to the death rate that would be expected based on national death rates for patients with the characteristics of the patients at this facility Time at risk and deaths within 60 days after transfer out of this facility are attributed to this facility Time at risk and deaths after transplantation are excluded from the analysis The SMR is adjusted for patient age sex race ethnicity diabetes as a cause of ESRD duration of ESRD nursing home status BMI at incidence and comorbidities at incidence as well as state population death rates The rate of withdrawal from dialysis and the percentage of deaths due to infection and cardiac related deaths are reported in the table to help in the interpretation of the mortality outcomes
There was a 23 annual observed death rate among the patients treated at this facility during 2005-2008 while a rate of 22 would be expected based on the age sex race ethnicity diabetes as cause of ESRD duration of ESRD nursing home status BMI at incidence comorbidities at incidence and state population death rates The SMR of observed to expected deaths is 105 which is not far (5) above the national reference value of 100
First Year Mortality Mortality summaries for new dialysis patients are also provided in Table 1 The first year SMR compares the observed death rate in this facility to the death rate that would be expected based on national death rates for new dialysis patients with the characteristics of the patients at this facility Similar to the mortality of all patients the SMR for new dialysis patients is adjusted for patient age sex race ethnicity diabetes as a cause of ESRD nursing home status BMI at incidence and comorbidities at incidence as well as state population death rates The rate of withdrawal from dialysis and the percentage of deaths due to infection and cardiac related deaths are also reported to facilitate the interpretation of the mortality outcomes
There was a 36 annual observed first year death rate among the patients starting dialysis at this facility during 2005-2007 while a rate of 26 would be expected based on the age sex race ethnicity diabetes as cause of ESRD nursing home status BMI at incidence comorbidities at incidence and state population death rates The first year SMR of observed to expected deaths is 140 which is 40 more deaths than expected at this facility This difference is not statistically significant (pgt005) so this higher mortality could plausibly be just a chance occurrence
Hospitalization Hospitalization summaries are reported for Medicare patients in Table 2 The table includes information on the number of days hospitalized the number of hospital admissions and the diagnoses present at admission for patients at this facility The Standardized Hospitalization Ratio (SHR) for Days compares the observed number of days hospitalized to the number of days that would be expected based on national hospitalization rates for patients with the characteristics of the patients at this facility The Standardized Hospitalization Ratio (SHR) for Admissions compares the observed number of admissions to the number of admissions that would be expected based on national hospitalization rates for patients with the characteristics of the patients at this facility Both measures are adjusted for age race ethnicity sex diabetes duration of ESRD nursing home status and BMI As in the mortality calculation time at risk and
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 318
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
hospitalizations within 60 days after transfer out of this facility are attributed to this facility Time at risk and hospitalizations starting 3 days before transplantation are excluded from the analysis
The SHR (days) of observed to expected number of days hospitalized at this facility during 2005-2007 is 090 which is 10 lower than expected The SHR (admissions) of observed to expected number of admissions for patients at this facility during 2005-2007 is 090 which is 10 lower than expected
Infection Information on hospitalizations for septicemia is reported on Table 2 The information in Table 2 is based on Medicare patient claims
SAMPLEThe percentage of Medicare dialysis patients at this facility hospitalized with septicemia during 2005-2007 was 17 compared to 12 nationally
Transplantation Transplantation summaries are reported in Table 3 The Standardized Transplantation Ratio (STR) represents relative first transplantation rates (observedexpected) for patients at this facility adjusting for patient age Patients who are 70 or older as well as those with a prior kidney transplant are excluded As in the mortality and hospitalization calculations time at risk and transplants within 60 days after transfer out of this facility are attributed to this facility
Of the patients under age 70 treated at this facility during 2005-2008 who had not previously received a transplant 7 were transplanted annually while a rate of 5 would be expected for these patients The STR of observed to expected number of patients transplanted for this facility is 126 which is 26 higher than expected for this facility This difference is not statistically significant (pgt005) and could plausibly be due to random chance
Transplant Waitlist Table 4 summarizes waitlist information for patients under age 70 being treated at this facility at the end of each year Unlike the mortality hospitalization and transplantation statistics the waitlist statistics do not include patients who transferred out of the facility
Among the 93 dialysis patients under age 70 treated at this facility on December 31 2008 25 were on the kidney transplant waitlist compared to 21 nationally This difference is not statistically significant (pgt005) and is plausibly due to random chance
Practice Patterns Table 5 summarizes the dialytic modality hemoglobin and URR for patients treated at this facility during each year These data are derived from CMS Medicare paid dialysis claim data Vascular access data for prevalent and incident patients as reported by the CMS Fistula First project are summarized in Table 6
Among the 110 ESA-treated dialysis patients included in the analysis of Medicare claims data of hemoglobin for 2008 at this facility 81 had hemoglobin between 10-12 gdL compared to 71 nationally Among the 113 hemodialysis patients in this facility included in the analysis of Medicare claims data of URR in 2008 92 had URR above the KDOQI minimum value for URR (URR ge 65) compared to 96 nationally
At this facility in 2008 an average of 39 of incident patients had AV fistulae in place compared to 31 nationally Also at this facility in 2008 an average of 51 of prevalent patients had AV fistulae in place compared to 58 nationally Of the prevalent patients receiving hemodialysis treatment at this facility in 2008 10 had a catheter which had been in place for more than 90 days as their only vascular access compared to 11 nationally See Tables 5 and 6 for more information about practice patterns
Patient Characteristics Characteristics of patients starting dialysis during 2005-2008 are reported in Table 7 Table 8 gives summaries for all dialysis patients being treated at the end of each year 2005-2008 Comorbidities are reported in Table 9 for Medicare dialysis patients being treated at the end of each year 2005-2007
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
There were 11 patients with Medical Evidence Forms (CMS-2728) which indicated that they started treatment at this facility during 2008 The average number of comorbidities reported for new patients is 35 which is higher than the average of 31 reported nationally Also 9 of these patients were not under the care of a nephrologist before starting dialysis compared to 31 nationally Furthermore 64 of these patients were informed of their transplant options compared to 72 nationally The average serum albumin calculated for these patients (before first dialysis) is 33 gdl which is higher than the national average value of 31 gdl The average residual renal function (GFR) calculated for these patients from serum creatinine (before first dialysis) and other parameters was 140 mlmin which is higher than the national average value of 110 mlmin
SAMPLEAmong patients treated at this facility on December 31 2008 6 were treated in a nursing home during the year which is lower than the national average value of 13 The average number of comorbidities reported on Medicare claims in 2007 for Medicare patients in this facility on December 31 2007 is 37 which is lower than the national average value of 41
Facility Information General information about this facility is provided in Tables 11 12 and 13 Table 11 provides counts of patients treated Medicare eligibility treatment modality and staffing from the Annual Facility Survey (Form CMS-2744) Table 12 reports survey and certification activity Table 13 includes services provided by this facility as well as information on ownership
This facility reported having 28 staff members to care for 140 patients at the end of 2008 This facility reported having 21 stations available as of March 31 2009 This facility offers both hemodialysis and peritoneal dialysis services Additional information regarding patient counts patient modality and facility staffing is available in Table 11
Sources of Patient Data This report is based primarily on Medicare claims and data collected for CMS Patients were assigned to this facility based on the Standard Information Management System (SIMS) database Medicare claims and Medical Evidence Forms (Form CMS-2728) Network 99 has a list of the patients included in the mortality analyses for this facility Table 9 reports comorbidities reported on Medicare claims Table 10 reports the number of patients placed in this facility for analyses in Tables 1 2 3 8 and 9 of this report Table 10 also provides information on patient status at the end of the year both for patients who remain in this facility until the end of each year and for those who transfer out of this facility receive a transplant or die during the year
These are just a few highlights of the statistics you will find in this report based on the data for this facility We hope that this report is of interest to you and that you will discuss it with your staff We welcome any questions or comments you might have about the content of the current report or any suggestions you might have for future reports Comments or suggestions can be submitted at the secure site available at wwwDialysisReportsorg until October 15 2009 If you have questions after the comment period is over please contact us directly at keccdfrumichedu or (734) 998-9823
For a complete description of the methods used to calculate the statistics in this report please see the Guide to the 2009 Dialysis Facility Reports The Guide is available from ESRD Network 99 and is also on the UM-KECC web site at wwwDialysisReportsorg
Prepared by The University of Michigan Kidney Epidemiology and Cost Center (UM-KECC) under contract with the Centers for Medicare amp Medicaid Services
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 518
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Death due to
2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 1 Mortality Summary for All Dialysis Patients (2005-08) amp New Dialysis Patients (2005-07)1
Regional Averages2 This Facility per Year 2005-2008
Measure Name 2005 2006 2007 2008 2005-2008 State Network US
SAMPLEAll Patients Death Rates 1a Patients (n=number) 205 184 166 177 7327 965 700 901
1b Patient years (PY) at risk (n) 1486 1265 1249 1262 52627 670 479 606
1c Deaths (n) 35 37 20 30 1227 146 108 127
1d Expected deaths (n) 322 264 280 296 1167 150 118 127
1e Death rate per 100 PY ( of 1b) 236 292 160 238 232 218 225 210
1f Expected death rate per 100 PY ( of 1b) 216 209 225 235 221 225 246 210
All Patients Categories of Death 1g Withdrawal from dialysis prior to death ( of 1c) 286 378 300 200 295 275 341 238
1h Death due to Infections ( of 1c) 286 243 200 200 238 173 180 175
Cardiac causes ( of 1c) 429 324 600 267 385 311 303 273
1i Dialysis unrelated deaths3 (n excluded from SMR) 0 0 1 2 37 01 01 01
All Patients Standardized Mortality Ratio (SMR)
1j SMR4 109 140 071 101 105 097 091 100
1k P-value5 066 006 014 099 062 na na na
1l Confidence interval for SMR6
High (95 limit) 151 193 110 145 125 na na na
Low (5 limit) 076 099 044 068 087 na na na
All Patients SMR Percentiles for this Facility (ie percent of facilities with lower mortality rates) 1m In this State 62 88 18 64 65
1n In this Network 69 89 31 69 76
1o In the US 53 82 21 60 59
Regional Averages New Patients First Year Death Rates 2005 2006 2007 2005-2007 Per Year 2005-20072
1p New Patients (n=number) 53 12 10 757 237 189 202
1q Patient years (PY) at risk (n) 422 96 92 6117 199 158 171
1r Deaths (n) 16 4 2 227 59 46 48
1s Expected deaths (n) 102 24 31 1577 62 51 48
1t Death rate per 100 PY 379 415 216 360 295 289 281
1u Expected death rate per 100 PY 242 247 338 257 309 321 281
New Patients Categories of Deaths 1v Withdrawal from dialysis prior to death ( of 1r) 250 750 100 409 343 429 322
1w Death due to Infections ( of 1r) 375 00 00 273 212 228 231
Cardiac causes ( of 1r) 250 750 00 318 336 362 331
New Patients First Year Standardized Mortality Ratio (SMR)
1x SMR4 157 168 064 140 095 090 100
1y P-value5 011 044 079 015 na na na
1z Confidence interval for SMR6
High (95 limit) 255 430 231 212 na na na
Low (5 limit) 090 046 008 088 na na na
na = not applicable [1] See Guide Section IV [2] Values are shown for the average facility annualized [3] Defined as deaths due to street drugs and accidents unrelated to treatment [4] Calculated as a ratio of deaths (1c to 1d for all patients 1r to 1s for new patients) to expected deaths not shown if there are too few expected deaths [5] A p-value less than or equal to 005 indicates that the difference between the actual and expected mortality is probably real and is not due to random
chance alone while a p-value greater than 005 indicates that the difference could plausibly be due to random chance [6] The confidence interval range represents uncertainty in the value of the SMR due to random variation [7] Sum of 4 years (all patients) or 3 years (new patients) used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 2 Hospitalization Summary for Medicare Dialysis Patients1 2005-2007
Regional Averages2 This Facility per Year 2005-2007
Measure Name 2005 2006 2007 2005-2007 State Network US Medicare Dialysis Patients
2a Medicare dialysis patients (n) 160 154 141 4555 791 572 674
2b Patient years (PY) at risk (n) 1136 1037 1037 32105 543 387 445
Days Hospitalized Statistics
2c Total days hospitalized (n) 1692 1758 924 43745 869 542 658
2d Expected total days hospitalized (n) 18024 15891 14855 487705 8082 5799 6580
2e Days hospitalized per PY 149 170 89 136 160 140 148
2f Expected days hospitalized per PY 159 153 143 152 149 150 148
2g Standardized Hospitalization Ratio (Days)3 094 111 062 090 107 093 100
Admission Statistics
2h Total admissions (n) 226 193 140 5595 115 77 84
2i Expected total admissions (n) 2287 2023 1919 62305 1039 747 844
2j Admissions per PY 20 19 13 17 21 20 19
2k Expected admissions per PY 20 20 19 19 19 19 19
2l Standardized Hospitalization Ratio (Admissions)4 099 095 073 090 111 103 100
Diagnoses Present at Admission ( of 2a) 2m Septicemia 188 169 142 167 153 128 123
2n Acute myocardial infarction 69 58 21 51 60 52 42
2o Congestive heart failure 288 208 191 231 309 281 252
2p Cardiac dysrhythmia 163 110 121 132 166 168 146
2q Cardiac arrest 31 13 28 24 22 18 17
Length of Stay 2r One day admissions ( of 2h) 186 155 229 186 124 144 136
2s Average length of stay (days per admission 2c2h) 75 91 66 78 75 70 78
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer see Guide Section V [2] Values are shown for the average facility annualized [3] Standardized Hospitalization Ratio (Days) calculated as ratio of actual (2c) to expected (2d) hospitalized days [4] Standardized Hospitalization Ratio (Admissions) calculated as ratio of actual (2h) to expected (2i) total admissions [5] Sum of 3 years used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 3 Transplantation Summary for Dialysis Patients under Age 70 2005-2008
Regional Averages2 This Facility per Year 2005-2008
Measure Name 2005 2006 2007 2008 2005-2008 State Network US
3a Eligible patients1 (n) 147 121 110 112 4909 636 437 616
3b Transplants (n) 8 7 7 3 259 30 25 25
3c Donor type (sums to 3b3)
Living Donor (n) 2 1 0 1 49 10 10 08
Deceased Donor (n) 6 6 7 2 219 20 16 17
Patients who have not Previously Received a Transplant
3d Eligible patients1 (n) 134 106 100 104 4449 575 389 550
3e Patient years (PY) at risk (n) 967 768 761 776 32739 404 268 378
3f 1st transplants4 (n) 7 6 6 3 229 27 22 21
3g Expected 1st transplants (n) 53 44 39 39 1759 22 15 21
3h 1st transplant rate per 100 PY 72 78 79 39 67 66 82 56
3i Expected 1st transplant rate per 100 PY 55 57 51 50 53 56 55 56
3j Donor type (sums to 3f5)
Living Donor (n) 2 0 0 1 39 09 08 06
Deceased Donor (n) 5 6 6 2 199 18 14 15
Standardized 1st Transplantation Ratio (STR)
3k STR6 131 136 154 078 126 119 149 100
3l P-value7 058 056 040 092 034 na na na
3m 95 Confidence interval for STR8
Upper limit 270 297 334 227 190 na na na
Lower limit 053 050 056 016 079 na na na
STR Percentiles for this Facility (ie percent of facilities with lower transplantation rates) 3n In this State 56 59 69 41 53
3o In this Network 47 49 55 35 40
3p In the US 67 69 76 48 67
SAMPLE na = not applicable [1] See Guide Section VI [2] Values are shown for the average facility annualized [3] Values may not sum to 3b due to unknown donor type [4] Among first transplants that occurred after the start of dialysis from 2005-2008 42 of transplants in the US were not included because the transplant
occurred less than 90 days after the start of ESRD and 02 were not included because the patient was not assigned to a facility at time of transplant [5] Values may not sum to 3f due to unknown donor type [6] Standardized Transplantation Ratio calculated as ratio of actual (3f) to expected (3g) Not shown if 3g is too small [7] A p-value less than or equal to 005 indicates that the difference between the actual and expected transplants is probably real and is not due to random
chance while a p-value greater than 005 indicates that the difference is plausibly due to random chance [8] The confidence interval range represents uncertainty in the value of the STR due to random variation [9] Sum of 4 years used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 4 Waitlist Summary for Dialysis Patients under Age 70 Treated as of December 31st of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
4a
4b
4c
4d
Eligible patients on 12311 (n)
Patients on the waitlist ( of 4a)
P-value 3 (compared to US value)
Patients on the waitlist by subgroup ( of corresponding value in 4e)
Age lt 40
Age 40-69
96
344
lt01
600
296
87
333
002
600
278
83
337
002
500
320
93
247
025
250
247
502
215
na
364
193
344
222
na
363
199
464
214
na
320
198
Male 327 333 349 239 221 223 220
Female 362 333 325 255 209 219 207
African American 392 308 277 200 197 202 200
AsianPacific Islander
Native American
00
100
284
313
372
220
326
172
White Hispanic
White Non-Hispanic
Otherunknown race
00
310
500
364
500
412
00
308
194
237
86
185
233
136
238
206
261
Diabetes 286 289 356 216 167 173 163
Non-diabetes 404 381 316 286 250 259 255
Previous kidney transplant
No previous kidney transplant
545
318
556
308
429
329
429
233
429
192
430
195
437
192
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
326
333
379
324
320
357
414
240
345
108
367
308
120
287
263
129
286
279
111
268
292
4e Eligible patients in 4a by subgroup (n)
Age lt 40
Age 40-69
15
81
15
72
8
75
8
85
66
435
46
298
63
400
Male 49 45 43 46 286 197 261
Female 47 42 40 47 216 148 202
African American 51 52 47 50 259 137 194
AsianPacific Islander
Native American
0
1
0
0
0
0
1
0
06
03
09
13
22
08
White Hispanic
White Non-Hispanic
Otherunknown race
2
42
0
2
33
0
2
34
0
3
39
0
15
216
02
14
169
02
70
164
06
Diabetes 49 45 45 51 210 148 204
Non-diabetes 47 42 38 42 292 196 259
Previous kidney transplant
No previous kidney transplant
11
85
9
78
7
76
7
86
50
451
39
306
42
422
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
43
24
29
34
25
28
29
25
29
37
30
26
195
164
143
137
110
97
180
145
139
SAMPLE
na = not applicable [1] See Guide Section VII [2] Values are shown for the average facility [3] Facility waitlist percentage is compared to the US waitlist percentage for that year 226 (2005) 230 (2006) 237 (2007) 214 (2008)
A p-value greater than 005 indicates that the difference between percent of patients waitlisted at the facility and national percentage is plausibly due to random chance
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 918
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 5 Facility Modality Hemoglobin and Urea Reduction Ratio for Medicare Dialysis Patients1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Modality (among all dialysis patients with ESRD for 90+ days and 1+ claim at this facility)
5a Patients treated during year1 (n) 163 162 152 153 843 661 771
5b Modality ( of 5a sums to 100)
Hemodialysis 840 858 862 869 891 896 895
CAPDCCPD 129 80 132 98 47 50 56
Other dialysis3 31 62 07 33 62 54 48
Hemoglobin (among ESA-treated dialysis patients with ESRD for 90+ days and 4+ Hemoglobin claims at this facility)
5c Eligible patients1 (n) 123 119 107 110 571 420 496
5d Average hemoglobin (gdL) 126 119 118 106 116 116 116
5e Hemoglobin categories ( of 5c sums to 100)
lt 10 gdL 16 25 19 164 26 24 23
10-12 gdL 187 429 617 809 684 727 713
gt 12 gdL 797 546 364 27 290 249 264
5f Hemoglobin 10-12 gdL ( of HD pts) 170 416 630 840 682 724 711
Hemoglobin 10-12 gdL ( of PD pts) 286 667 429 00 649 679 689
5g Hemoglobin percentiles for this facility4
In this State 7 48 79 72
In this Network 7 38 61 59
In the US 6 37 62 69
Urea Reduction Ratio (URR among HD patients with ESRD for 183+ days and 4+ URR claims at this facility)6
5h Eligible patients1(n) 95 100 97 113 521 384 454
5i URR categories ( of 5h sums to 100)
lt 600 74 50 31 09 17 19 15
600-649 126 140 52 71 25 30 27
650-699 474 480 515 265 113 130 110
700-749 295 250 309 469 391 391 360
75+ 32 80 93 186 454 430 488
5j URR 65+ ( of 5h meets a KDOQI guideline) 800 810 918 920 958 951 958
5k URR percentiles for this facility5
In this State 4 2 13 17
In this Network 4 2 18 21
In the US 3 3 16 16SAMPLE
na = not applicable [1] See Guide Section VIII [2] Counts are shown for the average facility [3] Other dialysis includes patients who switch between HD and PD during the year and patients for whom modality is unknown [4] Percent of facilities with a smaller percentage of patients with hemoglobin 10-12 gdl [5] Percent of facilities with a smaller percentage of patients with URR 65+ [6] Patients identified in the Standard Information Management System (SIMS) as having dialyzed five or more times per week were excluded from the URR
calculations Among eligible patients in the US 044 were excluded due to frequent dialysis in 2008
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1018
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 6 Vascular Access Information1 (CMS Fistula First) 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Vascular Access
6a Prevalent hemodialysis patient months3 1709 1454 1424 1446
6b Vascular access type in use ( of 6a sums to 100)
Arteriovenous fistula 263 352 410 427 465 483 502
Arteriovenous graft 420 384 361 315 271 214 227
Catheter 314 259 228 258 261 300 267
OtherMissing 03 04 01 00 03 03 04
6c Arteriovenous fistulae in place4 ( of 6a) 317 422 492 512 541 573 581
6d Catheter only ge 90 days5 ( of 6a) 142 94 103 95 116 137 115
Vascular Access at First Treatment 6e Incident hemodialysis patients (n) 26 0 12 23 189 148 173
6f Vascular access type in use6 ( of 6e sums to 100)
Arteriovenous fistula 154 417 217 146 149 158
Arteriovenous graft 115 83 43 53 45 68
Catheter 538 500 739 777 792 749
OtherMissing 192 00 00 23 13 25
6g Arteriovenous fistulae in place4 ( of 6e) 231 583 391 253 288 308
SAMPLE na = not applicable [1] See Guide Section IX [2] Values are shown for the average facility [3] Patients may be counted up to 12 times per year [4] Includes all patients with fistulae regardless of whether or not they received their hemodialysis treatments using their fistulae [5] Catheter was used for treatment and has been in place for 90 days or more prior to treatment Patient does not have an fistula or graft in place Catheter is
only access Port access devices are reported as catheters for this project [6] Patients listed as graft or catheter may have had fistulae in place for future use but they actually received their treatment through a graft or catheter
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1118
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patient Characteristics3
7a Total number of patients with forms (n) 53 12 10 11 350 304 319
7b Average age (years [0-95]) 632 658 732 612 643 648 633
7c Female ( of 7a) 434 500 400 455 448 442 440
7d Race4 ( of 7a sums to 100)
African-American 358 167 100 364 335 233 284
AsianPacific Islander 00 00 00 00 11 18 42
Native American 00 00 00 00 05 24 11
White 642 833 900 636 641 717 658
OtherUnknownMissing 00 00 00 00 08 08 05
7e Hispanic ( of 7a) 19 00 00 91 30 32 134
7f Primary cause of ESRD ( of 7a sums to 100)
Diabetes 509 417 300 545 408 403 451
Hypertension 189 167 400 364 304 272 287
Primary Glomerulonephritis 132 167 200 91 63 67 64
OtherMissing 170 250 100 00 226 258 199
7g Medical coverage ( of 7a sums to 100)
Employer group only 38 333 100 182 178 162 161
Medicare only 113 00 100 91 162 163 204
Medicaid only 75 00 00 91 103 100 114
Medicare and Medicaid only 226 00 00 91 112 102 126
Medicare and Other 377 500 800 455 360 370 238
OtherUnknown 151 167 00 91 40 60 86
None 19 00 00 00 46 43 71
7h Body Mass Index5
Male 287 242 281 227 268 269 266
Female 261 335 276 328 288 287 280
7i Employment6
Six months prior to ESRD treatment 190 667 333 400 348 387 362
At first ESRD treatment 95 667 333 400 181 225 220
7j Primary modality7 ( of 7a sums to 100)
Hemodialysis 500 444 500 944 945 939
CAPDCCPD 500 556 500 56 55 61
OtherUnknownMissing 00 00 00 00 00 00
7k Number of incident hemodialysis patients7 (n) 6 4 5 332 286 298
7l Access used at first outpatient dialysis7 ( of 7k sums to 100)
Arteriovenous fistula 00 500 00 127 141 136
Arteriovenous graft 00 00 00 29 27 33
Catheter 100 500 100 843 832 819
OtherUnknownMissing 00 00 00 01 00 12
7m Arteriovenous fistulae placed7 ( of 7k) 167 750 00 229 270 292
Average Lab Values Prior to Dialysis3
7n Hemoglobin (gdL [3-18]) 105 112 120 105 99 100 99
7o Serum Albumin (gdL [08-60]) 32 35 36 33 32 32 31
SAMPLE
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1218
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 (cont) Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Average Lab Values Prior to Dialysis3
7p Serum Creatinine (mgdL [2-33]) 70 50 54 51 58 58 63
7q GFR (mLmin [0-60]) 103 124 119 140 119 118 110
Care Prior to ESRD Therapy 7r Received ESA prior to ESRD ( of 7a) 472 333 700 364 261 295 263
7s Pre-ESRD nephrologist care7 ( of 7a sums to 100)
No 250 200 91 330 321 310
Yes lt 6 months 00 00 00 38 48 116
Yes 6-12 months 417 300 545 201 215 208
Yes gt 12 months 333 500 364 328 341 242
Unknown 00 00 00 103 76 124
7t Informed of transplant options7 ( of 7a) 917 900 636 690 710 724
7u Patients not informed of transplant options7 (n) 1 0 3 102 87 92
7v Reason not informed7 ( of 7u may not sum to 100)
Medically unfit 00 100 384 439 309
Unsuitable due to age 00 00 334 320 239
Psychologically unfit 00 00 21 30 28
Patient declined information 00 00 13 12 13
Patient has not been assessed 100 00 332 294 449
Comorbid Conditions 7w Pre-existing Comorbidity ( yes of 7a)
Congestive heart failure 566 250 400 273 415 374 328
Atherosclerotic heart disease8 340 417 400 364 268 268 210
Other cardiac disorder8 00 00 100 00 198 197 171
CVD CVA TIA 57 00 00 182 107 103 95
Peripheral vascular disease 189 333 100 182 154 155 140
History of hypertension 981 917 100 909 861 845 847
Diabetes8 566 417 300 636 574 560 578
Diabetes on insulin 170 250 300 455 383 380 363
COPD 57 333 00 182 130 123 93
Current smoker 57 00 00 91 82 77 62
Cancer 00 00 00 182 112 109 74
Alcohol dependence 00 00 00 00 21 23 16
Drug dependence 00 00 00 00 18 15 13
Inability to ambulate 00 00 00 91 88 75 69
Inability to transfer 00 00 00 00 51 38 35
7x Average number of comorbid conditions 30 29 26 35 35 33 31 SAMPLE
na= not applicable [1] See Guide Section X [2] Values are shown for the average facility [3] For continuous variables summaries include only responses in range indicated in brackets [4] Asian includes Indian sub-continent Native American includes Alaskan Native White includes Middle Eastern and Arabian [5] The median BMI is computed for adult patients at least 20 years old [6] Full-time part-time or student ( of 18-60 year olds) [7] Data collection for these items began mid-year 2005 Summaries for these items shown starting in 2006 [8] AHD includes ischemic heart disease (coronary artery disease) and myocardial infarction Other cardiac disorder includes cardiac arrest cardiac
dysrhythmia and pericarditis Diabetes includes patients with diabetes as the primary cause of ESRD
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1318
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 8 Summaries for All Dialysis Patients Treated as of December 31 of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
8a
8b
8c
Patients treated on 1231 (n)
Average age (years)
Age ( of 8a sums to 100)
lt 20
141
601
07
123
616
00
127
636
00
130
627
00
712
616
05
523
626
05
652
609
05
20-64 574 593 551 585 549 513 562
65+ 418 407 449 415 446 481 433
8d Female ( of 8a) 489 472 512 515 454 449 453
8e Race ( of 8a sums to 100)
African American 447 553 543 554 452 327 374
AsianPacific Islander
Native American
00
07
00
00
00
00
08
00
13
05
24
30
48
15
White 546 447 457 438 526 615 551
OtherUnknownMissing 00 00 00 00 04 05 12
8f Ethnicity ( of 8a sums to 100)
Hispanic
Non-Hispanic
Unknown
21
950
28
24
943
33
24
953
24
23
962
15
33
953
14
38
950
12
153
827
19
8g Cause of ESRD ( of 8a sums to 100)
Diabetes 475 472 480 538 410 415 437
Hypertension
Glomerulonephritis
OtherUnknown
Missing
199
163
135
28
220
154
114
41
252
118
118
31
215
115
108
23
298
100
168
23
267
106
190
22
277
102
173
11
8h Average duration of ESRD (years) 45 48 47 43 43 42 43
8i Years since start of ESRD ( of 8a sums to 100)
lt 1 220 163 134 123 185 191 181
1-2 255 211 189 269 186 189 187
2-3 106 187 142 154 153 158 149
3-6 206 187 291 208 265 258 259
6+ 213 252 244 246 211 204 224
8j Nursing home patients3 ( of 8a) 64 130 87 62 142 162 133
8k Modality ( of 8a sums to 100)
In-center hemodialysis
In-center self hemodialysis
Home hemodialysis
Continuous ambulatory peritoneal dialysis
Continuous cycling peritoneal dialysis
Other modality4
837
00
00
142
14
07
902
00
00
73
16
08
858
00
00
110
31
00
869
00
00
38
92
00
909
00
15
38
32
07
908
00
15
34
37
07
906
00
11
27
49
07SAMPLE
na = not applicable [1] See Guide Section XI [2] Values are shown for the average facility [3] Includes patients who were also treated by a nursing facility at any time during the year The source of nursing facility history of patients is the Nursing
Home Minimum Dataset [4] Other modality includes other dialysis uncertain modality and patients not on dialysis but still temporarily assigned to the facility (discontinued dialysis
recovered renal function and lost to follow up)
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 9 Comorbidities Reported on Medicare Claims for Medicare Dialysis Patients Treated as of December 31 of Each Year1 2005-2007
This Facility Regional Averages2 2007 Measure Name 2005 2006 2007 State Network US
9a Medicare dialysis patients on 1231 (n) 112 103 107 556 401 473
9b Comorbidity ( yes of 9a)
AIDSHIV positive 00 00 09 12 10 18
Alcohol dependence 36 29 19 24 27 22
Anemia 54 49 37 98 79 73
Cancer 125 107 103 121 119 107
Cardiac arrest 09 10 19 15 14 15
Cardiac dysrhythmia 241 233 224 434 416 351
Cerebrovascular disease 259 252 262 309 274 273
Chronic obstructive pulmonary disease 232 282 243 359 328 296
Congestive heart failure 438 417 495 576 542 518
Diabetes 554 573 636 632 621 623
Drug dependence 00 10 00 24 26 19
Gastrointestinal tract bleeding 36 68 09 34 32 29
Hepatitis B 09 10 09 13 10 12
Hepatitis other 45 29 28 46 36 38
Hyperparathyroidism 63 58 75 80 132 88
Infection 563 476 477 554 506 511
Ischemic heart disease 527 495 495 597 562 510
Myocardial infarction 54 117 37 115 98 85
Peripheral vascular disease3 536 447 533 498 476 465
Pneumonia 63 29 19 55 50 53
9c Average number of comorbid conditions 38 37 37 46 44 41
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer on 1231 each year See Guide Section XII [2] Values are shown for the average facility [3] Peripheral vascular disease includes both venous and arterial diseases
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 10 How Patients Were Assigned to This Facility and End of Year Patient Status1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
10a Number of patients placed in facility1 (n) 205 184 166 177 1015 749 911
10b Initial patient placement for the year in this facility
( of 10a sums to 100)
Continuing at facility on 0101 698 766 741 718 686 679 691
Incident (new to ESRD) 263 163 133 51 199 206 199
Transferred into facility 39 71 127 232 115 114 110
10c Patient status at end of year ( of 10a sums to 100)
Alive in this facility on 1231 688 668 765 734 702 698 716
Alive in another facility on 1231 93 65 36 34 86 85 82
Received a transplant 29 33 42 23 31 35 28
Died death attributed to this facility 171 201 120 169 150 152 142
Died death attributed to another facility 10 27 06 11 16 15 14
Other3 10 05 30 28 15 16 18
SAMPLE[1] Patient assignment for Tables 1238 and 9 only See Guide Section XIII [2] Values are shown for the average facility [3] Includes patients who recovered renal function discontinued dialysis or were lost to follow-up Also includes dialysis unrelated deaths Dialysis
unrelated deaths are not attributed to any facility for the purposes of the mortality calculations in this report
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
hospitalization and transplantation are adjusted to account for the characteristics of the patient mix at this facility including age sex race ethnicity and diabetes as a cause of ESRD Unless otherwise specified data refer to hemodialysis and peritoneal dialysis patients combined
Summary data about the percent of patients with URR of 65 or higher and with central catheters are included as suggested by Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines Summary data about the percent of patients with hemoglobin from 10 gdL to 12 gdL are also reported These practice pattern measures are strongly correlated with the mortality and hospitalization measures found in these reports Note that elevated mortality or hospitalization rates may be due to a variety of causes unrelated to clinical practices so it may not always be possible to identify clinical practices that explain those rates
SAMPLEMortality Mortality summaries are provided in Table 1 A Standardized Mortality Ratio (SMR) is calculated for each facility Although mortality statistics can vary substantially from year to year they are reported here as a key outcome for dialysis patients The SMR compares the observed death rate in this facility to the death rate that would be expected based on national death rates for patients with the characteristics of the patients at this facility Time at risk and deaths within 60 days after transfer out of this facility are attributed to this facility Time at risk and deaths after transplantation are excluded from the analysis The SMR is adjusted for patient age sex race ethnicity diabetes as a cause of ESRD duration of ESRD nursing home status BMI at incidence and comorbidities at incidence as well as state population death rates The rate of withdrawal from dialysis and the percentage of deaths due to infection and cardiac related deaths are reported in the table to help in the interpretation of the mortality outcomes
There was a 23 annual observed death rate among the patients treated at this facility during 2005-2008 while a rate of 22 would be expected based on the age sex race ethnicity diabetes as cause of ESRD duration of ESRD nursing home status BMI at incidence comorbidities at incidence and state population death rates The SMR of observed to expected deaths is 105 which is not far (5) above the national reference value of 100
First Year Mortality Mortality summaries for new dialysis patients are also provided in Table 1 The first year SMR compares the observed death rate in this facility to the death rate that would be expected based on national death rates for new dialysis patients with the characteristics of the patients at this facility Similar to the mortality of all patients the SMR for new dialysis patients is adjusted for patient age sex race ethnicity diabetes as a cause of ESRD nursing home status BMI at incidence and comorbidities at incidence as well as state population death rates The rate of withdrawal from dialysis and the percentage of deaths due to infection and cardiac related deaths are also reported to facilitate the interpretation of the mortality outcomes
There was a 36 annual observed first year death rate among the patients starting dialysis at this facility during 2005-2007 while a rate of 26 would be expected based on the age sex race ethnicity diabetes as cause of ESRD nursing home status BMI at incidence comorbidities at incidence and state population death rates The first year SMR of observed to expected deaths is 140 which is 40 more deaths than expected at this facility This difference is not statistically significant (pgt005) so this higher mortality could plausibly be just a chance occurrence
Hospitalization Hospitalization summaries are reported for Medicare patients in Table 2 The table includes information on the number of days hospitalized the number of hospital admissions and the diagnoses present at admission for patients at this facility The Standardized Hospitalization Ratio (SHR) for Days compares the observed number of days hospitalized to the number of days that would be expected based on national hospitalization rates for patients with the characteristics of the patients at this facility The Standardized Hospitalization Ratio (SHR) for Admissions compares the observed number of admissions to the number of admissions that would be expected based on national hospitalization rates for patients with the characteristics of the patients at this facility Both measures are adjusted for age race ethnicity sex diabetes duration of ESRD nursing home status and BMI As in the mortality calculation time at risk and
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 318
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
hospitalizations within 60 days after transfer out of this facility are attributed to this facility Time at risk and hospitalizations starting 3 days before transplantation are excluded from the analysis
The SHR (days) of observed to expected number of days hospitalized at this facility during 2005-2007 is 090 which is 10 lower than expected The SHR (admissions) of observed to expected number of admissions for patients at this facility during 2005-2007 is 090 which is 10 lower than expected
Infection Information on hospitalizations for septicemia is reported on Table 2 The information in Table 2 is based on Medicare patient claims
SAMPLEThe percentage of Medicare dialysis patients at this facility hospitalized with septicemia during 2005-2007 was 17 compared to 12 nationally
Transplantation Transplantation summaries are reported in Table 3 The Standardized Transplantation Ratio (STR) represents relative first transplantation rates (observedexpected) for patients at this facility adjusting for patient age Patients who are 70 or older as well as those with a prior kidney transplant are excluded As in the mortality and hospitalization calculations time at risk and transplants within 60 days after transfer out of this facility are attributed to this facility
Of the patients under age 70 treated at this facility during 2005-2008 who had not previously received a transplant 7 were transplanted annually while a rate of 5 would be expected for these patients The STR of observed to expected number of patients transplanted for this facility is 126 which is 26 higher than expected for this facility This difference is not statistically significant (pgt005) and could plausibly be due to random chance
Transplant Waitlist Table 4 summarizes waitlist information for patients under age 70 being treated at this facility at the end of each year Unlike the mortality hospitalization and transplantation statistics the waitlist statistics do not include patients who transferred out of the facility
Among the 93 dialysis patients under age 70 treated at this facility on December 31 2008 25 were on the kidney transplant waitlist compared to 21 nationally This difference is not statistically significant (pgt005) and is plausibly due to random chance
Practice Patterns Table 5 summarizes the dialytic modality hemoglobin and URR for patients treated at this facility during each year These data are derived from CMS Medicare paid dialysis claim data Vascular access data for prevalent and incident patients as reported by the CMS Fistula First project are summarized in Table 6
Among the 110 ESA-treated dialysis patients included in the analysis of Medicare claims data of hemoglobin for 2008 at this facility 81 had hemoglobin between 10-12 gdL compared to 71 nationally Among the 113 hemodialysis patients in this facility included in the analysis of Medicare claims data of URR in 2008 92 had URR above the KDOQI minimum value for URR (URR ge 65) compared to 96 nationally
At this facility in 2008 an average of 39 of incident patients had AV fistulae in place compared to 31 nationally Also at this facility in 2008 an average of 51 of prevalent patients had AV fistulae in place compared to 58 nationally Of the prevalent patients receiving hemodialysis treatment at this facility in 2008 10 had a catheter which had been in place for more than 90 days as their only vascular access compared to 11 nationally See Tables 5 and 6 for more information about practice patterns
Patient Characteristics Characteristics of patients starting dialysis during 2005-2008 are reported in Table 7 Table 8 gives summaries for all dialysis patients being treated at the end of each year 2005-2008 Comorbidities are reported in Table 9 for Medicare dialysis patients being treated at the end of each year 2005-2007
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
There were 11 patients with Medical Evidence Forms (CMS-2728) which indicated that they started treatment at this facility during 2008 The average number of comorbidities reported for new patients is 35 which is higher than the average of 31 reported nationally Also 9 of these patients were not under the care of a nephrologist before starting dialysis compared to 31 nationally Furthermore 64 of these patients were informed of their transplant options compared to 72 nationally The average serum albumin calculated for these patients (before first dialysis) is 33 gdl which is higher than the national average value of 31 gdl The average residual renal function (GFR) calculated for these patients from serum creatinine (before first dialysis) and other parameters was 140 mlmin which is higher than the national average value of 110 mlmin
SAMPLEAmong patients treated at this facility on December 31 2008 6 were treated in a nursing home during the year which is lower than the national average value of 13 The average number of comorbidities reported on Medicare claims in 2007 for Medicare patients in this facility on December 31 2007 is 37 which is lower than the national average value of 41
Facility Information General information about this facility is provided in Tables 11 12 and 13 Table 11 provides counts of patients treated Medicare eligibility treatment modality and staffing from the Annual Facility Survey (Form CMS-2744) Table 12 reports survey and certification activity Table 13 includes services provided by this facility as well as information on ownership
This facility reported having 28 staff members to care for 140 patients at the end of 2008 This facility reported having 21 stations available as of March 31 2009 This facility offers both hemodialysis and peritoneal dialysis services Additional information regarding patient counts patient modality and facility staffing is available in Table 11
Sources of Patient Data This report is based primarily on Medicare claims and data collected for CMS Patients were assigned to this facility based on the Standard Information Management System (SIMS) database Medicare claims and Medical Evidence Forms (Form CMS-2728) Network 99 has a list of the patients included in the mortality analyses for this facility Table 9 reports comorbidities reported on Medicare claims Table 10 reports the number of patients placed in this facility for analyses in Tables 1 2 3 8 and 9 of this report Table 10 also provides information on patient status at the end of the year both for patients who remain in this facility until the end of each year and for those who transfer out of this facility receive a transplant or die during the year
These are just a few highlights of the statistics you will find in this report based on the data for this facility We hope that this report is of interest to you and that you will discuss it with your staff We welcome any questions or comments you might have about the content of the current report or any suggestions you might have for future reports Comments or suggestions can be submitted at the secure site available at wwwDialysisReportsorg until October 15 2009 If you have questions after the comment period is over please contact us directly at keccdfrumichedu or (734) 998-9823
For a complete description of the methods used to calculate the statistics in this report please see the Guide to the 2009 Dialysis Facility Reports The Guide is available from ESRD Network 99 and is also on the UM-KECC web site at wwwDialysisReportsorg
Prepared by The University of Michigan Kidney Epidemiology and Cost Center (UM-KECC) under contract with the Centers for Medicare amp Medicaid Services
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 1 Mortality Summary for All Dialysis Patients (2005-08) amp New Dialysis Patients (2005-07)1
Regional Averages2 This Facility per Year 2005-2008
Measure Name 2005 2006 2007 2008 2005-2008 State Network US
SAMPLEAll Patients Death Rates 1a Patients (n=number) 205 184 166 177 7327 965 700 901
1b Patient years (PY) at risk (n) 1486 1265 1249 1262 52627 670 479 606
1c Deaths (n) 35 37 20 30 1227 146 108 127
1d Expected deaths (n) 322 264 280 296 1167 150 118 127
1e Death rate per 100 PY ( of 1b) 236 292 160 238 232 218 225 210
1f Expected death rate per 100 PY ( of 1b) 216 209 225 235 221 225 246 210
All Patients Categories of Death 1g Withdrawal from dialysis prior to death ( of 1c) 286 378 300 200 295 275 341 238
1h Death due to Infections ( of 1c) 286 243 200 200 238 173 180 175
Cardiac causes ( of 1c) 429 324 600 267 385 311 303 273
1i Dialysis unrelated deaths3 (n excluded from SMR) 0 0 1 2 37 01 01 01
All Patients Standardized Mortality Ratio (SMR)
1j SMR4 109 140 071 101 105 097 091 100
1k P-value5 066 006 014 099 062 na na na
1l Confidence interval for SMR6
High (95 limit) 151 193 110 145 125 na na na
Low (5 limit) 076 099 044 068 087 na na na
All Patients SMR Percentiles for this Facility (ie percent of facilities with lower mortality rates) 1m In this State 62 88 18 64 65
1n In this Network 69 89 31 69 76
1o In the US 53 82 21 60 59
Regional Averages New Patients First Year Death Rates 2005 2006 2007 2005-2007 Per Year 2005-20072
1p New Patients (n=number) 53 12 10 757 237 189 202
1q Patient years (PY) at risk (n) 422 96 92 6117 199 158 171
1r Deaths (n) 16 4 2 227 59 46 48
1s Expected deaths (n) 102 24 31 1577 62 51 48
1t Death rate per 100 PY 379 415 216 360 295 289 281
1u Expected death rate per 100 PY 242 247 338 257 309 321 281
New Patients Categories of Deaths 1v Withdrawal from dialysis prior to death ( of 1r) 250 750 100 409 343 429 322
1w Death due to Infections ( of 1r) 375 00 00 273 212 228 231
Cardiac causes ( of 1r) 250 750 00 318 336 362 331
New Patients First Year Standardized Mortality Ratio (SMR)
1x SMR4 157 168 064 140 095 090 100
1y P-value5 011 044 079 015 na na na
1z Confidence interval for SMR6
High (95 limit) 255 430 231 212 na na na
Low (5 limit) 090 046 008 088 na na na
na = not applicable [1] See Guide Section IV [2] Values are shown for the average facility annualized [3] Defined as deaths due to street drugs and accidents unrelated to treatment [4] Calculated as a ratio of deaths (1c to 1d for all patients 1r to 1s for new patients) to expected deaths not shown if there are too few expected deaths [5] A p-value less than or equal to 005 indicates that the difference between the actual and expected mortality is probably real and is not due to random
chance alone while a p-value greater than 005 indicates that the difference could plausibly be due to random chance [6] The confidence interval range represents uncertainty in the value of the SMR due to random variation [7] Sum of 4 years (all patients) or 3 years (new patients) used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 2 Hospitalization Summary for Medicare Dialysis Patients1 2005-2007
Regional Averages2 This Facility per Year 2005-2007
Measure Name 2005 2006 2007 2005-2007 State Network US Medicare Dialysis Patients
2a Medicare dialysis patients (n) 160 154 141 4555 791 572 674
2b Patient years (PY) at risk (n) 1136 1037 1037 32105 543 387 445
Days Hospitalized Statistics
2c Total days hospitalized (n) 1692 1758 924 43745 869 542 658
2d Expected total days hospitalized (n) 18024 15891 14855 487705 8082 5799 6580
2e Days hospitalized per PY 149 170 89 136 160 140 148
2f Expected days hospitalized per PY 159 153 143 152 149 150 148
2g Standardized Hospitalization Ratio (Days)3 094 111 062 090 107 093 100
Admission Statistics
2h Total admissions (n) 226 193 140 5595 115 77 84
2i Expected total admissions (n) 2287 2023 1919 62305 1039 747 844
2j Admissions per PY 20 19 13 17 21 20 19
2k Expected admissions per PY 20 20 19 19 19 19 19
2l Standardized Hospitalization Ratio (Admissions)4 099 095 073 090 111 103 100
Diagnoses Present at Admission ( of 2a) 2m Septicemia 188 169 142 167 153 128 123
2n Acute myocardial infarction 69 58 21 51 60 52 42
2o Congestive heart failure 288 208 191 231 309 281 252
2p Cardiac dysrhythmia 163 110 121 132 166 168 146
2q Cardiac arrest 31 13 28 24 22 18 17
Length of Stay 2r One day admissions ( of 2h) 186 155 229 186 124 144 136
2s Average length of stay (days per admission 2c2h) 75 91 66 78 75 70 78
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer see Guide Section V [2] Values are shown for the average facility annualized [3] Standardized Hospitalization Ratio (Days) calculated as ratio of actual (2c) to expected (2d) hospitalized days [4] Standardized Hospitalization Ratio (Admissions) calculated as ratio of actual (2h) to expected (2i) total admissions [5] Sum of 3 years used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 3 Transplantation Summary for Dialysis Patients under Age 70 2005-2008
Regional Averages2 This Facility per Year 2005-2008
Measure Name 2005 2006 2007 2008 2005-2008 State Network US
3a Eligible patients1 (n) 147 121 110 112 4909 636 437 616
3b Transplants (n) 8 7 7 3 259 30 25 25
3c Donor type (sums to 3b3)
Living Donor (n) 2 1 0 1 49 10 10 08
Deceased Donor (n) 6 6 7 2 219 20 16 17
Patients who have not Previously Received a Transplant
3d Eligible patients1 (n) 134 106 100 104 4449 575 389 550
3e Patient years (PY) at risk (n) 967 768 761 776 32739 404 268 378
3f 1st transplants4 (n) 7 6 6 3 229 27 22 21
3g Expected 1st transplants (n) 53 44 39 39 1759 22 15 21
3h 1st transplant rate per 100 PY 72 78 79 39 67 66 82 56
3i Expected 1st transplant rate per 100 PY 55 57 51 50 53 56 55 56
3j Donor type (sums to 3f5)
Living Donor (n) 2 0 0 1 39 09 08 06
Deceased Donor (n) 5 6 6 2 199 18 14 15
Standardized 1st Transplantation Ratio (STR)
3k STR6 131 136 154 078 126 119 149 100
3l P-value7 058 056 040 092 034 na na na
3m 95 Confidence interval for STR8
Upper limit 270 297 334 227 190 na na na
Lower limit 053 050 056 016 079 na na na
STR Percentiles for this Facility (ie percent of facilities with lower transplantation rates) 3n In this State 56 59 69 41 53
3o In this Network 47 49 55 35 40
3p In the US 67 69 76 48 67
SAMPLE na = not applicable [1] See Guide Section VI [2] Values are shown for the average facility annualized [3] Values may not sum to 3b due to unknown donor type [4] Among first transplants that occurred after the start of dialysis from 2005-2008 42 of transplants in the US were not included because the transplant
occurred less than 90 days after the start of ESRD and 02 were not included because the patient was not assigned to a facility at time of transplant [5] Values may not sum to 3f due to unknown donor type [6] Standardized Transplantation Ratio calculated as ratio of actual (3f) to expected (3g) Not shown if 3g is too small [7] A p-value less than or equal to 005 indicates that the difference between the actual and expected transplants is probably real and is not due to random
chance while a p-value greater than 005 indicates that the difference is plausibly due to random chance [8] The confidence interval range represents uncertainty in the value of the STR due to random variation [9] Sum of 4 years used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 4 Waitlist Summary for Dialysis Patients under Age 70 Treated as of December 31st of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
4a
4b
4c
4d
Eligible patients on 12311 (n)
Patients on the waitlist ( of 4a)
P-value 3 (compared to US value)
Patients on the waitlist by subgroup ( of corresponding value in 4e)
Age lt 40
Age 40-69
96
344
lt01
600
296
87
333
002
600
278
83
337
002
500
320
93
247
025
250
247
502
215
na
364
193
344
222
na
363
199
464
214
na
320
198
Male 327 333 349 239 221 223 220
Female 362 333 325 255 209 219 207
African American 392 308 277 200 197 202 200
AsianPacific Islander
Native American
00
100
284
313
372
220
326
172
White Hispanic
White Non-Hispanic
Otherunknown race
00
310
500
364
500
412
00
308
194
237
86
185
233
136
238
206
261
Diabetes 286 289 356 216 167 173 163
Non-diabetes 404 381 316 286 250 259 255
Previous kidney transplant
No previous kidney transplant
545
318
556
308
429
329
429
233
429
192
430
195
437
192
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
326
333
379
324
320
357
414
240
345
108
367
308
120
287
263
129
286
279
111
268
292
4e Eligible patients in 4a by subgroup (n)
Age lt 40
Age 40-69
15
81
15
72
8
75
8
85
66
435
46
298
63
400
Male 49 45 43 46 286 197 261
Female 47 42 40 47 216 148 202
African American 51 52 47 50 259 137 194
AsianPacific Islander
Native American
0
1
0
0
0
0
1
0
06
03
09
13
22
08
White Hispanic
White Non-Hispanic
Otherunknown race
2
42
0
2
33
0
2
34
0
3
39
0
15
216
02
14
169
02
70
164
06
Diabetes 49 45 45 51 210 148 204
Non-diabetes 47 42 38 42 292 196 259
Previous kidney transplant
No previous kidney transplant
11
85
9
78
7
76
7
86
50
451
39
306
42
422
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
43
24
29
34
25
28
29
25
29
37
30
26
195
164
143
137
110
97
180
145
139
SAMPLE
na = not applicable [1] See Guide Section VII [2] Values are shown for the average facility [3] Facility waitlist percentage is compared to the US waitlist percentage for that year 226 (2005) 230 (2006) 237 (2007) 214 (2008)
A p-value greater than 005 indicates that the difference between percent of patients waitlisted at the facility and national percentage is plausibly due to random chance
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 918
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 5 Facility Modality Hemoglobin and Urea Reduction Ratio for Medicare Dialysis Patients1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Modality (among all dialysis patients with ESRD for 90+ days and 1+ claim at this facility)
5a Patients treated during year1 (n) 163 162 152 153 843 661 771
5b Modality ( of 5a sums to 100)
Hemodialysis 840 858 862 869 891 896 895
CAPDCCPD 129 80 132 98 47 50 56
Other dialysis3 31 62 07 33 62 54 48
Hemoglobin (among ESA-treated dialysis patients with ESRD for 90+ days and 4+ Hemoglobin claims at this facility)
5c Eligible patients1 (n) 123 119 107 110 571 420 496
5d Average hemoglobin (gdL) 126 119 118 106 116 116 116
5e Hemoglobin categories ( of 5c sums to 100)
lt 10 gdL 16 25 19 164 26 24 23
10-12 gdL 187 429 617 809 684 727 713
gt 12 gdL 797 546 364 27 290 249 264
5f Hemoglobin 10-12 gdL ( of HD pts) 170 416 630 840 682 724 711
Hemoglobin 10-12 gdL ( of PD pts) 286 667 429 00 649 679 689
5g Hemoglobin percentiles for this facility4
In this State 7 48 79 72
In this Network 7 38 61 59
In the US 6 37 62 69
Urea Reduction Ratio (URR among HD patients with ESRD for 183+ days and 4+ URR claims at this facility)6
5h Eligible patients1(n) 95 100 97 113 521 384 454
5i URR categories ( of 5h sums to 100)
lt 600 74 50 31 09 17 19 15
600-649 126 140 52 71 25 30 27
650-699 474 480 515 265 113 130 110
700-749 295 250 309 469 391 391 360
75+ 32 80 93 186 454 430 488
5j URR 65+ ( of 5h meets a KDOQI guideline) 800 810 918 920 958 951 958
5k URR percentiles for this facility5
In this State 4 2 13 17
In this Network 4 2 18 21
In the US 3 3 16 16SAMPLE
na = not applicable [1] See Guide Section VIII [2] Counts are shown for the average facility [3] Other dialysis includes patients who switch between HD and PD during the year and patients for whom modality is unknown [4] Percent of facilities with a smaller percentage of patients with hemoglobin 10-12 gdl [5] Percent of facilities with a smaller percentage of patients with URR 65+ [6] Patients identified in the Standard Information Management System (SIMS) as having dialyzed five or more times per week were excluded from the URR
calculations Among eligible patients in the US 044 were excluded due to frequent dialysis in 2008
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1018
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 6 Vascular Access Information1 (CMS Fistula First) 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Vascular Access
6a Prevalent hemodialysis patient months3 1709 1454 1424 1446
6b Vascular access type in use ( of 6a sums to 100)
Arteriovenous fistula 263 352 410 427 465 483 502
Arteriovenous graft 420 384 361 315 271 214 227
Catheter 314 259 228 258 261 300 267
OtherMissing 03 04 01 00 03 03 04
6c Arteriovenous fistulae in place4 ( of 6a) 317 422 492 512 541 573 581
6d Catheter only ge 90 days5 ( of 6a) 142 94 103 95 116 137 115
Vascular Access at First Treatment 6e Incident hemodialysis patients (n) 26 0 12 23 189 148 173
6f Vascular access type in use6 ( of 6e sums to 100)
Arteriovenous fistula 154 417 217 146 149 158
Arteriovenous graft 115 83 43 53 45 68
Catheter 538 500 739 777 792 749
OtherMissing 192 00 00 23 13 25
6g Arteriovenous fistulae in place4 ( of 6e) 231 583 391 253 288 308
SAMPLE na = not applicable [1] See Guide Section IX [2] Values are shown for the average facility [3] Patients may be counted up to 12 times per year [4] Includes all patients with fistulae regardless of whether or not they received their hemodialysis treatments using their fistulae [5] Catheter was used for treatment and has been in place for 90 days or more prior to treatment Patient does not have an fistula or graft in place Catheter is
only access Port access devices are reported as catheters for this project [6] Patients listed as graft or catheter may have had fistulae in place for future use but they actually received their treatment through a graft or catheter
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1118
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patient Characteristics3
7a Total number of patients with forms (n) 53 12 10 11 350 304 319
7b Average age (years [0-95]) 632 658 732 612 643 648 633
7c Female ( of 7a) 434 500 400 455 448 442 440
7d Race4 ( of 7a sums to 100)
African-American 358 167 100 364 335 233 284
AsianPacific Islander 00 00 00 00 11 18 42
Native American 00 00 00 00 05 24 11
White 642 833 900 636 641 717 658
OtherUnknownMissing 00 00 00 00 08 08 05
7e Hispanic ( of 7a) 19 00 00 91 30 32 134
7f Primary cause of ESRD ( of 7a sums to 100)
Diabetes 509 417 300 545 408 403 451
Hypertension 189 167 400 364 304 272 287
Primary Glomerulonephritis 132 167 200 91 63 67 64
OtherMissing 170 250 100 00 226 258 199
7g Medical coverage ( of 7a sums to 100)
Employer group only 38 333 100 182 178 162 161
Medicare only 113 00 100 91 162 163 204
Medicaid only 75 00 00 91 103 100 114
Medicare and Medicaid only 226 00 00 91 112 102 126
Medicare and Other 377 500 800 455 360 370 238
OtherUnknown 151 167 00 91 40 60 86
None 19 00 00 00 46 43 71
7h Body Mass Index5
Male 287 242 281 227 268 269 266
Female 261 335 276 328 288 287 280
7i Employment6
Six months prior to ESRD treatment 190 667 333 400 348 387 362
At first ESRD treatment 95 667 333 400 181 225 220
7j Primary modality7 ( of 7a sums to 100)
Hemodialysis 500 444 500 944 945 939
CAPDCCPD 500 556 500 56 55 61
OtherUnknownMissing 00 00 00 00 00 00
7k Number of incident hemodialysis patients7 (n) 6 4 5 332 286 298
7l Access used at first outpatient dialysis7 ( of 7k sums to 100)
Arteriovenous fistula 00 500 00 127 141 136
Arteriovenous graft 00 00 00 29 27 33
Catheter 100 500 100 843 832 819
OtherUnknownMissing 00 00 00 01 00 12
7m Arteriovenous fistulae placed7 ( of 7k) 167 750 00 229 270 292
Average Lab Values Prior to Dialysis3
7n Hemoglobin (gdL [3-18]) 105 112 120 105 99 100 99
7o Serum Albumin (gdL [08-60]) 32 35 36 33 32 32 31
SAMPLE
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1218
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 (cont) Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Average Lab Values Prior to Dialysis3
7p Serum Creatinine (mgdL [2-33]) 70 50 54 51 58 58 63
7q GFR (mLmin [0-60]) 103 124 119 140 119 118 110
Care Prior to ESRD Therapy 7r Received ESA prior to ESRD ( of 7a) 472 333 700 364 261 295 263
7s Pre-ESRD nephrologist care7 ( of 7a sums to 100)
No 250 200 91 330 321 310
Yes lt 6 months 00 00 00 38 48 116
Yes 6-12 months 417 300 545 201 215 208
Yes gt 12 months 333 500 364 328 341 242
Unknown 00 00 00 103 76 124
7t Informed of transplant options7 ( of 7a) 917 900 636 690 710 724
7u Patients not informed of transplant options7 (n) 1 0 3 102 87 92
7v Reason not informed7 ( of 7u may not sum to 100)
Medically unfit 00 100 384 439 309
Unsuitable due to age 00 00 334 320 239
Psychologically unfit 00 00 21 30 28
Patient declined information 00 00 13 12 13
Patient has not been assessed 100 00 332 294 449
Comorbid Conditions 7w Pre-existing Comorbidity ( yes of 7a)
Congestive heart failure 566 250 400 273 415 374 328
Atherosclerotic heart disease8 340 417 400 364 268 268 210
Other cardiac disorder8 00 00 100 00 198 197 171
CVD CVA TIA 57 00 00 182 107 103 95
Peripheral vascular disease 189 333 100 182 154 155 140
History of hypertension 981 917 100 909 861 845 847
Diabetes8 566 417 300 636 574 560 578
Diabetes on insulin 170 250 300 455 383 380 363
COPD 57 333 00 182 130 123 93
Current smoker 57 00 00 91 82 77 62
Cancer 00 00 00 182 112 109 74
Alcohol dependence 00 00 00 00 21 23 16
Drug dependence 00 00 00 00 18 15 13
Inability to ambulate 00 00 00 91 88 75 69
Inability to transfer 00 00 00 00 51 38 35
7x Average number of comorbid conditions 30 29 26 35 35 33 31 SAMPLE
na= not applicable [1] See Guide Section X [2] Values are shown for the average facility [3] For continuous variables summaries include only responses in range indicated in brackets [4] Asian includes Indian sub-continent Native American includes Alaskan Native White includes Middle Eastern and Arabian [5] The median BMI is computed for adult patients at least 20 years old [6] Full-time part-time or student ( of 18-60 year olds) [7] Data collection for these items began mid-year 2005 Summaries for these items shown starting in 2006 [8] AHD includes ischemic heart disease (coronary artery disease) and myocardial infarction Other cardiac disorder includes cardiac arrest cardiac
dysrhythmia and pericarditis Diabetes includes patients with diabetes as the primary cause of ESRD
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1318
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 8 Summaries for All Dialysis Patients Treated as of December 31 of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
8a
8b
8c
Patients treated on 1231 (n)
Average age (years)
Age ( of 8a sums to 100)
lt 20
141
601
07
123
616
00
127
636
00
130
627
00
712
616
05
523
626
05
652
609
05
20-64 574 593 551 585 549 513 562
65+ 418 407 449 415 446 481 433
8d Female ( of 8a) 489 472 512 515 454 449 453
8e Race ( of 8a sums to 100)
African American 447 553 543 554 452 327 374
AsianPacific Islander
Native American
00
07
00
00
00
00
08
00
13
05
24
30
48
15
White 546 447 457 438 526 615 551
OtherUnknownMissing 00 00 00 00 04 05 12
8f Ethnicity ( of 8a sums to 100)
Hispanic
Non-Hispanic
Unknown
21
950
28
24
943
33
24
953
24
23
962
15
33
953
14
38
950
12
153
827
19
8g Cause of ESRD ( of 8a sums to 100)
Diabetes 475 472 480 538 410 415 437
Hypertension
Glomerulonephritis
OtherUnknown
Missing
199
163
135
28
220
154
114
41
252
118
118
31
215
115
108
23
298
100
168
23
267
106
190
22
277
102
173
11
8h Average duration of ESRD (years) 45 48 47 43 43 42 43
8i Years since start of ESRD ( of 8a sums to 100)
lt 1 220 163 134 123 185 191 181
1-2 255 211 189 269 186 189 187
2-3 106 187 142 154 153 158 149
3-6 206 187 291 208 265 258 259
6+ 213 252 244 246 211 204 224
8j Nursing home patients3 ( of 8a) 64 130 87 62 142 162 133
8k Modality ( of 8a sums to 100)
In-center hemodialysis
In-center self hemodialysis
Home hemodialysis
Continuous ambulatory peritoneal dialysis
Continuous cycling peritoneal dialysis
Other modality4
837
00
00
142
14
07
902
00
00
73
16
08
858
00
00
110
31
00
869
00
00
38
92
00
909
00
15
38
32
07
908
00
15
34
37
07
906
00
11
27
49
07SAMPLE
na = not applicable [1] See Guide Section XI [2] Values are shown for the average facility [3] Includes patients who were also treated by a nursing facility at any time during the year The source of nursing facility history of patients is the Nursing
Home Minimum Dataset [4] Other modality includes other dialysis uncertain modality and patients not on dialysis but still temporarily assigned to the facility (discontinued dialysis
recovered renal function and lost to follow up)
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 9 Comorbidities Reported on Medicare Claims for Medicare Dialysis Patients Treated as of December 31 of Each Year1 2005-2007
This Facility Regional Averages2 2007 Measure Name 2005 2006 2007 State Network US
9a Medicare dialysis patients on 1231 (n) 112 103 107 556 401 473
9b Comorbidity ( yes of 9a)
AIDSHIV positive 00 00 09 12 10 18
Alcohol dependence 36 29 19 24 27 22
Anemia 54 49 37 98 79 73
Cancer 125 107 103 121 119 107
Cardiac arrest 09 10 19 15 14 15
Cardiac dysrhythmia 241 233 224 434 416 351
Cerebrovascular disease 259 252 262 309 274 273
Chronic obstructive pulmonary disease 232 282 243 359 328 296
Congestive heart failure 438 417 495 576 542 518
Diabetes 554 573 636 632 621 623
Drug dependence 00 10 00 24 26 19
Gastrointestinal tract bleeding 36 68 09 34 32 29
Hepatitis B 09 10 09 13 10 12
Hepatitis other 45 29 28 46 36 38
Hyperparathyroidism 63 58 75 80 132 88
Infection 563 476 477 554 506 511
Ischemic heart disease 527 495 495 597 562 510
Myocardial infarction 54 117 37 115 98 85
Peripheral vascular disease3 536 447 533 498 476 465
Pneumonia 63 29 19 55 50 53
9c Average number of comorbid conditions 38 37 37 46 44 41
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer on 1231 each year See Guide Section XII [2] Values are shown for the average facility [3] Peripheral vascular disease includes both venous and arterial diseases
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 10 How Patients Were Assigned to This Facility and End of Year Patient Status1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
10a Number of patients placed in facility1 (n) 205 184 166 177 1015 749 911
10b Initial patient placement for the year in this facility
( of 10a sums to 100)
Continuing at facility on 0101 698 766 741 718 686 679 691
Incident (new to ESRD) 263 163 133 51 199 206 199
Transferred into facility 39 71 127 232 115 114 110
10c Patient status at end of year ( of 10a sums to 100)
Alive in this facility on 1231 688 668 765 734 702 698 716
Alive in another facility on 1231 93 65 36 34 86 85 82
Received a transplant 29 33 42 23 31 35 28
Died death attributed to this facility 171 201 120 169 150 152 142
Died death attributed to another facility 10 27 06 11 16 15 14
Other3 10 05 30 28 15 16 18
SAMPLE[1] Patient assignment for Tables 1238 and 9 only See Guide Section XIII [2] Values are shown for the average facility [3] Includes patients who recovered renal function discontinued dialysis or were lost to follow-up Also includes dialysis unrelated deaths Dialysis
unrelated deaths are not attributed to any facility for the purposes of the mortality calculations in this report
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
hospitalizations within 60 days after transfer out of this facility are attributed to this facility Time at risk and hospitalizations starting 3 days before transplantation are excluded from the analysis
The SHR (days) of observed to expected number of days hospitalized at this facility during 2005-2007 is 090 which is 10 lower than expected The SHR (admissions) of observed to expected number of admissions for patients at this facility during 2005-2007 is 090 which is 10 lower than expected
Infection Information on hospitalizations for septicemia is reported on Table 2 The information in Table 2 is based on Medicare patient claims
SAMPLEThe percentage of Medicare dialysis patients at this facility hospitalized with septicemia during 2005-2007 was 17 compared to 12 nationally
Transplantation Transplantation summaries are reported in Table 3 The Standardized Transplantation Ratio (STR) represents relative first transplantation rates (observedexpected) for patients at this facility adjusting for patient age Patients who are 70 or older as well as those with a prior kidney transplant are excluded As in the mortality and hospitalization calculations time at risk and transplants within 60 days after transfer out of this facility are attributed to this facility
Of the patients under age 70 treated at this facility during 2005-2008 who had not previously received a transplant 7 were transplanted annually while a rate of 5 would be expected for these patients The STR of observed to expected number of patients transplanted for this facility is 126 which is 26 higher than expected for this facility This difference is not statistically significant (pgt005) and could plausibly be due to random chance
Transplant Waitlist Table 4 summarizes waitlist information for patients under age 70 being treated at this facility at the end of each year Unlike the mortality hospitalization and transplantation statistics the waitlist statistics do not include patients who transferred out of the facility
Among the 93 dialysis patients under age 70 treated at this facility on December 31 2008 25 were on the kidney transplant waitlist compared to 21 nationally This difference is not statistically significant (pgt005) and is plausibly due to random chance
Practice Patterns Table 5 summarizes the dialytic modality hemoglobin and URR for patients treated at this facility during each year These data are derived from CMS Medicare paid dialysis claim data Vascular access data for prevalent and incident patients as reported by the CMS Fistula First project are summarized in Table 6
Among the 110 ESA-treated dialysis patients included in the analysis of Medicare claims data of hemoglobin for 2008 at this facility 81 had hemoglobin between 10-12 gdL compared to 71 nationally Among the 113 hemodialysis patients in this facility included in the analysis of Medicare claims data of URR in 2008 92 had URR above the KDOQI minimum value for URR (URR ge 65) compared to 96 nationally
At this facility in 2008 an average of 39 of incident patients had AV fistulae in place compared to 31 nationally Also at this facility in 2008 an average of 51 of prevalent patients had AV fistulae in place compared to 58 nationally Of the prevalent patients receiving hemodialysis treatment at this facility in 2008 10 had a catheter which had been in place for more than 90 days as their only vascular access compared to 11 nationally See Tables 5 and 6 for more information about practice patterns
Patient Characteristics Characteristics of patients starting dialysis during 2005-2008 are reported in Table 7 Table 8 gives summaries for all dialysis patients being treated at the end of each year 2005-2008 Comorbidities are reported in Table 9 for Medicare dialysis patients being treated at the end of each year 2005-2007
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
There were 11 patients with Medical Evidence Forms (CMS-2728) which indicated that they started treatment at this facility during 2008 The average number of comorbidities reported for new patients is 35 which is higher than the average of 31 reported nationally Also 9 of these patients were not under the care of a nephrologist before starting dialysis compared to 31 nationally Furthermore 64 of these patients were informed of their transplant options compared to 72 nationally The average serum albumin calculated for these patients (before first dialysis) is 33 gdl which is higher than the national average value of 31 gdl The average residual renal function (GFR) calculated for these patients from serum creatinine (before first dialysis) and other parameters was 140 mlmin which is higher than the national average value of 110 mlmin
SAMPLEAmong patients treated at this facility on December 31 2008 6 were treated in a nursing home during the year which is lower than the national average value of 13 The average number of comorbidities reported on Medicare claims in 2007 for Medicare patients in this facility on December 31 2007 is 37 which is lower than the national average value of 41
Facility Information General information about this facility is provided in Tables 11 12 and 13 Table 11 provides counts of patients treated Medicare eligibility treatment modality and staffing from the Annual Facility Survey (Form CMS-2744) Table 12 reports survey and certification activity Table 13 includes services provided by this facility as well as information on ownership
This facility reported having 28 staff members to care for 140 patients at the end of 2008 This facility reported having 21 stations available as of March 31 2009 This facility offers both hemodialysis and peritoneal dialysis services Additional information regarding patient counts patient modality and facility staffing is available in Table 11
Sources of Patient Data This report is based primarily on Medicare claims and data collected for CMS Patients were assigned to this facility based on the Standard Information Management System (SIMS) database Medicare claims and Medical Evidence Forms (Form CMS-2728) Network 99 has a list of the patients included in the mortality analyses for this facility Table 9 reports comorbidities reported on Medicare claims Table 10 reports the number of patients placed in this facility for analyses in Tables 1 2 3 8 and 9 of this report Table 10 also provides information on patient status at the end of the year both for patients who remain in this facility until the end of each year and for those who transfer out of this facility receive a transplant or die during the year
These are just a few highlights of the statistics you will find in this report based on the data for this facility We hope that this report is of interest to you and that you will discuss it with your staff We welcome any questions or comments you might have about the content of the current report or any suggestions you might have for future reports Comments or suggestions can be submitted at the secure site available at wwwDialysisReportsorg until October 15 2009 If you have questions after the comment period is over please contact us directly at keccdfrumichedu or (734) 998-9823
For a complete description of the methods used to calculate the statistics in this report please see the Guide to the 2009 Dialysis Facility Reports The Guide is available from ESRD Network 99 and is also on the UM-KECC web site at wwwDialysisReportsorg
Prepared by The University of Michigan Kidney Epidemiology and Cost Center (UM-KECC) under contract with the Centers for Medicare amp Medicaid Services
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 1 Mortality Summary for All Dialysis Patients (2005-08) amp New Dialysis Patients (2005-07)1
Regional Averages2 This Facility per Year 2005-2008
Measure Name 2005 2006 2007 2008 2005-2008 State Network US
SAMPLEAll Patients Death Rates 1a Patients (n=number) 205 184 166 177 7327 965 700 901
1b Patient years (PY) at risk (n) 1486 1265 1249 1262 52627 670 479 606
1c Deaths (n) 35 37 20 30 1227 146 108 127
1d Expected deaths (n) 322 264 280 296 1167 150 118 127
1e Death rate per 100 PY ( of 1b) 236 292 160 238 232 218 225 210
1f Expected death rate per 100 PY ( of 1b) 216 209 225 235 221 225 246 210
All Patients Categories of Death 1g Withdrawal from dialysis prior to death ( of 1c) 286 378 300 200 295 275 341 238
1h Death due to Infections ( of 1c) 286 243 200 200 238 173 180 175
Cardiac causes ( of 1c) 429 324 600 267 385 311 303 273
1i Dialysis unrelated deaths3 (n excluded from SMR) 0 0 1 2 37 01 01 01
All Patients Standardized Mortality Ratio (SMR)
1j SMR4 109 140 071 101 105 097 091 100
1k P-value5 066 006 014 099 062 na na na
1l Confidence interval for SMR6
High (95 limit) 151 193 110 145 125 na na na
Low (5 limit) 076 099 044 068 087 na na na
All Patients SMR Percentiles for this Facility (ie percent of facilities with lower mortality rates) 1m In this State 62 88 18 64 65
1n In this Network 69 89 31 69 76
1o In the US 53 82 21 60 59
Regional Averages New Patients First Year Death Rates 2005 2006 2007 2005-2007 Per Year 2005-20072
1p New Patients (n=number) 53 12 10 757 237 189 202
1q Patient years (PY) at risk (n) 422 96 92 6117 199 158 171
1r Deaths (n) 16 4 2 227 59 46 48
1s Expected deaths (n) 102 24 31 1577 62 51 48
1t Death rate per 100 PY 379 415 216 360 295 289 281
1u Expected death rate per 100 PY 242 247 338 257 309 321 281
New Patients Categories of Deaths 1v Withdrawal from dialysis prior to death ( of 1r) 250 750 100 409 343 429 322
1w Death due to Infections ( of 1r) 375 00 00 273 212 228 231
Cardiac causes ( of 1r) 250 750 00 318 336 362 331
New Patients First Year Standardized Mortality Ratio (SMR)
1x SMR4 157 168 064 140 095 090 100
1y P-value5 011 044 079 015 na na na
1z Confidence interval for SMR6
High (95 limit) 255 430 231 212 na na na
Low (5 limit) 090 046 008 088 na na na
na = not applicable [1] See Guide Section IV [2] Values are shown for the average facility annualized [3] Defined as deaths due to street drugs and accidents unrelated to treatment [4] Calculated as a ratio of deaths (1c to 1d for all patients 1r to 1s for new patients) to expected deaths not shown if there are too few expected deaths [5] A p-value less than or equal to 005 indicates that the difference between the actual and expected mortality is probably real and is not due to random
chance alone while a p-value greater than 005 indicates that the difference could plausibly be due to random chance [6] The confidence interval range represents uncertainty in the value of the SMR due to random variation [7] Sum of 4 years (all patients) or 3 years (new patients) used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 2 Hospitalization Summary for Medicare Dialysis Patients1 2005-2007
Regional Averages2 This Facility per Year 2005-2007
Measure Name 2005 2006 2007 2005-2007 State Network US Medicare Dialysis Patients
2a Medicare dialysis patients (n) 160 154 141 4555 791 572 674
2b Patient years (PY) at risk (n) 1136 1037 1037 32105 543 387 445
Days Hospitalized Statistics
2c Total days hospitalized (n) 1692 1758 924 43745 869 542 658
2d Expected total days hospitalized (n) 18024 15891 14855 487705 8082 5799 6580
2e Days hospitalized per PY 149 170 89 136 160 140 148
2f Expected days hospitalized per PY 159 153 143 152 149 150 148
2g Standardized Hospitalization Ratio (Days)3 094 111 062 090 107 093 100
Admission Statistics
2h Total admissions (n) 226 193 140 5595 115 77 84
2i Expected total admissions (n) 2287 2023 1919 62305 1039 747 844
2j Admissions per PY 20 19 13 17 21 20 19
2k Expected admissions per PY 20 20 19 19 19 19 19
2l Standardized Hospitalization Ratio (Admissions)4 099 095 073 090 111 103 100
Diagnoses Present at Admission ( of 2a) 2m Septicemia 188 169 142 167 153 128 123
2n Acute myocardial infarction 69 58 21 51 60 52 42
2o Congestive heart failure 288 208 191 231 309 281 252
2p Cardiac dysrhythmia 163 110 121 132 166 168 146
2q Cardiac arrest 31 13 28 24 22 18 17
Length of Stay 2r One day admissions ( of 2h) 186 155 229 186 124 144 136
2s Average length of stay (days per admission 2c2h) 75 91 66 78 75 70 78
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer see Guide Section V [2] Values are shown for the average facility annualized [3] Standardized Hospitalization Ratio (Days) calculated as ratio of actual (2c) to expected (2d) hospitalized days [4] Standardized Hospitalization Ratio (Admissions) calculated as ratio of actual (2h) to expected (2i) total admissions [5] Sum of 3 years used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 3 Transplantation Summary for Dialysis Patients under Age 70 2005-2008
Regional Averages2 This Facility per Year 2005-2008
Measure Name 2005 2006 2007 2008 2005-2008 State Network US
3a Eligible patients1 (n) 147 121 110 112 4909 636 437 616
3b Transplants (n) 8 7 7 3 259 30 25 25
3c Donor type (sums to 3b3)
Living Donor (n) 2 1 0 1 49 10 10 08
Deceased Donor (n) 6 6 7 2 219 20 16 17
Patients who have not Previously Received a Transplant
3d Eligible patients1 (n) 134 106 100 104 4449 575 389 550
3e Patient years (PY) at risk (n) 967 768 761 776 32739 404 268 378
3f 1st transplants4 (n) 7 6 6 3 229 27 22 21
3g Expected 1st transplants (n) 53 44 39 39 1759 22 15 21
3h 1st transplant rate per 100 PY 72 78 79 39 67 66 82 56
3i Expected 1st transplant rate per 100 PY 55 57 51 50 53 56 55 56
3j Donor type (sums to 3f5)
Living Donor (n) 2 0 0 1 39 09 08 06
Deceased Donor (n) 5 6 6 2 199 18 14 15
Standardized 1st Transplantation Ratio (STR)
3k STR6 131 136 154 078 126 119 149 100
3l P-value7 058 056 040 092 034 na na na
3m 95 Confidence interval for STR8
Upper limit 270 297 334 227 190 na na na
Lower limit 053 050 056 016 079 na na na
STR Percentiles for this Facility (ie percent of facilities with lower transplantation rates) 3n In this State 56 59 69 41 53
3o In this Network 47 49 55 35 40
3p In the US 67 69 76 48 67
SAMPLE na = not applicable [1] See Guide Section VI [2] Values are shown for the average facility annualized [3] Values may not sum to 3b due to unknown donor type [4] Among first transplants that occurred after the start of dialysis from 2005-2008 42 of transplants in the US were not included because the transplant
occurred less than 90 days after the start of ESRD and 02 were not included because the patient was not assigned to a facility at time of transplant [5] Values may not sum to 3f due to unknown donor type [6] Standardized Transplantation Ratio calculated as ratio of actual (3f) to expected (3g) Not shown if 3g is too small [7] A p-value less than or equal to 005 indicates that the difference between the actual and expected transplants is probably real and is not due to random
chance while a p-value greater than 005 indicates that the difference is plausibly due to random chance [8] The confidence interval range represents uncertainty in the value of the STR due to random variation [9] Sum of 4 years used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 4 Waitlist Summary for Dialysis Patients under Age 70 Treated as of December 31st of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
4a
4b
4c
4d
Eligible patients on 12311 (n)
Patients on the waitlist ( of 4a)
P-value 3 (compared to US value)
Patients on the waitlist by subgroup ( of corresponding value in 4e)
Age lt 40
Age 40-69
96
344
lt01
600
296
87
333
002
600
278
83
337
002
500
320
93
247
025
250
247
502
215
na
364
193
344
222
na
363
199
464
214
na
320
198
Male 327 333 349 239 221 223 220
Female 362 333 325 255 209 219 207
African American 392 308 277 200 197 202 200
AsianPacific Islander
Native American
00
100
284
313
372
220
326
172
White Hispanic
White Non-Hispanic
Otherunknown race
00
310
500
364
500
412
00
308
194
237
86
185
233
136
238
206
261
Diabetes 286 289 356 216 167 173 163
Non-diabetes 404 381 316 286 250 259 255
Previous kidney transplant
No previous kidney transplant
545
318
556
308
429
329
429
233
429
192
430
195
437
192
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
326
333
379
324
320
357
414
240
345
108
367
308
120
287
263
129
286
279
111
268
292
4e Eligible patients in 4a by subgroup (n)
Age lt 40
Age 40-69
15
81
15
72
8
75
8
85
66
435
46
298
63
400
Male 49 45 43 46 286 197 261
Female 47 42 40 47 216 148 202
African American 51 52 47 50 259 137 194
AsianPacific Islander
Native American
0
1
0
0
0
0
1
0
06
03
09
13
22
08
White Hispanic
White Non-Hispanic
Otherunknown race
2
42
0
2
33
0
2
34
0
3
39
0
15
216
02
14
169
02
70
164
06
Diabetes 49 45 45 51 210 148 204
Non-diabetes 47 42 38 42 292 196 259
Previous kidney transplant
No previous kidney transplant
11
85
9
78
7
76
7
86
50
451
39
306
42
422
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
43
24
29
34
25
28
29
25
29
37
30
26
195
164
143
137
110
97
180
145
139
SAMPLE
na = not applicable [1] See Guide Section VII [2] Values are shown for the average facility [3] Facility waitlist percentage is compared to the US waitlist percentage for that year 226 (2005) 230 (2006) 237 (2007) 214 (2008)
A p-value greater than 005 indicates that the difference between percent of patients waitlisted at the facility and national percentage is plausibly due to random chance
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 918
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 5 Facility Modality Hemoglobin and Urea Reduction Ratio for Medicare Dialysis Patients1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Modality (among all dialysis patients with ESRD for 90+ days and 1+ claim at this facility)
5a Patients treated during year1 (n) 163 162 152 153 843 661 771
5b Modality ( of 5a sums to 100)
Hemodialysis 840 858 862 869 891 896 895
CAPDCCPD 129 80 132 98 47 50 56
Other dialysis3 31 62 07 33 62 54 48
Hemoglobin (among ESA-treated dialysis patients with ESRD for 90+ days and 4+ Hemoglobin claims at this facility)
5c Eligible patients1 (n) 123 119 107 110 571 420 496
5d Average hemoglobin (gdL) 126 119 118 106 116 116 116
5e Hemoglobin categories ( of 5c sums to 100)
lt 10 gdL 16 25 19 164 26 24 23
10-12 gdL 187 429 617 809 684 727 713
gt 12 gdL 797 546 364 27 290 249 264
5f Hemoglobin 10-12 gdL ( of HD pts) 170 416 630 840 682 724 711
Hemoglobin 10-12 gdL ( of PD pts) 286 667 429 00 649 679 689
5g Hemoglobin percentiles for this facility4
In this State 7 48 79 72
In this Network 7 38 61 59
In the US 6 37 62 69
Urea Reduction Ratio (URR among HD patients with ESRD for 183+ days and 4+ URR claims at this facility)6
5h Eligible patients1(n) 95 100 97 113 521 384 454
5i URR categories ( of 5h sums to 100)
lt 600 74 50 31 09 17 19 15
600-649 126 140 52 71 25 30 27
650-699 474 480 515 265 113 130 110
700-749 295 250 309 469 391 391 360
75+ 32 80 93 186 454 430 488
5j URR 65+ ( of 5h meets a KDOQI guideline) 800 810 918 920 958 951 958
5k URR percentiles for this facility5
In this State 4 2 13 17
In this Network 4 2 18 21
In the US 3 3 16 16SAMPLE
na = not applicable [1] See Guide Section VIII [2] Counts are shown for the average facility [3] Other dialysis includes patients who switch between HD and PD during the year and patients for whom modality is unknown [4] Percent of facilities with a smaller percentage of patients with hemoglobin 10-12 gdl [5] Percent of facilities with a smaller percentage of patients with URR 65+ [6] Patients identified in the Standard Information Management System (SIMS) as having dialyzed five or more times per week were excluded from the URR
calculations Among eligible patients in the US 044 were excluded due to frequent dialysis in 2008
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1018
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 6 Vascular Access Information1 (CMS Fistula First) 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Vascular Access
6a Prevalent hemodialysis patient months3 1709 1454 1424 1446
6b Vascular access type in use ( of 6a sums to 100)
Arteriovenous fistula 263 352 410 427 465 483 502
Arteriovenous graft 420 384 361 315 271 214 227
Catheter 314 259 228 258 261 300 267
OtherMissing 03 04 01 00 03 03 04
6c Arteriovenous fistulae in place4 ( of 6a) 317 422 492 512 541 573 581
6d Catheter only ge 90 days5 ( of 6a) 142 94 103 95 116 137 115
Vascular Access at First Treatment 6e Incident hemodialysis patients (n) 26 0 12 23 189 148 173
6f Vascular access type in use6 ( of 6e sums to 100)
Arteriovenous fistula 154 417 217 146 149 158
Arteriovenous graft 115 83 43 53 45 68
Catheter 538 500 739 777 792 749
OtherMissing 192 00 00 23 13 25
6g Arteriovenous fistulae in place4 ( of 6e) 231 583 391 253 288 308
SAMPLE na = not applicable [1] See Guide Section IX [2] Values are shown for the average facility [3] Patients may be counted up to 12 times per year [4] Includes all patients with fistulae regardless of whether or not they received their hemodialysis treatments using their fistulae [5] Catheter was used for treatment and has been in place for 90 days or more prior to treatment Patient does not have an fistula or graft in place Catheter is
only access Port access devices are reported as catheters for this project [6] Patients listed as graft or catheter may have had fistulae in place for future use but they actually received their treatment through a graft or catheter
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1118
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patient Characteristics3
7a Total number of patients with forms (n) 53 12 10 11 350 304 319
7b Average age (years [0-95]) 632 658 732 612 643 648 633
7c Female ( of 7a) 434 500 400 455 448 442 440
7d Race4 ( of 7a sums to 100)
African-American 358 167 100 364 335 233 284
AsianPacific Islander 00 00 00 00 11 18 42
Native American 00 00 00 00 05 24 11
White 642 833 900 636 641 717 658
OtherUnknownMissing 00 00 00 00 08 08 05
7e Hispanic ( of 7a) 19 00 00 91 30 32 134
7f Primary cause of ESRD ( of 7a sums to 100)
Diabetes 509 417 300 545 408 403 451
Hypertension 189 167 400 364 304 272 287
Primary Glomerulonephritis 132 167 200 91 63 67 64
OtherMissing 170 250 100 00 226 258 199
7g Medical coverage ( of 7a sums to 100)
Employer group only 38 333 100 182 178 162 161
Medicare only 113 00 100 91 162 163 204
Medicaid only 75 00 00 91 103 100 114
Medicare and Medicaid only 226 00 00 91 112 102 126
Medicare and Other 377 500 800 455 360 370 238
OtherUnknown 151 167 00 91 40 60 86
None 19 00 00 00 46 43 71
7h Body Mass Index5
Male 287 242 281 227 268 269 266
Female 261 335 276 328 288 287 280
7i Employment6
Six months prior to ESRD treatment 190 667 333 400 348 387 362
At first ESRD treatment 95 667 333 400 181 225 220
7j Primary modality7 ( of 7a sums to 100)
Hemodialysis 500 444 500 944 945 939
CAPDCCPD 500 556 500 56 55 61
OtherUnknownMissing 00 00 00 00 00 00
7k Number of incident hemodialysis patients7 (n) 6 4 5 332 286 298
7l Access used at first outpatient dialysis7 ( of 7k sums to 100)
Arteriovenous fistula 00 500 00 127 141 136
Arteriovenous graft 00 00 00 29 27 33
Catheter 100 500 100 843 832 819
OtherUnknownMissing 00 00 00 01 00 12
7m Arteriovenous fistulae placed7 ( of 7k) 167 750 00 229 270 292
Average Lab Values Prior to Dialysis3
7n Hemoglobin (gdL [3-18]) 105 112 120 105 99 100 99
7o Serum Albumin (gdL [08-60]) 32 35 36 33 32 32 31
SAMPLE
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1218
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 (cont) Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Average Lab Values Prior to Dialysis3
7p Serum Creatinine (mgdL [2-33]) 70 50 54 51 58 58 63
7q GFR (mLmin [0-60]) 103 124 119 140 119 118 110
Care Prior to ESRD Therapy 7r Received ESA prior to ESRD ( of 7a) 472 333 700 364 261 295 263
7s Pre-ESRD nephrologist care7 ( of 7a sums to 100)
No 250 200 91 330 321 310
Yes lt 6 months 00 00 00 38 48 116
Yes 6-12 months 417 300 545 201 215 208
Yes gt 12 months 333 500 364 328 341 242
Unknown 00 00 00 103 76 124
7t Informed of transplant options7 ( of 7a) 917 900 636 690 710 724
7u Patients not informed of transplant options7 (n) 1 0 3 102 87 92
7v Reason not informed7 ( of 7u may not sum to 100)
Medically unfit 00 100 384 439 309
Unsuitable due to age 00 00 334 320 239
Psychologically unfit 00 00 21 30 28
Patient declined information 00 00 13 12 13
Patient has not been assessed 100 00 332 294 449
Comorbid Conditions 7w Pre-existing Comorbidity ( yes of 7a)
Congestive heart failure 566 250 400 273 415 374 328
Atherosclerotic heart disease8 340 417 400 364 268 268 210
Other cardiac disorder8 00 00 100 00 198 197 171
CVD CVA TIA 57 00 00 182 107 103 95
Peripheral vascular disease 189 333 100 182 154 155 140
History of hypertension 981 917 100 909 861 845 847
Diabetes8 566 417 300 636 574 560 578
Diabetes on insulin 170 250 300 455 383 380 363
COPD 57 333 00 182 130 123 93
Current smoker 57 00 00 91 82 77 62
Cancer 00 00 00 182 112 109 74
Alcohol dependence 00 00 00 00 21 23 16
Drug dependence 00 00 00 00 18 15 13
Inability to ambulate 00 00 00 91 88 75 69
Inability to transfer 00 00 00 00 51 38 35
7x Average number of comorbid conditions 30 29 26 35 35 33 31 SAMPLE
na= not applicable [1] See Guide Section X [2] Values are shown for the average facility [3] For continuous variables summaries include only responses in range indicated in brackets [4] Asian includes Indian sub-continent Native American includes Alaskan Native White includes Middle Eastern and Arabian [5] The median BMI is computed for adult patients at least 20 years old [6] Full-time part-time or student ( of 18-60 year olds) [7] Data collection for these items began mid-year 2005 Summaries for these items shown starting in 2006 [8] AHD includes ischemic heart disease (coronary artery disease) and myocardial infarction Other cardiac disorder includes cardiac arrest cardiac
dysrhythmia and pericarditis Diabetes includes patients with diabetes as the primary cause of ESRD
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1318
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 8 Summaries for All Dialysis Patients Treated as of December 31 of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
8a
8b
8c
Patients treated on 1231 (n)
Average age (years)
Age ( of 8a sums to 100)
lt 20
141
601
07
123
616
00
127
636
00
130
627
00
712
616
05
523
626
05
652
609
05
20-64 574 593 551 585 549 513 562
65+ 418 407 449 415 446 481 433
8d Female ( of 8a) 489 472 512 515 454 449 453
8e Race ( of 8a sums to 100)
African American 447 553 543 554 452 327 374
AsianPacific Islander
Native American
00
07
00
00
00
00
08
00
13
05
24
30
48
15
White 546 447 457 438 526 615 551
OtherUnknownMissing 00 00 00 00 04 05 12
8f Ethnicity ( of 8a sums to 100)
Hispanic
Non-Hispanic
Unknown
21
950
28
24
943
33
24
953
24
23
962
15
33
953
14
38
950
12
153
827
19
8g Cause of ESRD ( of 8a sums to 100)
Diabetes 475 472 480 538 410 415 437
Hypertension
Glomerulonephritis
OtherUnknown
Missing
199
163
135
28
220
154
114
41
252
118
118
31
215
115
108
23
298
100
168
23
267
106
190
22
277
102
173
11
8h Average duration of ESRD (years) 45 48 47 43 43 42 43
8i Years since start of ESRD ( of 8a sums to 100)
lt 1 220 163 134 123 185 191 181
1-2 255 211 189 269 186 189 187
2-3 106 187 142 154 153 158 149
3-6 206 187 291 208 265 258 259
6+ 213 252 244 246 211 204 224
8j Nursing home patients3 ( of 8a) 64 130 87 62 142 162 133
8k Modality ( of 8a sums to 100)
In-center hemodialysis
In-center self hemodialysis
Home hemodialysis
Continuous ambulatory peritoneal dialysis
Continuous cycling peritoneal dialysis
Other modality4
837
00
00
142
14
07
902
00
00
73
16
08
858
00
00
110
31
00
869
00
00
38
92
00
909
00
15
38
32
07
908
00
15
34
37
07
906
00
11
27
49
07SAMPLE
na = not applicable [1] See Guide Section XI [2] Values are shown for the average facility [3] Includes patients who were also treated by a nursing facility at any time during the year The source of nursing facility history of patients is the Nursing
Home Minimum Dataset [4] Other modality includes other dialysis uncertain modality and patients not on dialysis but still temporarily assigned to the facility (discontinued dialysis
recovered renal function and lost to follow up)
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 9 Comorbidities Reported on Medicare Claims for Medicare Dialysis Patients Treated as of December 31 of Each Year1 2005-2007
This Facility Regional Averages2 2007 Measure Name 2005 2006 2007 State Network US
9a Medicare dialysis patients on 1231 (n) 112 103 107 556 401 473
9b Comorbidity ( yes of 9a)
AIDSHIV positive 00 00 09 12 10 18
Alcohol dependence 36 29 19 24 27 22
Anemia 54 49 37 98 79 73
Cancer 125 107 103 121 119 107
Cardiac arrest 09 10 19 15 14 15
Cardiac dysrhythmia 241 233 224 434 416 351
Cerebrovascular disease 259 252 262 309 274 273
Chronic obstructive pulmonary disease 232 282 243 359 328 296
Congestive heart failure 438 417 495 576 542 518
Diabetes 554 573 636 632 621 623
Drug dependence 00 10 00 24 26 19
Gastrointestinal tract bleeding 36 68 09 34 32 29
Hepatitis B 09 10 09 13 10 12
Hepatitis other 45 29 28 46 36 38
Hyperparathyroidism 63 58 75 80 132 88
Infection 563 476 477 554 506 511
Ischemic heart disease 527 495 495 597 562 510
Myocardial infarction 54 117 37 115 98 85
Peripheral vascular disease3 536 447 533 498 476 465
Pneumonia 63 29 19 55 50 53
9c Average number of comorbid conditions 38 37 37 46 44 41
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer on 1231 each year See Guide Section XII [2] Values are shown for the average facility [3] Peripheral vascular disease includes both venous and arterial diseases
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 10 How Patients Were Assigned to This Facility and End of Year Patient Status1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
10a Number of patients placed in facility1 (n) 205 184 166 177 1015 749 911
10b Initial patient placement for the year in this facility
( of 10a sums to 100)
Continuing at facility on 0101 698 766 741 718 686 679 691
Incident (new to ESRD) 263 163 133 51 199 206 199
Transferred into facility 39 71 127 232 115 114 110
10c Patient status at end of year ( of 10a sums to 100)
Alive in this facility on 1231 688 668 765 734 702 698 716
Alive in another facility on 1231 93 65 36 34 86 85 82
Received a transplant 29 33 42 23 31 35 28
Died death attributed to this facility 171 201 120 169 150 152 142
Died death attributed to another facility 10 27 06 11 16 15 14
Other3 10 05 30 28 15 16 18
SAMPLE[1] Patient assignment for Tables 1238 and 9 only See Guide Section XIII [2] Values are shown for the average facility [3] Includes patients who recovered renal function discontinued dialysis or were lost to follow-up Also includes dialysis unrelated deaths Dialysis
unrelated deaths are not attributed to any facility for the purposes of the mortality calculations in this report
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
There were 11 patients with Medical Evidence Forms (CMS-2728) which indicated that they started treatment at this facility during 2008 The average number of comorbidities reported for new patients is 35 which is higher than the average of 31 reported nationally Also 9 of these patients were not under the care of a nephrologist before starting dialysis compared to 31 nationally Furthermore 64 of these patients were informed of their transplant options compared to 72 nationally The average serum albumin calculated for these patients (before first dialysis) is 33 gdl which is higher than the national average value of 31 gdl The average residual renal function (GFR) calculated for these patients from serum creatinine (before first dialysis) and other parameters was 140 mlmin which is higher than the national average value of 110 mlmin
SAMPLEAmong patients treated at this facility on December 31 2008 6 were treated in a nursing home during the year which is lower than the national average value of 13 The average number of comorbidities reported on Medicare claims in 2007 for Medicare patients in this facility on December 31 2007 is 37 which is lower than the national average value of 41
Facility Information General information about this facility is provided in Tables 11 12 and 13 Table 11 provides counts of patients treated Medicare eligibility treatment modality and staffing from the Annual Facility Survey (Form CMS-2744) Table 12 reports survey and certification activity Table 13 includes services provided by this facility as well as information on ownership
This facility reported having 28 staff members to care for 140 patients at the end of 2008 This facility reported having 21 stations available as of March 31 2009 This facility offers both hemodialysis and peritoneal dialysis services Additional information regarding patient counts patient modality and facility staffing is available in Table 11
Sources of Patient Data This report is based primarily on Medicare claims and data collected for CMS Patients were assigned to this facility based on the Standard Information Management System (SIMS) database Medicare claims and Medical Evidence Forms (Form CMS-2728) Network 99 has a list of the patients included in the mortality analyses for this facility Table 9 reports comorbidities reported on Medicare claims Table 10 reports the number of patients placed in this facility for analyses in Tables 1 2 3 8 and 9 of this report Table 10 also provides information on patient status at the end of the year both for patients who remain in this facility until the end of each year and for those who transfer out of this facility receive a transplant or die during the year
These are just a few highlights of the statistics you will find in this report based on the data for this facility We hope that this report is of interest to you and that you will discuss it with your staff We welcome any questions or comments you might have about the content of the current report or any suggestions you might have for future reports Comments or suggestions can be submitted at the secure site available at wwwDialysisReportsorg until October 15 2009 If you have questions after the comment period is over please contact us directly at keccdfrumichedu or (734) 998-9823
For a complete description of the methods used to calculate the statistics in this report please see the Guide to the 2009 Dialysis Facility Reports The Guide is available from ESRD Network 99 and is also on the UM-KECC web site at wwwDialysisReportsorg
Prepared by The University of Michigan Kidney Epidemiology and Cost Center (UM-KECC) under contract with the Centers for Medicare amp Medicaid Services
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 518
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Death due to
2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 1 Mortality Summary for All Dialysis Patients (2005-08) amp New Dialysis Patients (2005-07)1
Regional Averages2 This Facility per Year 2005-2008
Measure Name 2005 2006 2007 2008 2005-2008 State Network US
SAMPLEAll Patients Death Rates 1a Patients (n=number) 205 184 166 177 7327 965 700 901
1b Patient years (PY) at risk (n) 1486 1265 1249 1262 52627 670 479 606
1c Deaths (n) 35 37 20 30 1227 146 108 127
1d Expected deaths (n) 322 264 280 296 1167 150 118 127
1e Death rate per 100 PY ( of 1b) 236 292 160 238 232 218 225 210
1f Expected death rate per 100 PY ( of 1b) 216 209 225 235 221 225 246 210
All Patients Categories of Death 1g Withdrawal from dialysis prior to death ( of 1c) 286 378 300 200 295 275 341 238
1h Death due to Infections ( of 1c) 286 243 200 200 238 173 180 175
Cardiac causes ( of 1c) 429 324 600 267 385 311 303 273
1i Dialysis unrelated deaths3 (n excluded from SMR) 0 0 1 2 37 01 01 01
All Patients Standardized Mortality Ratio (SMR)
1j SMR4 109 140 071 101 105 097 091 100
1k P-value5 066 006 014 099 062 na na na
1l Confidence interval for SMR6
High (95 limit) 151 193 110 145 125 na na na
Low (5 limit) 076 099 044 068 087 na na na
All Patients SMR Percentiles for this Facility (ie percent of facilities with lower mortality rates) 1m In this State 62 88 18 64 65
1n In this Network 69 89 31 69 76
1o In the US 53 82 21 60 59
Regional Averages New Patients First Year Death Rates 2005 2006 2007 2005-2007 Per Year 2005-20072
1p New Patients (n=number) 53 12 10 757 237 189 202
1q Patient years (PY) at risk (n) 422 96 92 6117 199 158 171
1r Deaths (n) 16 4 2 227 59 46 48
1s Expected deaths (n) 102 24 31 1577 62 51 48
1t Death rate per 100 PY 379 415 216 360 295 289 281
1u Expected death rate per 100 PY 242 247 338 257 309 321 281
New Patients Categories of Deaths 1v Withdrawal from dialysis prior to death ( of 1r) 250 750 100 409 343 429 322
1w Death due to Infections ( of 1r) 375 00 00 273 212 228 231
Cardiac causes ( of 1r) 250 750 00 318 336 362 331
New Patients First Year Standardized Mortality Ratio (SMR)
1x SMR4 157 168 064 140 095 090 100
1y P-value5 011 044 079 015 na na na
1z Confidence interval for SMR6
High (95 limit) 255 430 231 212 na na na
Low (5 limit) 090 046 008 088 na na na
na = not applicable [1] See Guide Section IV [2] Values are shown for the average facility annualized [3] Defined as deaths due to street drugs and accidents unrelated to treatment [4] Calculated as a ratio of deaths (1c to 1d for all patients 1r to 1s for new patients) to expected deaths not shown if there are too few expected deaths [5] A p-value less than or equal to 005 indicates that the difference between the actual and expected mortality is probably real and is not due to random
chance alone while a p-value greater than 005 indicates that the difference could plausibly be due to random chance [6] The confidence interval range represents uncertainty in the value of the SMR due to random variation [7] Sum of 4 years (all patients) or 3 years (new patients) used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 2 Hospitalization Summary for Medicare Dialysis Patients1 2005-2007
Regional Averages2 This Facility per Year 2005-2007
Measure Name 2005 2006 2007 2005-2007 State Network US Medicare Dialysis Patients
2a Medicare dialysis patients (n) 160 154 141 4555 791 572 674
2b Patient years (PY) at risk (n) 1136 1037 1037 32105 543 387 445
Days Hospitalized Statistics
2c Total days hospitalized (n) 1692 1758 924 43745 869 542 658
2d Expected total days hospitalized (n) 18024 15891 14855 487705 8082 5799 6580
2e Days hospitalized per PY 149 170 89 136 160 140 148
2f Expected days hospitalized per PY 159 153 143 152 149 150 148
2g Standardized Hospitalization Ratio (Days)3 094 111 062 090 107 093 100
Admission Statistics
2h Total admissions (n) 226 193 140 5595 115 77 84
2i Expected total admissions (n) 2287 2023 1919 62305 1039 747 844
2j Admissions per PY 20 19 13 17 21 20 19
2k Expected admissions per PY 20 20 19 19 19 19 19
2l Standardized Hospitalization Ratio (Admissions)4 099 095 073 090 111 103 100
Diagnoses Present at Admission ( of 2a) 2m Septicemia 188 169 142 167 153 128 123
2n Acute myocardial infarction 69 58 21 51 60 52 42
2o Congestive heart failure 288 208 191 231 309 281 252
2p Cardiac dysrhythmia 163 110 121 132 166 168 146
2q Cardiac arrest 31 13 28 24 22 18 17
Length of Stay 2r One day admissions ( of 2h) 186 155 229 186 124 144 136
2s Average length of stay (days per admission 2c2h) 75 91 66 78 75 70 78
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer see Guide Section V [2] Values are shown for the average facility annualized [3] Standardized Hospitalization Ratio (Days) calculated as ratio of actual (2c) to expected (2d) hospitalized days [4] Standardized Hospitalization Ratio (Admissions) calculated as ratio of actual (2h) to expected (2i) total admissions [5] Sum of 3 years used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 3 Transplantation Summary for Dialysis Patients under Age 70 2005-2008
Regional Averages2 This Facility per Year 2005-2008
Measure Name 2005 2006 2007 2008 2005-2008 State Network US
3a Eligible patients1 (n) 147 121 110 112 4909 636 437 616
3b Transplants (n) 8 7 7 3 259 30 25 25
3c Donor type (sums to 3b3)
Living Donor (n) 2 1 0 1 49 10 10 08
Deceased Donor (n) 6 6 7 2 219 20 16 17
Patients who have not Previously Received a Transplant
3d Eligible patients1 (n) 134 106 100 104 4449 575 389 550
3e Patient years (PY) at risk (n) 967 768 761 776 32739 404 268 378
3f 1st transplants4 (n) 7 6 6 3 229 27 22 21
3g Expected 1st transplants (n) 53 44 39 39 1759 22 15 21
3h 1st transplant rate per 100 PY 72 78 79 39 67 66 82 56
3i Expected 1st transplant rate per 100 PY 55 57 51 50 53 56 55 56
3j Donor type (sums to 3f5)
Living Donor (n) 2 0 0 1 39 09 08 06
Deceased Donor (n) 5 6 6 2 199 18 14 15
Standardized 1st Transplantation Ratio (STR)
3k STR6 131 136 154 078 126 119 149 100
3l P-value7 058 056 040 092 034 na na na
3m 95 Confidence interval for STR8
Upper limit 270 297 334 227 190 na na na
Lower limit 053 050 056 016 079 na na na
STR Percentiles for this Facility (ie percent of facilities with lower transplantation rates) 3n In this State 56 59 69 41 53
3o In this Network 47 49 55 35 40
3p In the US 67 69 76 48 67
SAMPLE na = not applicable [1] See Guide Section VI [2] Values are shown for the average facility annualized [3] Values may not sum to 3b due to unknown donor type [4] Among first transplants that occurred after the start of dialysis from 2005-2008 42 of transplants in the US were not included because the transplant
occurred less than 90 days after the start of ESRD and 02 were not included because the patient was not assigned to a facility at time of transplant [5] Values may not sum to 3f due to unknown donor type [6] Standardized Transplantation Ratio calculated as ratio of actual (3f) to expected (3g) Not shown if 3g is too small [7] A p-value less than or equal to 005 indicates that the difference between the actual and expected transplants is probably real and is not due to random
chance while a p-value greater than 005 indicates that the difference is plausibly due to random chance [8] The confidence interval range represents uncertainty in the value of the STR due to random variation [9] Sum of 4 years used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 4 Waitlist Summary for Dialysis Patients under Age 70 Treated as of December 31st of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
4a
4b
4c
4d
Eligible patients on 12311 (n)
Patients on the waitlist ( of 4a)
P-value 3 (compared to US value)
Patients on the waitlist by subgroup ( of corresponding value in 4e)
Age lt 40
Age 40-69
96
344
lt01
600
296
87
333
002
600
278
83
337
002
500
320
93
247
025
250
247
502
215
na
364
193
344
222
na
363
199
464
214
na
320
198
Male 327 333 349 239 221 223 220
Female 362 333 325 255 209 219 207
African American 392 308 277 200 197 202 200
AsianPacific Islander
Native American
00
100
284
313
372
220
326
172
White Hispanic
White Non-Hispanic
Otherunknown race
00
310
500
364
500
412
00
308
194
237
86
185
233
136
238
206
261
Diabetes 286 289 356 216 167 173 163
Non-diabetes 404 381 316 286 250 259 255
Previous kidney transplant
No previous kidney transplant
545
318
556
308
429
329
429
233
429
192
430
195
437
192
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
326
333
379
324
320
357
414
240
345
108
367
308
120
287
263
129
286
279
111
268
292
4e Eligible patients in 4a by subgroup (n)
Age lt 40
Age 40-69
15
81
15
72
8
75
8
85
66
435
46
298
63
400
Male 49 45 43 46 286 197 261
Female 47 42 40 47 216 148 202
African American 51 52 47 50 259 137 194
AsianPacific Islander
Native American
0
1
0
0
0
0
1
0
06
03
09
13
22
08
White Hispanic
White Non-Hispanic
Otherunknown race
2
42
0
2
33
0
2
34
0
3
39
0
15
216
02
14
169
02
70
164
06
Diabetes 49 45 45 51 210 148 204
Non-diabetes 47 42 38 42 292 196 259
Previous kidney transplant
No previous kidney transplant
11
85
9
78
7
76
7
86
50
451
39
306
42
422
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
43
24
29
34
25
28
29
25
29
37
30
26
195
164
143
137
110
97
180
145
139
SAMPLE
na = not applicable [1] See Guide Section VII [2] Values are shown for the average facility [3] Facility waitlist percentage is compared to the US waitlist percentage for that year 226 (2005) 230 (2006) 237 (2007) 214 (2008)
A p-value greater than 005 indicates that the difference between percent of patients waitlisted at the facility and national percentage is plausibly due to random chance
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 918
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 5 Facility Modality Hemoglobin and Urea Reduction Ratio for Medicare Dialysis Patients1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Modality (among all dialysis patients with ESRD for 90+ days and 1+ claim at this facility)
5a Patients treated during year1 (n) 163 162 152 153 843 661 771
5b Modality ( of 5a sums to 100)
Hemodialysis 840 858 862 869 891 896 895
CAPDCCPD 129 80 132 98 47 50 56
Other dialysis3 31 62 07 33 62 54 48
Hemoglobin (among ESA-treated dialysis patients with ESRD for 90+ days and 4+ Hemoglobin claims at this facility)
5c Eligible patients1 (n) 123 119 107 110 571 420 496
5d Average hemoglobin (gdL) 126 119 118 106 116 116 116
5e Hemoglobin categories ( of 5c sums to 100)
lt 10 gdL 16 25 19 164 26 24 23
10-12 gdL 187 429 617 809 684 727 713
gt 12 gdL 797 546 364 27 290 249 264
5f Hemoglobin 10-12 gdL ( of HD pts) 170 416 630 840 682 724 711
Hemoglobin 10-12 gdL ( of PD pts) 286 667 429 00 649 679 689
5g Hemoglobin percentiles for this facility4
In this State 7 48 79 72
In this Network 7 38 61 59
In the US 6 37 62 69
Urea Reduction Ratio (URR among HD patients with ESRD for 183+ days and 4+ URR claims at this facility)6
5h Eligible patients1(n) 95 100 97 113 521 384 454
5i URR categories ( of 5h sums to 100)
lt 600 74 50 31 09 17 19 15
600-649 126 140 52 71 25 30 27
650-699 474 480 515 265 113 130 110
700-749 295 250 309 469 391 391 360
75+ 32 80 93 186 454 430 488
5j URR 65+ ( of 5h meets a KDOQI guideline) 800 810 918 920 958 951 958
5k URR percentiles for this facility5
In this State 4 2 13 17
In this Network 4 2 18 21
In the US 3 3 16 16SAMPLE
na = not applicable [1] See Guide Section VIII [2] Counts are shown for the average facility [3] Other dialysis includes patients who switch between HD and PD during the year and patients for whom modality is unknown [4] Percent of facilities with a smaller percentage of patients with hemoglobin 10-12 gdl [5] Percent of facilities with a smaller percentage of patients with URR 65+ [6] Patients identified in the Standard Information Management System (SIMS) as having dialyzed five or more times per week were excluded from the URR
calculations Among eligible patients in the US 044 were excluded due to frequent dialysis in 2008
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1018
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 6 Vascular Access Information1 (CMS Fistula First) 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Vascular Access
6a Prevalent hemodialysis patient months3 1709 1454 1424 1446
6b Vascular access type in use ( of 6a sums to 100)
Arteriovenous fistula 263 352 410 427 465 483 502
Arteriovenous graft 420 384 361 315 271 214 227
Catheter 314 259 228 258 261 300 267
OtherMissing 03 04 01 00 03 03 04
6c Arteriovenous fistulae in place4 ( of 6a) 317 422 492 512 541 573 581
6d Catheter only ge 90 days5 ( of 6a) 142 94 103 95 116 137 115
Vascular Access at First Treatment 6e Incident hemodialysis patients (n) 26 0 12 23 189 148 173
6f Vascular access type in use6 ( of 6e sums to 100)
Arteriovenous fistula 154 417 217 146 149 158
Arteriovenous graft 115 83 43 53 45 68
Catheter 538 500 739 777 792 749
OtherMissing 192 00 00 23 13 25
6g Arteriovenous fistulae in place4 ( of 6e) 231 583 391 253 288 308
SAMPLE na = not applicable [1] See Guide Section IX [2] Values are shown for the average facility [3] Patients may be counted up to 12 times per year [4] Includes all patients with fistulae regardless of whether or not they received their hemodialysis treatments using their fistulae [5] Catheter was used for treatment and has been in place for 90 days or more prior to treatment Patient does not have an fistula or graft in place Catheter is
only access Port access devices are reported as catheters for this project [6] Patients listed as graft or catheter may have had fistulae in place for future use but they actually received their treatment through a graft or catheter
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1118
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patient Characteristics3
7a Total number of patients with forms (n) 53 12 10 11 350 304 319
7b Average age (years [0-95]) 632 658 732 612 643 648 633
7c Female ( of 7a) 434 500 400 455 448 442 440
7d Race4 ( of 7a sums to 100)
African-American 358 167 100 364 335 233 284
AsianPacific Islander 00 00 00 00 11 18 42
Native American 00 00 00 00 05 24 11
White 642 833 900 636 641 717 658
OtherUnknownMissing 00 00 00 00 08 08 05
7e Hispanic ( of 7a) 19 00 00 91 30 32 134
7f Primary cause of ESRD ( of 7a sums to 100)
Diabetes 509 417 300 545 408 403 451
Hypertension 189 167 400 364 304 272 287
Primary Glomerulonephritis 132 167 200 91 63 67 64
OtherMissing 170 250 100 00 226 258 199
7g Medical coverage ( of 7a sums to 100)
Employer group only 38 333 100 182 178 162 161
Medicare only 113 00 100 91 162 163 204
Medicaid only 75 00 00 91 103 100 114
Medicare and Medicaid only 226 00 00 91 112 102 126
Medicare and Other 377 500 800 455 360 370 238
OtherUnknown 151 167 00 91 40 60 86
None 19 00 00 00 46 43 71
7h Body Mass Index5
Male 287 242 281 227 268 269 266
Female 261 335 276 328 288 287 280
7i Employment6
Six months prior to ESRD treatment 190 667 333 400 348 387 362
At first ESRD treatment 95 667 333 400 181 225 220
7j Primary modality7 ( of 7a sums to 100)
Hemodialysis 500 444 500 944 945 939
CAPDCCPD 500 556 500 56 55 61
OtherUnknownMissing 00 00 00 00 00 00
7k Number of incident hemodialysis patients7 (n) 6 4 5 332 286 298
7l Access used at first outpatient dialysis7 ( of 7k sums to 100)
Arteriovenous fistula 00 500 00 127 141 136
Arteriovenous graft 00 00 00 29 27 33
Catheter 100 500 100 843 832 819
OtherUnknownMissing 00 00 00 01 00 12
7m Arteriovenous fistulae placed7 ( of 7k) 167 750 00 229 270 292
Average Lab Values Prior to Dialysis3
7n Hemoglobin (gdL [3-18]) 105 112 120 105 99 100 99
7o Serum Albumin (gdL [08-60]) 32 35 36 33 32 32 31
SAMPLE
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1218
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 (cont) Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Average Lab Values Prior to Dialysis3
7p Serum Creatinine (mgdL [2-33]) 70 50 54 51 58 58 63
7q GFR (mLmin [0-60]) 103 124 119 140 119 118 110
Care Prior to ESRD Therapy 7r Received ESA prior to ESRD ( of 7a) 472 333 700 364 261 295 263
7s Pre-ESRD nephrologist care7 ( of 7a sums to 100)
No 250 200 91 330 321 310
Yes lt 6 months 00 00 00 38 48 116
Yes 6-12 months 417 300 545 201 215 208
Yes gt 12 months 333 500 364 328 341 242
Unknown 00 00 00 103 76 124
7t Informed of transplant options7 ( of 7a) 917 900 636 690 710 724
7u Patients not informed of transplant options7 (n) 1 0 3 102 87 92
7v Reason not informed7 ( of 7u may not sum to 100)
Medically unfit 00 100 384 439 309
Unsuitable due to age 00 00 334 320 239
Psychologically unfit 00 00 21 30 28
Patient declined information 00 00 13 12 13
Patient has not been assessed 100 00 332 294 449
Comorbid Conditions 7w Pre-existing Comorbidity ( yes of 7a)
Congestive heart failure 566 250 400 273 415 374 328
Atherosclerotic heart disease8 340 417 400 364 268 268 210
Other cardiac disorder8 00 00 100 00 198 197 171
CVD CVA TIA 57 00 00 182 107 103 95
Peripheral vascular disease 189 333 100 182 154 155 140
History of hypertension 981 917 100 909 861 845 847
Diabetes8 566 417 300 636 574 560 578
Diabetes on insulin 170 250 300 455 383 380 363
COPD 57 333 00 182 130 123 93
Current smoker 57 00 00 91 82 77 62
Cancer 00 00 00 182 112 109 74
Alcohol dependence 00 00 00 00 21 23 16
Drug dependence 00 00 00 00 18 15 13
Inability to ambulate 00 00 00 91 88 75 69
Inability to transfer 00 00 00 00 51 38 35
7x Average number of comorbid conditions 30 29 26 35 35 33 31 SAMPLE
na= not applicable [1] See Guide Section X [2] Values are shown for the average facility [3] For continuous variables summaries include only responses in range indicated in brackets [4] Asian includes Indian sub-continent Native American includes Alaskan Native White includes Middle Eastern and Arabian [5] The median BMI is computed for adult patients at least 20 years old [6] Full-time part-time or student ( of 18-60 year olds) [7] Data collection for these items began mid-year 2005 Summaries for these items shown starting in 2006 [8] AHD includes ischemic heart disease (coronary artery disease) and myocardial infarction Other cardiac disorder includes cardiac arrest cardiac
dysrhythmia and pericarditis Diabetes includes patients with diabetes as the primary cause of ESRD
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1318
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 8 Summaries for All Dialysis Patients Treated as of December 31 of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
8a
8b
8c
Patients treated on 1231 (n)
Average age (years)
Age ( of 8a sums to 100)
lt 20
141
601
07
123
616
00
127
636
00
130
627
00
712
616
05
523
626
05
652
609
05
20-64 574 593 551 585 549 513 562
65+ 418 407 449 415 446 481 433
8d Female ( of 8a) 489 472 512 515 454 449 453
8e Race ( of 8a sums to 100)
African American 447 553 543 554 452 327 374
AsianPacific Islander
Native American
00
07
00
00
00
00
08
00
13
05
24
30
48
15
White 546 447 457 438 526 615 551
OtherUnknownMissing 00 00 00 00 04 05 12
8f Ethnicity ( of 8a sums to 100)
Hispanic
Non-Hispanic
Unknown
21
950
28
24
943
33
24
953
24
23
962
15
33
953
14
38
950
12
153
827
19
8g Cause of ESRD ( of 8a sums to 100)
Diabetes 475 472 480 538 410 415 437
Hypertension
Glomerulonephritis
OtherUnknown
Missing
199
163
135
28
220
154
114
41
252
118
118
31
215
115
108
23
298
100
168
23
267
106
190
22
277
102
173
11
8h Average duration of ESRD (years) 45 48 47 43 43 42 43
8i Years since start of ESRD ( of 8a sums to 100)
lt 1 220 163 134 123 185 191 181
1-2 255 211 189 269 186 189 187
2-3 106 187 142 154 153 158 149
3-6 206 187 291 208 265 258 259
6+ 213 252 244 246 211 204 224
8j Nursing home patients3 ( of 8a) 64 130 87 62 142 162 133
8k Modality ( of 8a sums to 100)
In-center hemodialysis
In-center self hemodialysis
Home hemodialysis
Continuous ambulatory peritoneal dialysis
Continuous cycling peritoneal dialysis
Other modality4
837
00
00
142
14
07
902
00
00
73
16
08
858
00
00
110
31
00
869
00
00
38
92
00
909
00
15
38
32
07
908
00
15
34
37
07
906
00
11
27
49
07SAMPLE
na = not applicable [1] See Guide Section XI [2] Values are shown for the average facility [3] Includes patients who were also treated by a nursing facility at any time during the year The source of nursing facility history of patients is the Nursing
Home Minimum Dataset [4] Other modality includes other dialysis uncertain modality and patients not on dialysis but still temporarily assigned to the facility (discontinued dialysis
recovered renal function and lost to follow up)
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 9 Comorbidities Reported on Medicare Claims for Medicare Dialysis Patients Treated as of December 31 of Each Year1 2005-2007
This Facility Regional Averages2 2007 Measure Name 2005 2006 2007 State Network US
9a Medicare dialysis patients on 1231 (n) 112 103 107 556 401 473
9b Comorbidity ( yes of 9a)
AIDSHIV positive 00 00 09 12 10 18
Alcohol dependence 36 29 19 24 27 22
Anemia 54 49 37 98 79 73
Cancer 125 107 103 121 119 107
Cardiac arrest 09 10 19 15 14 15
Cardiac dysrhythmia 241 233 224 434 416 351
Cerebrovascular disease 259 252 262 309 274 273
Chronic obstructive pulmonary disease 232 282 243 359 328 296
Congestive heart failure 438 417 495 576 542 518
Diabetes 554 573 636 632 621 623
Drug dependence 00 10 00 24 26 19
Gastrointestinal tract bleeding 36 68 09 34 32 29
Hepatitis B 09 10 09 13 10 12
Hepatitis other 45 29 28 46 36 38
Hyperparathyroidism 63 58 75 80 132 88
Infection 563 476 477 554 506 511
Ischemic heart disease 527 495 495 597 562 510
Myocardial infarction 54 117 37 115 98 85
Peripheral vascular disease3 536 447 533 498 476 465
Pneumonia 63 29 19 55 50 53
9c Average number of comorbid conditions 38 37 37 46 44 41
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer on 1231 each year See Guide Section XII [2] Values are shown for the average facility [3] Peripheral vascular disease includes both venous and arterial diseases
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 10 How Patients Were Assigned to This Facility and End of Year Patient Status1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
10a Number of patients placed in facility1 (n) 205 184 166 177 1015 749 911
10b Initial patient placement for the year in this facility
( of 10a sums to 100)
Continuing at facility on 0101 698 766 741 718 686 679 691
Incident (new to ESRD) 263 163 133 51 199 206 199
Transferred into facility 39 71 127 232 115 114 110
10c Patient status at end of year ( of 10a sums to 100)
Alive in this facility on 1231 688 668 765 734 702 698 716
Alive in another facility on 1231 93 65 36 34 86 85 82
Received a transplant 29 33 42 23 31 35 28
Died death attributed to this facility 171 201 120 169 150 152 142
Died death attributed to another facility 10 27 06 11 16 15 14
Other3 10 05 30 28 15 16 18
SAMPLE[1] Patient assignment for Tables 1238 and 9 only See Guide Section XIII [2] Values are shown for the average facility [3] Includes patients who recovered renal function discontinued dialysis or were lost to follow-up Also includes dialysis unrelated deaths Dialysis
unrelated deaths are not attributed to any facility for the purposes of the mortality calculations in this report
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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Death due to
2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 1 Mortality Summary for All Dialysis Patients (2005-08) amp New Dialysis Patients (2005-07)1
Regional Averages2 This Facility per Year 2005-2008
Measure Name 2005 2006 2007 2008 2005-2008 State Network US
SAMPLEAll Patients Death Rates 1a Patients (n=number) 205 184 166 177 7327 965 700 901
1b Patient years (PY) at risk (n) 1486 1265 1249 1262 52627 670 479 606
1c Deaths (n) 35 37 20 30 1227 146 108 127
1d Expected deaths (n) 322 264 280 296 1167 150 118 127
1e Death rate per 100 PY ( of 1b) 236 292 160 238 232 218 225 210
1f Expected death rate per 100 PY ( of 1b) 216 209 225 235 221 225 246 210
All Patients Categories of Death 1g Withdrawal from dialysis prior to death ( of 1c) 286 378 300 200 295 275 341 238
1h Death due to Infections ( of 1c) 286 243 200 200 238 173 180 175
Cardiac causes ( of 1c) 429 324 600 267 385 311 303 273
1i Dialysis unrelated deaths3 (n excluded from SMR) 0 0 1 2 37 01 01 01
All Patients Standardized Mortality Ratio (SMR)
1j SMR4 109 140 071 101 105 097 091 100
1k P-value5 066 006 014 099 062 na na na
1l Confidence interval for SMR6
High (95 limit) 151 193 110 145 125 na na na
Low (5 limit) 076 099 044 068 087 na na na
All Patients SMR Percentiles for this Facility (ie percent of facilities with lower mortality rates) 1m In this State 62 88 18 64 65
1n In this Network 69 89 31 69 76
1o In the US 53 82 21 60 59
Regional Averages New Patients First Year Death Rates 2005 2006 2007 2005-2007 Per Year 2005-20072
1p New Patients (n=number) 53 12 10 757 237 189 202
1q Patient years (PY) at risk (n) 422 96 92 6117 199 158 171
1r Deaths (n) 16 4 2 227 59 46 48
1s Expected deaths (n) 102 24 31 1577 62 51 48
1t Death rate per 100 PY 379 415 216 360 295 289 281
1u Expected death rate per 100 PY 242 247 338 257 309 321 281
New Patients Categories of Deaths 1v Withdrawal from dialysis prior to death ( of 1r) 250 750 100 409 343 429 322
1w Death due to Infections ( of 1r) 375 00 00 273 212 228 231
Cardiac causes ( of 1r) 250 750 00 318 336 362 331
New Patients First Year Standardized Mortality Ratio (SMR)
1x SMR4 157 168 064 140 095 090 100
1y P-value5 011 044 079 015 na na na
1z Confidence interval for SMR6
High (95 limit) 255 430 231 212 na na na
Low (5 limit) 090 046 008 088 na na na
na = not applicable [1] See Guide Section IV [2] Values are shown for the average facility annualized [3] Defined as deaths due to street drugs and accidents unrelated to treatment [4] Calculated as a ratio of deaths (1c to 1d for all patients 1r to 1s for new patients) to expected deaths not shown if there are too few expected deaths [5] A p-value less than or equal to 005 indicates that the difference between the actual and expected mortality is probably real and is not due to random
chance alone while a p-value greater than 005 indicates that the difference could plausibly be due to random chance [6] The confidence interval range represents uncertainty in the value of the SMR due to random variation [7] Sum of 4 years (all patients) or 3 years (new patients) used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 2 Hospitalization Summary for Medicare Dialysis Patients1 2005-2007
Regional Averages2 This Facility per Year 2005-2007
Measure Name 2005 2006 2007 2005-2007 State Network US Medicare Dialysis Patients
2a Medicare dialysis patients (n) 160 154 141 4555 791 572 674
2b Patient years (PY) at risk (n) 1136 1037 1037 32105 543 387 445
Days Hospitalized Statistics
2c Total days hospitalized (n) 1692 1758 924 43745 869 542 658
2d Expected total days hospitalized (n) 18024 15891 14855 487705 8082 5799 6580
2e Days hospitalized per PY 149 170 89 136 160 140 148
2f Expected days hospitalized per PY 159 153 143 152 149 150 148
2g Standardized Hospitalization Ratio (Days)3 094 111 062 090 107 093 100
Admission Statistics
2h Total admissions (n) 226 193 140 5595 115 77 84
2i Expected total admissions (n) 2287 2023 1919 62305 1039 747 844
2j Admissions per PY 20 19 13 17 21 20 19
2k Expected admissions per PY 20 20 19 19 19 19 19
2l Standardized Hospitalization Ratio (Admissions)4 099 095 073 090 111 103 100
Diagnoses Present at Admission ( of 2a) 2m Septicemia 188 169 142 167 153 128 123
2n Acute myocardial infarction 69 58 21 51 60 52 42
2o Congestive heart failure 288 208 191 231 309 281 252
2p Cardiac dysrhythmia 163 110 121 132 166 168 146
2q Cardiac arrest 31 13 28 24 22 18 17
Length of Stay 2r One day admissions ( of 2h) 186 155 229 186 124 144 136
2s Average length of stay (days per admission 2c2h) 75 91 66 78 75 70 78
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer see Guide Section V [2] Values are shown for the average facility annualized [3] Standardized Hospitalization Ratio (Days) calculated as ratio of actual (2c) to expected (2d) hospitalized days [4] Standardized Hospitalization Ratio (Admissions) calculated as ratio of actual (2h) to expected (2i) total admissions [5] Sum of 3 years used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 3 Transplantation Summary for Dialysis Patients under Age 70 2005-2008
Regional Averages2 This Facility per Year 2005-2008
Measure Name 2005 2006 2007 2008 2005-2008 State Network US
3a Eligible patients1 (n) 147 121 110 112 4909 636 437 616
3b Transplants (n) 8 7 7 3 259 30 25 25
3c Donor type (sums to 3b3)
Living Donor (n) 2 1 0 1 49 10 10 08
Deceased Donor (n) 6 6 7 2 219 20 16 17
Patients who have not Previously Received a Transplant
3d Eligible patients1 (n) 134 106 100 104 4449 575 389 550
3e Patient years (PY) at risk (n) 967 768 761 776 32739 404 268 378
3f 1st transplants4 (n) 7 6 6 3 229 27 22 21
3g Expected 1st transplants (n) 53 44 39 39 1759 22 15 21
3h 1st transplant rate per 100 PY 72 78 79 39 67 66 82 56
3i Expected 1st transplant rate per 100 PY 55 57 51 50 53 56 55 56
3j Donor type (sums to 3f5)
Living Donor (n) 2 0 0 1 39 09 08 06
Deceased Donor (n) 5 6 6 2 199 18 14 15
Standardized 1st Transplantation Ratio (STR)
3k STR6 131 136 154 078 126 119 149 100
3l P-value7 058 056 040 092 034 na na na
3m 95 Confidence interval for STR8
Upper limit 270 297 334 227 190 na na na
Lower limit 053 050 056 016 079 na na na
STR Percentiles for this Facility (ie percent of facilities with lower transplantation rates) 3n In this State 56 59 69 41 53
3o In this Network 47 49 55 35 40
3p In the US 67 69 76 48 67
SAMPLE na = not applicable [1] See Guide Section VI [2] Values are shown for the average facility annualized [3] Values may not sum to 3b due to unknown donor type [4] Among first transplants that occurred after the start of dialysis from 2005-2008 42 of transplants in the US were not included because the transplant
occurred less than 90 days after the start of ESRD and 02 were not included because the patient was not assigned to a facility at time of transplant [5] Values may not sum to 3f due to unknown donor type [6] Standardized Transplantation Ratio calculated as ratio of actual (3f) to expected (3g) Not shown if 3g is too small [7] A p-value less than or equal to 005 indicates that the difference between the actual and expected transplants is probably real and is not due to random
chance while a p-value greater than 005 indicates that the difference is plausibly due to random chance [8] The confidence interval range represents uncertainty in the value of the STR due to random variation [9] Sum of 4 years used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 4 Waitlist Summary for Dialysis Patients under Age 70 Treated as of December 31st of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
4a
4b
4c
4d
Eligible patients on 12311 (n)
Patients on the waitlist ( of 4a)
P-value 3 (compared to US value)
Patients on the waitlist by subgroup ( of corresponding value in 4e)
Age lt 40
Age 40-69
96
344
lt01
600
296
87
333
002
600
278
83
337
002
500
320
93
247
025
250
247
502
215
na
364
193
344
222
na
363
199
464
214
na
320
198
Male 327 333 349 239 221 223 220
Female 362 333 325 255 209 219 207
African American 392 308 277 200 197 202 200
AsianPacific Islander
Native American
00
100
284
313
372
220
326
172
White Hispanic
White Non-Hispanic
Otherunknown race
00
310
500
364
500
412
00
308
194
237
86
185
233
136
238
206
261
Diabetes 286 289 356 216 167 173 163
Non-diabetes 404 381 316 286 250 259 255
Previous kidney transplant
No previous kidney transplant
545
318
556
308
429
329
429
233
429
192
430
195
437
192
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
326
333
379
324
320
357
414
240
345
108
367
308
120
287
263
129
286
279
111
268
292
4e Eligible patients in 4a by subgroup (n)
Age lt 40
Age 40-69
15
81
15
72
8
75
8
85
66
435
46
298
63
400
Male 49 45 43 46 286 197 261
Female 47 42 40 47 216 148 202
African American 51 52 47 50 259 137 194
AsianPacific Islander
Native American
0
1
0
0
0
0
1
0
06
03
09
13
22
08
White Hispanic
White Non-Hispanic
Otherunknown race
2
42
0
2
33
0
2
34
0
3
39
0
15
216
02
14
169
02
70
164
06
Diabetes 49 45 45 51 210 148 204
Non-diabetes 47 42 38 42 292 196 259
Previous kidney transplant
No previous kidney transplant
11
85
9
78
7
76
7
86
50
451
39
306
42
422
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
43
24
29
34
25
28
29
25
29
37
30
26
195
164
143
137
110
97
180
145
139
SAMPLE
na = not applicable [1] See Guide Section VII [2] Values are shown for the average facility [3] Facility waitlist percentage is compared to the US waitlist percentage for that year 226 (2005) 230 (2006) 237 (2007) 214 (2008)
A p-value greater than 005 indicates that the difference between percent of patients waitlisted at the facility and national percentage is plausibly due to random chance
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 918
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 5 Facility Modality Hemoglobin and Urea Reduction Ratio for Medicare Dialysis Patients1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Modality (among all dialysis patients with ESRD for 90+ days and 1+ claim at this facility)
5a Patients treated during year1 (n) 163 162 152 153 843 661 771
5b Modality ( of 5a sums to 100)
Hemodialysis 840 858 862 869 891 896 895
CAPDCCPD 129 80 132 98 47 50 56
Other dialysis3 31 62 07 33 62 54 48
Hemoglobin (among ESA-treated dialysis patients with ESRD for 90+ days and 4+ Hemoglobin claims at this facility)
5c Eligible patients1 (n) 123 119 107 110 571 420 496
5d Average hemoglobin (gdL) 126 119 118 106 116 116 116
5e Hemoglobin categories ( of 5c sums to 100)
lt 10 gdL 16 25 19 164 26 24 23
10-12 gdL 187 429 617 809 684 727 713
gt 12 gdL 797 546 364 27 290 249 264
5f Hemoglobin 10-12 gdL ( of HD pts) 170 416 630 840 682 724 711
Hemoglobin 10-12 gdL ( of PD pts) 286 667 429 00 649 679 689
5g Hemoglobin percentiles for this facility4
In this State 7 48 79 72
In this Network 7 38 61 59
In the US 6 37 62 69
Urea Reduction Ratio (URR among HD patients with ESRD for 183+ days and 4+ URR claims at this facility)6
5h Eligible patients1(n) 95 100 97 113 521 384 454
5i URR categories ( of 5h sums to 100)
lt 600 74 50 31 09 17 19 15
600-649 126 140 52 71 25 30 27
650-699 474 480 515 265 113 130 110
700-749 295 250 309 469 391 391 360
75+ 32 80 93 186 454 430 488
5j URR 65+ ( of 5h meets a KDOQI guideline) 800 810 918 920 958 951 958
5k URR percentiles for this facility5
In this State 4 2 13 17
In this Network 4 2 18 21
In the US 3 3 16 16SAMPLE
na = not applicable [1] See Guide Section VIII [2] Counts are shown for the average facility [3] Other dialysis includes patients who switch between HD and PD during the year and patients for whom modality is unknown [4] Percent of facilities with a smaller percentage of patients with hemoglobin 10-12 gdl [5] Percent of facilities with a smaller percentage of patients with URR 65+ [6] Patients identified in the Standard Information Management System (SIMS) as having dialyzed five or more times per week were excluded from the URR
calculations Among eligible patients in the US 044 were excluded due to frequent dialysis in 2008
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1018
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 6 Vascular Access Information1 (CMS Fistula First) 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Vascular Access
6a Prevalent hemodialysis patient months3 1709 1454 1424 1446
6b Vascular access type in use ( of 6a sums to 100)
Arteriovenous fistula 263 352 410 427 465 483 502
Arteriovenous graft 420 384 361 315 271 214 227
Catheter 314 259 228 258 261 300 267
OtherMissing 03 04 01 00 03 03 04
6c Arteriovenous fistulae in place4 ( of 6a) 317 422 492 512 541 573 581
6d Catheter only ge 90 days5 ( of 6a) 142 94 103 95 116 137 115
Vascular Access at First Treatment 6e Incident hemodialysis patients (n) 26 0 12 23 189 148 173
6f Vascular access type in use6 ( of 6e sums to 100)
Arteriovenous fistula 154 417 217 146 149 158
Arteriovenous graft 115 83 43 53 45 68
Catheter 538 500 739 777 792 749
OtherMissing 192 00 00 23 13 25
6g Arteriovenous fistulae in place4 ( of 6e) 231 583 391 253 288 308
SAMPLE na = not applicable [1] See Guide Section IX [2] Values are shown for the average facility [3] Patients may be counted up to 12 times per year [4] Includes all patients with fistulae regardless of whether or not they received their hemodialysis treatments using their fistulae [5] Catheter was used for treatment and has been in place for 90 days or more prior to treatment Patient does not have an fistula or graft in place Catheter is
only access Port access devices are reported as catheters for this project [6] Patients listed as graft or catheter may have had fistulae in place for future use but they actually received their treatment through a graft or catheter
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1118
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patient Characteristics3
7a Total number of patients with forms (n) 53 12 10 11 350 304 319
7b Average age (years [0-95]) 632 658 732 612 643 648 633
7c Female ( of 7a) 434 500 400 455 448 442 440
7d Race4 ( of 7a sums to 100)
African-American 358 167 100 364 335 233 284
AsianPacific Islander 00 00 00 00 11 18 42
Native American 00 00 00 00 05 24 11
White 642 833 900 636 641 717 658
OtherUnknownMissing 00 00 00 00 08 08 05
7e Hispanic ( of 7a) 19 00 00 91 30 32 134
7f Primary cause of ESRD ( of 7a sums to 100)
Diabetes 509 417 300 545 408 403 451
Hypertension 189 167 400 364 304 272 287
Primary Glomerulonephritis 132 167 200 91 63 67 64
OtherMissing 170 250 100 00 226 258 199
7g Medical coverage ( of 7a sums to 100)
Employer group only 38 333 100 182 178 162 161
Medicare only 113 00 100 91 162 163 204
Medicaid only 75 00 00 91 103 100 114
Medicare and Medicaid only 226 00 00 91 112 102 126
Medicare and Other 377 500 800 455 360 370 238
OtherUnknown 151 167 00 91 40 60 86
None 19 00 00 00 46 43 71
7h Body Mass Index5
Male 287 242 281 227 268 269 266
Female 261 335 276 328 288 287 280
7i Employment6
Six months prior to ESRD treatment 190 667 333 400 348 387 362
At first ESRD treatment 95 667 333 400 181 225 220
7j Primary modality7 ( of 7a sums to 100)
Hemodialysis 500 444 500 944 945 939
CAPDCCPD 500 556 500 56 55 61
OtherUnknownMissing 00 00 00 00 00 00
7k Number of incident hemodialysis patients7 (n) 6 4 5 332 286 298
7l Access used at first outpatient dialysis7 ( of 7k sums to 100)
Arteriovenous fistula 00 500 00 127 141 136
Arteriovenous graft 00 00 00 29 27 33
Catheter 100 500 100 843 832 819
OtherUnknownMissing 00 00 00 01 00 12
7m Arteriovenous fistulae placed7 ( of 7k) 167 750 00 229 270 292
Average Lab Values Prior to Dialysis3
7n Hemoglobin (gdL [3-18]) 105 112 120 105 99 100 99
7o Serum Albumin (gdL [08-60]) 32 35 36 33 32 32 31
SAMPLE
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1218
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 (cont) Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Average Lab Values Prior to Dialysis3
7p Serum Creatinine (mgdL [2-33]) 70 50 54 51 58 58 63
7q GFR (mLmin [0-60]) 103 124 119 140 119 118 110
Care Prior to ESRD Therapy 7r Received ESA prior to ESRD ( of 7a) 472 333 700 364 261 295 263
7s Pre-ESRD nephrologist care7 ( of 7a sums to 100)
No 250 200 91 330 321 310
Yes lt 6 months 00 00 00 38 48 116
Yes 6-12 months 417 300 545 201 215 208
Yes gt 12 months 333 500 364 328 341 242
Unknown 00 00 00 103 76 124
7t Informed of transplant options7 ( of 7a) 917 900 636 690 710 724
7u Patients not informed of transplant options7 (n) 1 0 3 102 87 92
7v Reason not informed7 ( of 7u may not sum to 100)
Medically unfit 00 100 384 439 309
Unsuitable due to age 00 00 334 320 239
Psychologically unfit 00 00 21 30 28
Patient declined information 00 00 13 12 13
Patient has not been assessed 100 00 332 294 449
Comorbid Conditions 7w Pre-existing Comorbidity ( yes of 7a)
Congestive heart failure 566 250 400 273 415 374 328
Atherosclerotic heart disease8 340 417 400 364 268 268 210
Other cardiac disorder8 00 00 100 00 198 197 171
CVD CVA TIA 57 00 00 182 107 103 95
Peripheral vascular disease 189 333 100 182 154 155 140
History of hypertension 981 917 100 909 861 845 847
Diabetes8 566 417 300 636 574 560 578
Diabetes on insulin 170 250 300 455 383 380 363
COPD 57 333 00 182 130 123 93
Current smoker 57 00 00 91 82 77 62
Cancer 00 00 00 182 112 109 74
Alcohol dependence 00 00 00 00 21 23 16
Drug dependence 00 00 00 00 18 15 13
Inability to ambulate 00 00 00 91 88 75 69
Inability to transfer 00 00 00 00 51 38 35
7x Average number of comorbid conditions 30 29 26 35 35 33 31 SAMPLE
na= not applicable [1] See Guide Section X [2] Values are shown for the average facility [3] For continuous variables summaries include only responses in range indicated in brackets [4] Asian includes Indian sub-continent Native American includes Alaskan Native White includes Middle Eastern and Arabian [5] The median BMI is computed for adult patients at least 20 years old [6] Full-time part-time or student ( of 18-60 year olds) [7] Data collection for these items began mid-year 2005 Summaries for these items shown starting in 2006 [8] AHD includes ischemic heart disease (coronary artery disease) and myocardial infarction Other cardiac disorder includes cardiac arrest cardiac
dysrhythmia and pericarditis Diabetes includes patients with diabetes as the primary cause of ESRD
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1318
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 8 Summaries for All Dialysis Patients Treated as of December 31 of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
8a
8b
8c
Patients treated on 1231 (n)
Average age (years)
Age ( of 8a sums to 100)
lt 20
141
601
07
123
616
00
127
636
00
130
627
00
712
616
05
523
626
05
652
609
05
20-64 574 593 551 585 549 513 562
65+ 418 407 449 415 446 481 433
8d Female ( of 8a) 489 472 512 515 454 449 453
8e Race ( of 8a sums to 100)
African American 447 553 543 554 452 327 374
AsianPacific Islander
Native American
00
07
00
00
00
00
08
00
13
05
24
30
48
15
White 546 447 457 438 526 615 551
OtherUnknownMissing 00 00 00 00 04 05 12
8f Ethnicity ( of 8a sums to 100)
Hispanic
Non-Hispanic
Unknown
21
950
28
24
943
33
24
953
24
23
962
15
33
953
14
38
950
12
153
827
19
8g Cause of ESRD ( of 8a sums to 100)
Diabetes 475 472 480 538 410 415 437
Hypertension
Glomerulonephritis
OtherUnknown
Missing
199
163
135
28
220
154
114
41
252
118
118
31
215
115
108
23
298
100
168
23
267
106
190
22
277
102
173
11
8h Average duration of ESRD (years) 45 48 47 43 43 42 43
8i Years since start of ESRD ( of 8a sums to 100)
lt 1 220 163 134 123 185 191 181
1-2 255 211 189 269 186 189 187
2-3 106 187 142 154 153 158 149
3-6 206 187 291 208 265 258 259
6+ 213 252 244 246 211 204 224
8j Nursing home patients3 ( of 8a) 64 130 87 62 142 162 133
8k Modality ( of 8a sums to 100)
In-center hemodialysis
In-center self hemodialysis
Home hemodialysis
Continuous ambulatory peritoneal dialysis
Continuous cycling peritoneal dialysis
Other modality4
837
00
00
142
14
07
902
00
00
73
16
08
858
00
00
110
31
00
869
00
00
38
92
00
909
00
15
38
32
07
908
00
15
34
37
07
906
00
11
27
49
07SAMPLE
na = not applicable [1] See Guide Section XI [2] Values are shown for the average facility [3] Includes patients who were also treated by a nursing facility at any time during the year The source of nursing facility history of patients is the Nursing
Home Minimum Dataset [4] Other modality includes other dialysis uncertain modality and patients not on dialysis but still temporarily assigned to the facility (discontinued dialysis
recovered renal function and lost to follow up)
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 9 Comorbidities Reported on Medicare Claims for Medicare Dialysis Patients Treated as of December 31 of Each Year1 2005-2007
This Facility Regional Averages2 2007 Measure Name 2005 2006 2007 State Network US
9a Medicare dialysis patients on 1231 (n) 112 103 107 556 401 473
9b Comorbidity ( yes of 9a)
AIDSHIV positive 00 00 09 12 10 18
Alcohol dependence 36 29 19 24 27 22
Anemia 54 49 37 98 79 73
Cancer 125 107 103 121 119 107
Cardiac arrest 09 10 19 15 14 15
Cardiac dysrhythmia 241 233 224 434 416 351
Cerebrovascular disease 259 252 262 309 274 273
Chronic obstructive pulmonary disease 232 282 243 359 328 296
Congestive heart failure 438 417 495 576 542 518
Diabetes 554 573 636 632 621 623
Drug dependence 00 10 00 24 26 19
Gastrointestinal tract bleeding 36 68 09 34 32 29
Hepatitis B 09 10 09 13 10 12
Hepatitis other 45 29 28 46 36 38
Hyperparathyroidism 63 58 75 80 132 88
Infection 563 476 477 554 506 511
Ischemic heart disease 527 495 495 597 562 510
Myocardial infarction 54 117 37 115 98 85
Peripheral vascular disease3 536 447 533 498 476 465
Pneumonia 63 29 19 55 50 53
9c Average number of comorbid conditions 38 37 37 46 44 41
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer on 1231 each year See Guide Section XII [2] Values are shown for the average facility [3] Peripheral vascular disease includes both venous and arterial diseases
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 10 How Patients Were Assigned to This Facility and End of Year Patient Status1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
10a Number of patients placed in facility1 (n) 205 184 166 177 1015 749 911
10b Initial patient placement for the year in this facility
( of 10a sums to 100)
Continuing at facility on 0101 698 766 741 718 686 679 691
Incident (new to ESRD) 263 163 133 51 199 206 199
Transferred into facility 39 71 127 232 115 114 110
10c Patient status at end of year ( of 10a sums to 100)
Alive in this facility on 1231 688 668 765 734 702 698 716
Alive in another facility on 1231 93 65 36 34 86 85 82
Received a transplant 29 33 42 23 31 35 28
Died death attributed to this facility 171 201 120 169 150 152 142
Died death attributed to another facility 10 27 06 11 16 15 14
Other3 10 05 30 28 15 16 18
SAMPLE[1] Patient assignment for Tables 1238 and 9 only See Guide Section XIII [2] Values are shown for the average facility [3] Includes patients who recovered renal function discontinued dialysis or were lost to follow-up Also includes dialysis unrelated deaths Dialysis
unrelated deaths are not attributed to any facility for the purposes of the mortality calculations in this report
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 2 Hospitalization Summary for Medicare Dialysis Patients1 2005-2007
Regional Averages2 This Facility per Year 2005-2007
Measure Name 2005 2006 2007 2005-2007 State Network US Medicare Dialysis Patients
2a Medicare dialysis patients (n) 160 154 141 4555 791 572 674
2b Patient years (PY) at risk (n) 1136 1037 1037 32105 543 387 445
Days Hospitalized Statistics
2c Total days hospitalized (n) 1692 1758 924 43745 869 542 658
2d Expected total days hospitalized (n) 18024 15891 14855 487705 8082 5799 6580
2e Days hospitalized per PY 149 170 89 136 160 140 148
2f Expected days hospitalized per PY 159 153 143 152 149 150 148
2g Standardized Hospitalization Ratio (Days)3 094 111 062 090 107 093 100
Admission Statistics
2h Total admissions (n) 226 193 140 5595 115 77 84
2i Expected total admissions (n) 2287 2023 1919 62305 1039 747 844
2j Admissions per PY 20 19 13 17 21 20 19
2k Expected admissions per PY 20 20 19 19 19 19 19
2l Standardized Hospitalization Ratio (Admissions)4 099 095 073 090 111 103 100
Diagnoses Present at Admission ( of 2a) 2m Septicemia 188 169 142 167 153 128 123
2n Acute myocardial infarction 69 58 21 51 60 52 42
2o Congestive heart failure 288 208 191 231 309 281 252
2p Cardiac dysrhythmia 163 110 121 132 166 168 146
2q Cardiac arrest 31 13 28 24 22 18 17
Length of Stay 2r One day admissions ( of 2h) 186 155 229 186 124 144 136
2s Average length of stay (days per admission 2c2h) 75 91 66 78 75 70 78
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer see Guide Section V [2] Values are shown for the average facility annualized [3] Standardized Hospitalization Ratio (Days) calculated as ratio of actual (2c) to expected (2d) hospitalized days [4] Standardized Hospitalization Ratio (Admissions) calculated as ratio of actual (2h) to expected (2i) total admissions [5] Sum of 3 years used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 3 Transplantation Summary for Dialysis Patients under Age 70 2005-2008
Regional Averages2 This Facility per Year 2005-2008
Measure Name 2005 2006 2007 2008 2005-2008 State Network US
3a Eligible patients1 (n) 147 121 110 112 4909 636 437 616
3b Transplants (n) 8 7 7 3 259 30 25 25
3c Donor type (sums to 3b3)
Living Donor (n) 2 1 0 1 49 10 10 08
Deceased Donor (n) 6 6 7 2 219 20 16 17
Patients who have not Previously Received a Transplant
3d Eligible patients1 (n) 134 106 100 104 4449 575 389 550
3e Patient years (PY) at risk (n) 967 768 761 776 32739 404 268 378
3f 1st transplants4 (n) 7 6 6 3 229 27 22 21
3g Expected 1st transplants (n) 53 44 39 39 1759 22 15 21
3h 1st transplant rate per 100 PY 72 78 79 39 67 66 82 56
3i Expected 1st transplant rate per 100 PY 55 57 51 50 53 56 55 56
3j Donor type (sums to 3f5)
Living Donor (n) 2 0 0 1 39 09 08 06
Deceased Donor (n) 5 6 6 2 199 18 14 15
Standardized 1st Transplantation Ratio (STR)
3k STR6 131 136 154 078 126 119 149 100
3l P-value7 058 056 040 092 034 na na na
3m 95 Confidence interval for STR8
Upper limit 270 297 334 227 190 na na na
Lower limit 053 050 056 016 079 na na na
STR Percentiles for this Facility (ie percent of facilities with lower transplantation rates) 3n In this State 56 59 69 41 53
3o In this Network 47 49 55 35 40
3p In the US 67 69 76 48 67
SAMPLE na = not applicable [1] See Guide Section VI [2] Values are shown for the average facility annualized [3] Values may not sum to 3b due to unknown donor type [4] Among first transplants that occurred after the start of dialysis from 2005-2008 42 of transplants in the US were not included because the transplant
occurred less than 90 days after the start of ESRD and 02 were not included because the patient was not assigned to a facility at time of transplant [5] Values may not sum to 3f due to unknown donor type [6] Standardized Transplantation Ratio calculated as ratio of actual (3f) to expected (3g) Not shown if 3g is too small [7] A p-value less than or equal to 005 indicates that the difference between the actual and expected transplants is probably real and is not due to random
chance while a p-value greater than 005 indicates that the difference is plausibly due to random chance [8] The confidence interval range represents uncertainty in the value of the STR due to random variation [9] Sum of 4 years used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 4 Waitlist Summary for Dialysis Patients under Age 70 Treated as of December 31st of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
4a
4b
4c
4d
Eligible patients on 12311 (n)
Patients on the waitlist ( of 4a)
P-value 3 (compared to US value)
Patients on the waitlist by subgroup ( of corresponding value in 4e)
Age lt 40
Age 40-69
96
344
lt01
600
296
87
333
002
600
278
83
337
002
500
320
93
247
025
250
247
502
215
na
364
193
344
222
na
363
199
464
214
na
320
198
Male 327 333 349 239 221 223 220
Female 362 333 325 255 209 219 207
African American 392 308 277 200 197 202 200
AsianPacific Islander
Native American
00
100
284
313
372
220
326
172
White Hispanic
White Non-Hispanic
Otherunknown race
00
310
500
364
500
412
00
308
194
237
86
185
233
136
238
206
261
Diabetes 286 289 356 216 167 173 163
Non-diabetes 404 381 316 286 250 259 255
Previous kidney transplant
No previous kidney transplant
545
318
556
308
429
329
429
233
429
192
430
195
437
192
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
326
333
379
324
320
357
414
240
345
108
367
308
120
287
263
129
286
279
111
268
292
4e Eligible patients in 4a by subgroup (n)
Age lt 40
Age 40-69
15
81
15
72
8
75
8
85
66
435
46
298
63
400
Male 49 45 43 46 286 197 261
Female 47 42 40 47 216 148 202
African American 51 52 47 50 259 137 194
AsianPacific Islander
Native American
0
1
0
0
0
0
1
0
06
03
09
13
22
08
White Hispanic
White Non-Hispanic
Otherunknown race
2
42
0
2
33
0
2
34
0
3
39
0
15
216
02
14
169
02
70
164
06
Diabetes 49 45 45 51 210 148 204
Non-diabetes 47 42 38 42 292 196 259
Previous kidney transplant
No previous kidney transplant
11
85
9
78
7
76
7
86
50
451
39
306
42
422
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
43
24
29
34
25
28
29
25
29
37
30
26
195
164
143
137
110
97
180
145
139
SAMPLE
na = not applicable [1] See Guide Section VII [2] Values are shown for the average facility [3] Facility waitlist percentage is compared to the US waitlist percentage for that year 226 (2005) 230 (2006) 237 (2007) 214 (2008)
A p-value greater than 005 indicates that the difference between percent of patients waitlisted at the facility and national percentage is plausibly due to random chance
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 918
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 5 Facility Modality Hemoglobin and Urea Reduction Ratio for Medicare Dialysis Patients1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Modality (among all dialysis patients with ESRD for 90+ days and 1+ claim at this facility)
5a Patients treated during year1 (n) 163 162 152 153 843 661 771
5b Modality ( of 5a sums to 100)
Hemodialysis 840 858 862 869 891 896 895
CAPDCCPD 129 80 132 98 47 50 56
Other dialysis3 31 62 07 33 62 54 48
Hemoglobin (among ESA-treated dialysis patients with ESRD for 90+ days and 4+ Hemoglobin claims at this facility)
5c Eligible patients1 (n) 123 119 107 110 571 420 496
5d Average hemoglobin (gdL) 126 119 118 106 116 116 116
5e Hemoglobin categories ( of 5c sums to 100)
lt 10 gdL 16 25 19 164 26 24 23
10-12 gdL 187 429 617 809 684 727 713
gt 12 gdL 797 546 364 27 290 249 264
5f Hemoglobin 10-12 gdL ( of HD pts) 170 416 630 840 682 724 711
Hemoglobin 10-12 gdL ( of PD pts) 286 667 429 00 649 679 689
5g Hemoglobin percentiles for this facility4
In this State 7 48 79 72
In this Network 7 38 61 59
In the US 6 37 62 69
Urea Reduction Ratio (URR among HD patients with ESRD for 183+ days and 4+ URR claims at this facility)6
5h Eligible patients1(n) 95 100 97 113 521 384 454
5i URR categories ( of 5h sums to 100)
lt 600 74 50 31 09 17 19 15
600-649 126 140 52 71 25 30 27
650-699 474 480 515 265 113 130 110
700-749 295 250 309 469 391 391 360
75+ 32 80 93 186 454 430 488
5j URR 65+ ( of 5h meets a KDOQI guideline) 800 810 918 920 958 951 958
5k URR percentiles for this facility5
In this State 4 2 13 17
In this Network 4 2 18 21
In the US 3 3 16 16SAMPLE
na = not applicable [1] See Guide Section VIII [2] Counts are shown for the average facility [3] Other dialysis includes patients who switch between HD and PD during the year and patients for whom modality is unknown [4] Percent of facilities with a smaller percentage of patients with hemoglobin 10-12 gdl [5] Percent of facilities with a smaller percentage of patients with URR 65+ [6] Patients identified in the Standard Information Management System (SIMS) as having dialyzed five or more times per week were excluded from the URR
calculations Among eligible patients in the US 044 were excluded due to frequent dialysis in 2008
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1018
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 6 Vascular Access Information1 (CMS Fistula First) 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Vascular Access
6a Prevalent hemodialysis patient months3 1709 1454 1424 1446
6b Vascular access type in use ( of 6a sums to 100)
Arteriovenous fistula 263 352 410 427 465 483 502
Arteriovenous graft 420 384 361 315 271 214 227
Catheter 314 259 228 258 261 300 267
OtherMissing 03 04 01 00 03 03 04
6c Arteriovenous fistulae in place4 ( of 6a) 317 422 492 512 541 573 581
6d Catheter only ge 90 days5 ( of 6a) 142 94 103 95 116 137 115
Vascular Access at First Treatment 6e Incident hemodialysis patients (n) 26 0 12 23 189 148 173
6f Vascular access type in use6 ( of 6e sums to 100)
Arteriovenous fistula 154 417 217 146 149 158
Arteriovenous graft 115 83 43 53 45 68
Catheter 538 500 739 777 792 749
OtherMissing 192 00 00 23 13 25
6g Arteriovenous fistulae in place4 ( of 6e) 231 583 391 253 288 308
SAMPLE na = not applicable [1] See Guide Section IX [2] Values are shown for the average facility [3] Patients may be counted up to 12 times per year [4] Includes all patients with fistulae regardless of whether or not they received their hemodialysis treatments using their fistulae [5] Catheter was used for treatment and has been in place for 90 days or more prior to treatment Patient does not have an fistula or graft in place Catheter is
only access Port access devices are reported as catheters for this project [6] Patients listed as graft or catheter may have had fistulae in place for future use but they actually received their treatment through a graft or catheter
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1118
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patient Characteristics3
7a Total number of patients with forms (n) 53 12 10 11 350 304 319
7b Average age (years [0-95]) 632 658 732 612 643 648 633
7c Female ( of 7a) 434 500 400 455 448 442 440
7d Race4 ( of 7a sums to 100)
African-American 358 167 100 364 335 233 284
AsianPacific Islander 00 00 00 00 11 18 42
Native American 00 00 00 00 05 24 11
White 642 833 900 636 641 717 658
OtherUnknownMissing 00 00 00 00 08 08 05
7e Hispanic ( of 7a) 19 00 00 91 30 32 134
7f Primary cause of ESRD ( of 7a sums to 100)
Diabetes 509 417 300 545 408 403 451
Hypertension 189 167 400 364 304 272 287
Primary Glomerulonephritis 132 167 200 91 63 67 64
OtherMissing 170 250 100 00 226 258 199
7g Medical coverage ( of 7a sums to 100)
Employer group only 38 333 100 182 178 162 161
Medicare only 113 00 100 91 162 163 204
Medicaid only 75 00 00 91 103 100 114
Medicare and Medicaid only 226 00 00 91 112 102 126
Medicare and Other 377 500 800 455 360 370 238
OtherUnknown 151 167 00 91 40 60 86
None 19 00 00 00 46 43 71
7h Body Mass Index5
Male 287 242 281 227 268 269 266
Female 261 335 276 328 288 287 280
7i Employment6
Six months prior to ESRD treatment 190 667 333 400 348 387 362
At first ESRD treatment 95 667 333 400 181 225 220
7j Primary modality7 ( of 7a sums to 100)
Hemodialysis 500 444 500 944 945 939
CAPDCCPD 500 556 500 56 55 61
OtherUnknownMissing 00 00 00 00 00 00
7k Number of incident hemodialysis patients7 (n) 6 4 5 332 286 298
7l Access used at first outpatient dialysis7 ( of 7k sums to 100)
Arteriovenous fistula 00 500 00 127 141 136
Arteriovenous graft 00 00 00 29 27 33
Catheter 100 500 100 843 832 819
OtherUnknownMissing 00 00 00 01 00 12
7m Arteriovenous fistulae placed7 ( of 7k) 167 750 00 229 270 292
Average Lab Values Prior to Dialysis3
7n Hemoglobin (gdL [3-18]) 105 112 120 105 99 100 99
7o Serum Albumin (gdL [08-60]) 32 35 36 33 32 32 31
SAMPLE
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1218
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 (cont) Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Average Lab Values Prior to Dialysis3
7p Serum Creatinine (mgdL [2-33]) 70 50 54 51 58 58 63
7q GFR (mLmin [0-60]) 103 124 119 140 119 118 110
Care Prior to ESRD Therapy 7r Received ESA prior to ESRD ( of 7a) 472 333 700 364 261 295 263
7s Pre-ESRD nephrologist care7 ( of 7a sums to 100)
No 250 200 91 330 321 310
Yes lt 6 months 00 00 00 38 48 116
Yes 6-12 months 417 300 545 201 215 208
Yes gt 12 months 333 500 364 328 341 242
Unknown 00 00 00 103 76 124
7t Informed of transplant options7 ( of 7a) 917 900 636 690 710 724
7u Patients not informed of transplant options7 (n) 1 0 3 102 87 92
7v Reason not informed7 ( of 7u may not sum to 100)
Medically unfit 00 100 384 439 309
Unsuitable due to age 00 00 334 320 239
Psychologically unfit 00 00 21 30 28
Patient declined information 00 00 13 12 13
Patient has not been assessed 100 00 332 294 449
Comorbid Conditions 7w Pre-existing Comorbidity ( yes of 7a)
Congestive heart failure 566 250 400 273 415 374 328
Atherosclerotic heart disease8 340 417 400 364 268 268 210
Other cardiac disorder8 00 00 100 00 198 197 171
CVD CVA TIA 57 00 00 182 107 103 95
Peripheral vascular disease 189 333 100 182 154 155 140
History of hypertension 981 917 100 909 861 845 847
Diabetes8 566 417 300 636 574 560 578
Diabetes on insulin 170 250 300 455 383 380 363
COPD 57 333 00 182 130 123 93
Current smoker 57 00 00 91 82 77 62
Cancer 00 00 00 182 112 109 74
Alcohol dependence 00 00 00 00 21 23 16
Drug dependence 00 00 00 00 18 15 13
Inability to ambulate 00 00 00 91 88 75 69
Inability to transfer 00 00 00 00 51 38 35
7x Average number of comorbid conditions 30 29 26 35 35 33 31 SAMPLE
na= not applicable [1] See Guide Section X [2] Values are shown for the average facility [3] For continuous variables summaries include only responses in range indicated in brackets [4] Asian includes Indian sub-continent Native American includes Alaskan Native White includes Middle Eastern and Arabian [5] The median BMI is computed for adult patients at least 20 years old [6] Full-time part-time or student ( of 18-60 year olds) [7] Data collection for these items began mid-year 2005 Summaries for these items shown starting in 2006 [8] AHD includes ischemic heart disease (coronary artery disease) and myocardial infarction Other cardiac disorder includes cardiac arrest cardiac
dysrhythmia and pericarditis Diabetes includes patients with diabetes as the primary cause of ESRD
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1318
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 8 Summaries for All Dialysis Patients Treated as of December 31 of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
8a
8b
8c
Patients treated on 1231 (n)
Average age (years)
Age ( of 8a sums to 100)
lt 20
141
601
07
123
616
00
127
636
00
130
627
00
712
616
05
523
626
05
652
609
05
20-64 574 593 551 585 549 513 562
65+ 418 407 449 415 446 481 433
8d Female ( of 8a) 489 472 512 515 454 449 453
8e Race ( of 8a sums to 100)
African American 447 553 543 554 452 327 374
AsianPacific Islander
Native American
00
07
00
00
00
00
08
00
13
05
24
30
48
15
White 546 447 457 438 526 615 551
OtherUnknownMissing 00 00 00 00 04 05 12
8f Ethnicity ( of 8a sums to 100)
Hispanic
Non-Hispanic
Unknown
21
950
28
24
943
33
24
953
24
23
962
15
33
953
14
38
950
12
153
827
19
8g Cause of ESRD ( of 8a sums to 100)
Diabetes 475 472 480 538 410 415 437
Hypertension
Glomerulonephritis
OtherUnknown
Missing
199
163
135
28
220
154
114
41
252
118
118
31
215
115
108
23
298
100
168
23
267
106
190
22
277
102
173
11
8h Average duration of ESRD (years) 45 48 47 43 43 42 43
8i Years since start of ESRD ( of 8a sums to 100)
lt 1 220 163 134 123 185 191 181
1-2 255 211 189 269 186 189 187
2-3 106 187 142 154 153 158 149
3-6 206 187 291 208 265 258 259
6+ 213 252 244 246 211 204 224
8j Nursing home patients3 ( of 8a) 64 130 87 62 142 162 133
8k Modality ( of 8a sums to 100)
In-center hemodialysis
In-center self hemodialysis
Home hemodialysis
Continuous ambulatory peritoneal dialysis
Continuous cycling peritoneal dialysis
Other modality4
837
00
00
142
14
07
902
00
00
73
16
08
858
00
00
110
31
00
869
00
00
38
92
00
909
00
15
38
32
07
908
00
15
34
37
07
906
00
11
27
49
07SAMPLE
na = not applicable [1] See Guide Section XI [2] Values are shown for the average facility [3] Includes patients who were also treated by a nursing facility at any time during the year The source of nursing facility history of patients is the Nursing
Home Minimum Dataset [4] Other modality includes other dialysis uncertain modality and patients not on dialysis but still temporarily assigned to the facility (discontinued dialysis
recovered renal function and lost to follow up)
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 9 Comorbidities Reported on Medicare Claims for Medicare Dialysis Patients Treated as of December 31 of Each Year1 2005-2007
This Facility Regional Averages2 2007 Measure Name 2005 2006 2007 State Network US
9a Medicare dialysis patients on 1231 (n) 112 103 107 556 401 473
9b Comorbidity ( yes of 9a)
AIDSHIV positive 00 00 09 12 10 18
Alcohol dependence 36 29 19 24 27 22
Anemia 54 49 37 98 79 73
Cancer 125 107 103 121 119 107
Cardiac arrest 09 10 19 15 14 15
Cardiac dysrhythmia 241 233 224 434 416 351
Cerebrovascular disease 259 252 262 309 274 273
Chronic obstructive pulmonary disease 232 282 243 359 328 296
Congestive heart failure 438 417 495 576 542 518
Diabetes 554 573 636 632 621 623
Drug dependence 00 10 00 24 26 19
Gastrointestinal tract bleeding 36 68 09 34 32 29
Hepatitis B 09 10 09 13 10 12
Hepatitis other 45 29 28 46 36 38
Hyperparathyroidism 63 58 75 80 132 88
Infection 563 476 477 554 506 511
Ischemic heart disease 527 495 495 597 562 510
Myocardial infarction 54 117 37 115 98 85
Peripheral vascular disease3 536 447 533 498 476 465
Pneumonia 63 29 19 55 50 53
9c Average number of comorbid conditions 38 37 37 46 44 41
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer on 1231 each year See Guide Section XII [2] Values are shown for the average facility [3] Peripheral vascular disease includes both venous and arterial diseases
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 10 How Patients Were Assigned to This Facility and End of Year Patient Status1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
10a Number of patients placed in facility1 (n) 205 184 166 177 1015 749 911
10b Initial patient placement for the year in this facility
( of 10a sums to 100)
Continuing at facility on 0101 698 766 741 718 686 679 691
Incident (new to ESRD) 263 163 133 51 199 206 199
Transferred into facility 39 71 127 232 115 114 110
10c Patient status at end of year ( of 10a sums to 100)
Alive in this facility on 1231 688 668 765 734 702 698 716
Alive in another facility on 1231 93 65 36 34 86 85 82
Received a transplant 29 33 42 23 31 35 28
Died death attributed to this facility 171 201 120 169 150 152 142
Died death attributed to another facility 10 27 06 11 16 15 14
Other3 10 05 30 28 15 16 18
SAMPLE[1] Patient assignment for Tables 1238 and 9 only See Guide Section XIII [2] Values are shown for the average facility [3] Includes patients who recovered renal function discontinued dialysis or were lost to follow-up Also includes dialysis unrelated deaths Dialysis
unrelated deaths are not attributed to any facility for the purposes of the mortality calculations in this report
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 3 Transplantation Summary for Dialysis Patients under Age 70 2005-2008
Regional Averages2 This Facility per Year 2005-2008
Measure Name 2005 2006 2007 2008 2005-2008 State Network US
3a Eligible patients1 (n) 147 121 110 112 4909 636 437 616
3b Transplants (n) 8 7 7 3 259 30 25 25
3c Donor type (sums to 3b3)
Living Donor (n) 2 1 0 1 49 10 10 08
Deceased Donor (n) 6 6 7 2 219 20 16 17
Patients who have not Previously Received a Transplant
3d Eligible patients1 (n) 134 106 100 104 4449 575 389 550
3e Patient years (PY) at risk (n) 967 768 761 776 32739 404 268 378
3f 1st transplants4 (n) 7 6 6 3 229 27 22 21
3g Expected 1st transplants (n) 53 44 39 39 1759 22 15 21
3h 1st transplant rate per 100 PY 72 78 79 39 67 66 82 56
3i Expected 1st transplant rate per 100 PY 55 57 51 50 53 56 55 56
3j Donor type (sums to 3f5)
Living Donor (n) 2 0 0 1 39 09 08 06
Deceased Donor (n) 5 6 6 2 199 18 14 15
Standardized 1st Transplantation Ratio (STR)
3k STR6 131 136 154 078 126 119 149 100
3l P-value7 058 056 040 092 034 na na na
3m 95 Confidence interval for STR8
Upper limit 270 297 334 227 190 na na na
Lower limit 053 050 056 016 079 na na na
STR Percentiles for this Facility (ie percent of facilities with lower transplantation rates) 3n In this State 56 59 69 41 53
3o In this Network 47 49 55 35 40
3p In the US 67 69 76 48 67
SAMPLE na = not applicable [1] See Guide Section VI [2] Values are shown for the average facility annualized [3] Values may not sum to 3b due to unknown donor type [4] Among first transplants that occurred after the start of dialysis from 2005-2008 42 of transplants in the US were not included because the transplant
occurred less than 90 days after the start of ESRD and 02 were not included because the patient was not assigned to a facility at time of transplant [5] Values may not sum to 3f due to unknown donor type [6] Standardized Transplantation Ratio calculated as ratio of actual (3f) to expected (3g) Not shown if 3g is too small [7] A p-value less than or equal to 005 indicates that the difference between the actual and expected transplants is probably real and is not due to random
chance while a p-value greater than 005 indicates that the difference is plausibly due to random chance [8] The confidence interval range represents uncertainty in the value of the STR due to random variation [9] Sum of 4 years used for calculations should not be compared to regional averages
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 4 Waitlist Summary for Dialysis Patients under Age 70 Treated as of December 31st of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
4a
4b
4c
4d
Eligible patients on 12311 (n)
Patients on the waitlist ( of 4a)
P-value 3 (compared to US value)
Patients on the waitlist by subgroup ( of corresponding value in 4e)
Age lt 40
Age 40-69
96
344
lt01
600
296
87
333
002
600
278
83
337
002
500
320
93
247
025
250
247
502
215
na
364
193
344
222
na
363
199
464
214
na
320
198
Male 327 333 349 239 221 223 220
Female 362 333 325 255 209 219 207
African American 392 308 277 200 197 202 200
AsianPacific Islander
Native American
00
100
284
313
372
220
326
172
White Hispanic
White Non-Hispanic
Otherunknown race
00
310
500
364
500
412
00
308
194
237
86
185
233
136
238
206
261
Diabetes 286 289 356 216 167 173 163
Non-diabetes 404 381 316 286 250 259 255
Previous kidney transplant
No previous kidney transplant
545
318
556
308
429
329
429
233
429
192
430
195
437
192
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
326
333
379
324
320
357
414
240
345
108
367
308
120
287
263
129
286
279
111
268
292
4e Eligible patients in 4a by subgroup (n)
Age lt 40
Age 40-69
15
81
15
72
8
75
8
85
66
435
46
298
63
400
Male 49 45 43 46 286 197 261
Female 47 42 40 47 216 148 202
African American 51 52 47 50 259 137 194
AsianPacific Islander
Native American
0
1
0
0
0
0
1
0
06
03
09
13
22
08
White Hispanic
White Non-Hispanic
Otherunknown race
2
42
0
2
33
0
2
34
0
3
39
0
15
216
02
14
169
02
70
164
06
Diabetes 49 45 45 51 210 148 204
Non-diabetes 47 42 38 42 292 196 259
Previous kidney transplant
No previous kidney transplant
11
85
9
78
7
76
7
86
50
451
39
306
42
422
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
43
24
29
34
25
28
29
25
29
37
30
26
195
164
143
137
110
97
180
145
139
SAMPLE
na = not applicable [1] See Guide Section VII [2] Values are shown for the average facility [3] Facility waitlist percentage is compared to the US waitlist percentage for that year 226 (2005) 230 (2006) 237 (2007) 214 (2008)
A p-value greater than 005 indicates that the difference between percent of patients waitlisted at the facility and national percentage is plausibly due to random chance
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 918
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 5 Facility Modality Hemoglobin and Urea Reduction Ratio for Medicare Dialysis Patients1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Modality (among all dialysis patients with ESRD for 90+ days and 1+ claim at this facility)
5a Patients treated during year1 (n) 163 162 152 153 843 661 771
5b Modality ( of 5a sums to 100)
Hemodialysis 840 858 862 869 891 896 895
CAPDCCPD 129 80 132 98 47 50 56
Other dialysis3 31 62 07 33 62 54 48
Hemoglobin (among ESA-treated dialysis patients with ESRD for 90+ days and 4+ Hemoglobin claims at this facility)
5c Eligible patients1 (n) 123 119 107 110 571 420 496
5d Average hemoglobin (gdL) 126 119 118 106 116 116 116
5e Hemoglobin categories ( of 5c sums to 100)
lt 10 gdL 16 25 19 164 26 24 23
10-12 gdL 187 429 617 809 684 727 713
gt 12 gdL 797 546 364 27 290 249 264
5f Hemoglobin 10-12 gdL ( of HD pts) 170 416 630 840 682 724 711
Hemoglobin 10-12 gdL ( of PD pts) 286 667 429 00 649 679 689
5g Hemoglobin percentiles for this facility4
In this State 7 48 79 72
In this Network 7 38 61 59
In the US 6 37 62 69
Urea Reduction Ratio (URR among HD patients with ESRD for 183+ days and 4+ URR claims at this facility)6
5h Eligible patients1(n) 95 100 97 113 521 384 454
5i URR categories ( of 5h sums to 100)
lt 600 74 50 31 09 17 19 15
600-649 126 140 52 71 25 30 27
650-699 474 480 515 265 113 130 110
700-749 295 250 309 469 391 391 360
75+ 32 80 93 186 454 430 488
5j URR 65+ ( of 5h meets a KDOQI guideline) 800 810 918 920 958 951 958
5k URR percentiles for this facility5
In this State 4 2 13 17
In this Network 4 2 18 21
In the US 3 3 16 16SAMPLE
na = not applicable [1] See Guide Section VIII [2] Counts are shown for the average facility [3] Other dialysis includes patients who switch between HD and PD during the year and patients for whom modality is unknown [4] Percent of facilities with a smaller percentage of patients with hemoglobin 10-12 gdl [5] Percent of facilities with a smaller percentage of patients with URR 65+ [6] Patients identified in the Standard Information Management System (SIMS) as having dialyzed five or more times per week were excluded from the URR
calculations Among eligible patients in the US 044 were excluded due to frequent dialysis in 2008
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1018
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 6 Vascular Access Information1 (CMS Fistula First) 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Vascular Access
6a Prevalent hemodialysis patient months3 1709 1454 1424 1446
6b Vascular access type in use ( of 6a sums to 100)
Arteriovenous fistula 263 352 410 427 465 483 502
Arteriovenous graft 420 384 361 315 271 214 227
Catheter 314 259 228 258 261 300 267
OtherMissing 03 04 01 00 03 03 04
6c Arteriovenous fistulae in place4 ( of 6a) 317 422 492 512 541 573 581
6d Catheter only ge 90 days5 ( of 6a) 142 94 103 95 116 137 115
Vascular Access at First Treatment 6e Incident hemodialysis patients (n) 26 0 12 23 189 148 173
6f Vascular access type in use6 ( of 6e sums to 100)
Arteriovenous fistula 154 417 217 146 149 158
Arteriovenous graft 115 83 43 53 45 68
Catheter 538 500 739 777 792 749
OtherMissing 192 00 00 23 13 25
6g Arteriovenous fistulae in place4 ( of 6e) 231 583 391 253 288 308
SAMPLE na = not applicable [1] See Guide Section IX [2] Values are shown for the average facility [3] Patients may be counted up to 12 times per year [4] Includes all patients with fistulae regardless of whether or not they received their hemodialysis treatments using their fistulae [5] Catheter was used for treatment and has been in place for 90 days or more prior to treatment Patient does not have an fistula or graft in place Catheter is
only access Port access devices are reported as catheters for this project [6] Patients listed as graft or catheter may have had fistulae in place for future use but they actually received their treatment through a graft or catheter
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1118
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patient Characteristics3
7a Total number of patients with forms (n) 53 12 10 11 350 304 319
7b Average age (years [0-95]) 632 658 732 612 643 648 633
7c Female ( of 7a) 434 500 400 455 448 442 440
7d Race4 ( of 7a sums to 100)
African-American 358 167 100 364 335 233 284
AsianPacific Islander 00 00 00 00 11 18 42
Native American 00 00 00 00 05 24 11
White 642 833 900 636 641 717 658
OtherUnknownMissing 00 00 00 00 08 08 05
7e Hispanic ( of 7a) 19 00 00 91 30 32 134
7f Primary cause of ESRD ( of 7a sums to 100)
Diabetes 509 417 300 545 408 403 451
Hypertension 189 167 400 364 304 272 287
Primary Glomerulonephritis 132 167 200 91 63 67 64
OtherMissing 170 250 100 00 226 258 199
7g Medical coverage ( of 7a sums to 100)
Employer group only 38 333 100 182 178 162 161
Medicare only 113 00 100 91 162 163 204
Medicaid only 75 00 00 91 103 100 114
Medicare and Medicaid only 226 00 00 91 112 102 126
Medicare and Other 377 500 800 455 360 370 238
OtherUnknown 151 167 00 91 40 60 86
None 19 00 00 00 46 43 71
7h Body Mass Index5
Male 287 242 281 227 268 269 266
Female 261 335 276 328 288 287 280
7i Employment6
Six months prior to ESRD treatment 190 667 333 400 348 387 362
At first ESRD treatment 95 667 333 400 181 225 220
7j Primary modality7 ( of 7a sums to 100)
Hemodialysis 500 444 500 944 945 939
CAPDCCPD 500 556 500 56 55 61
OtherUnknownMissing 00 00 00 00 00 00
7k Number of incident hemodialysis patients7 (n) 6 4 5 332 286 298
7l Access used at first outpatient dialysis7 ( of 7k sums to 100)
Arteriovenous fistula 00 500 00 127 141 136
Arteriovenous graft 00 00 00 29 27 33
Catheter 100 500 100 843 832 819
OtherUnknownMissing 00 00 00 01 00 12
7m Arteriovenous fistulae placed7 ( of 7k) 167 750 00 229 270 292
Average Lab Values Prior to Dialysis3
7n Hemoglobin (gdL [3-18]) 105 112 120 105 99 100 99
7o Serum Albumin (gdL [08-60]) 32 35 36 33 32 32 31
SAMPLE
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1218
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 (cont) Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Average Lab Values Prior to Dialysis3
7p Serum Creatinine (mgdL [2-33]) 70 50 54 51 58 58 63
7q GFR (mLmin [0-60]) 103 124 119 140 119 118 110
Care Prior to ESRD Therapy 7r Received ESA prior to ESRD ( of 7a) 472 333 700 364 261 295 263
7s Pre-ESRD nephrologist care7 ( of 7a sums to 100)
No 250 200 91 330 321 310
Yes lt 6 months 00 00 00 38 48 116
Yes 6-12 months 417 300 545 201 215 208
Yes gt 12 months 333 500 364 328 341 242
Unknown 00 00 00 103 76 124
7t Informed of transplant options7 ( of 7a) 917 900 636 690 710 724
7u Patients not informed of transplant options7 (n) 1 0 3 102 87 92
7v Reason not informed7 ( of 7u may not sum to 100)
Medically unfit 00 100 384 439 309
Unsuitable due to age 00 00 334 320 239
Psychologically unfit 00 00 21 30 28
Patient declined information 00 00 13 12 13
Patient has not been assessed 100 00 332 294 449
Comorbid Conditions 7w Pre-existing Comorbidity ( yes of 7a)
Congestive heart failure 566 250 400 273 415 374 328
Atherosclerotic heart disease8 340 417 400 364 268 268 210
Other cardiac disorder8 00 00 100 00 198 197 171
CVD CVA TIA 57 00 00 182 107 103 95
Peripheral vascular disease 189 333 100 182 154 155 140
History of hypertension 981 917 100 909 861 845 847
Diabetes8 566 417 300 636 574 560 578
Diabetes on insulin 170 250 300 455 383 380 363
COPD 57 333 00 182 130 123 93
Current smoker 57 00 00 91 82 77 62
Cancer 00 00 00 182 112 109 74
Alcohol dependence 00 00 00 00 21 23 16
Drug dependence 00 00 00 00 18 15 13
Inability to ambulate 00 00 00 91 88 75 69
Inability to transfer 00 00 00 00 51 38 35
7x Average number of comorbid conditions 30 29 26 35 35 33 31 SAMPLE
na= not applicable [1] See Guide Section X [2] Values are shown for the average facility [3] For continuous variables summaries include only responses in range indicated in brackets [4] Asian includes Indian sub-continent Native American includes Alaskan Native White includes Middle Eastern and Arabian [5] The median BMI is computed for adult patients at least 20 years old [6] Full-time part-time or student ( of 18-60 year olds) [7] Data collection for these items began mid-year 2005 Summaries for these items shown starting in 2006 [8] AHD includes ischemic heart disease (coronary artery disease) and myocardial infarction Other cardiac disorder includes cardiac arrest cardiac
dysrhythmia and pericarditis Diabetes includes patients with diabetes as the primary cause of ESRD
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1318
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 8 Summaries for All Dialysis Patients Treated as of December 31 of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
8a
8b
8c
Patients treated on 1231 (n)
Average age (years)
Age ( of 8a sums to 100)
lt 20
141
601
07
123
616
00
127
636
00
130
627
00
712
616
05
523
626
05
652
609
05
20-64 574 593 551 585 549 513 562
65+ 418 407 449 415 446 481 433
8d Female ( of 8a) 489 472 512 515 454 449 453
8e Race ( of 8a sums to 100)
African American 447 553 543 554 452 327 374
AsianPacific Islander
Native American
00
07
00
00
00
00
08
00
13
05
24
30
48
15
White 546 447 457 438 526 615 551
OtherUnknownMissing 00 00 00 00 04 05 12
8f Ethnicity ( of 8a sums to 100)
Hispanic
Non-Hispanic
Unknown
21
950
28
24
943
33
24
953
24
23
962
15
33
953
14
38
950
12
153
827
19
8g Cause of ESRD ( of 8a sums to 100)
Diabetes 475 472 480 538 410 415 437
Hypertension
Glomerulonephritis
OtherUnknown
Missing
199
163
135
28
220
154
114
41
252
118
118
31
215
115
108
23
298
100
168
23
267
106
190
22
277
102
173
11
8h Average duration of ESRD (years) 45 48 47 43 43 42 43
8i Years since start of ESRD ( of 8a sums to 100)
lt 1 220 163 134 123 185 191 181
1-2 255 211 189 269 186 189 187
2-3 106 187 142 154 153 158 149
3-6 206 187 291 208 265 258 259
6+ 213 252 244 246 211 204 224
8j Nursing home patients3 ( of 8a) 64 130 87 62 142 162 133
8k Modality ( of 8a sums to 100)
In-center hemodialysis
In-center self hemodialysis
Home hemodialysis
Continuous ambulatory peritoneal dialysis
Continuous cycling peritoneal dialysis
Other modality4
837
00
00
142
14
07
902
00
00
73
16
08
858
00
00
110
31
00
869
00
00
38
92
00
909
00
15
38
32
07
908
00
15
34
37
07
906
00
11
27
49
07SAMPLE
na = not applicable [1] See Guide Section XI [2] Values are shown for the average facility [3] Includes patients who were also treated by a nursing facility at any time during the year The source of nursing facility history of patients is the Nursing
Home Minimum Dataset [4] Other modality includes other dialysis uncertain modality and patients not on dialysis but still temporarily assigned to the facility (discontinued dialysis
recovered renal function and lost to follow up)
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 9 Comorbidities Reported on Medicare Claims for Medicare Dialysis Patients Treated as of December 31 of Each Year1 2005-2007
This Facility Regional Averages2 2007 Measure Name 2005 2006 2007 State Network US
9a Medicare dialysis patients on 1231 (n) 112 103 107 556 401 473
9b Comorbidity ( yes of 9a)
AIDSHIV positive 00 00 09 12 10 18
Alcohol dependence 36 29 19 24 27 22
Anemia 54 49 37 98 79 73
Cancer 125 107 103 121 119 107
Cardiac arrest 09 10 19 15 14 15
Cardiac dysrhythmia 241 233 224 434 416 351
Cerebrovascular disease 259 252 262 309 274 273
Chronic obstructive pulmonary disease 232 282 243 359 328 296
Congestive heart failure 438 417 495 576 542 518
Diabetes 554 573 636 632 621 623
Drug dependence 00 10 00 24 26 19
Gastrointestinal tract bleeding 36 68 09 34 32 29
Hepatitis B 09 10 09 13 10 12
Hepatitis other 45 29 28 46 36 38
Hyperparathyroidism 63 58 75 80 132 88
Infection 563 476 477 554 506 511
Ischemic heart disease 527 495 495 597 562 510
Myocardial infarction 54 117 37 115 98 85
Peripheral vascular disease3 536 447 533 498 476 465
Pneumonia 63 29 19 55 50 53
9c Average number of comorbid conditions 38 37 37 46 44 41
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer on 1231 each year See Guide Section XII [2] Values are shown for the average facility [3] Peripheral vascular disease includes both venous and arterial diseases
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 10 How Patients Were Assigned to This Facility and End of Year Patient Status1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
10a Number of patients placed in facility1 (n) 205 184 166 177 1015 749 911
10b Initial patient placement for the year in this facility
( of 10a sums to 100)
Continuing at facility on 0101 698 766 741 718 686 679 691
Incident (new to ESRD) 263 163 133 51 199 206 199
Transferred into facility 39 71 127 232 115 114 110
10c Patient status at end of year ( of 10a sums to 100)
Alive in this facility on 1231 688 668 765 734 702 698 716
Alive in another facility on 1231 93 65 36 34 86 85 82
Received a transplant 29 33 42 23 31 35 28
Died death attributed to this facility 171 201 120 169 150 152 142
Died death attributed to another facility 10 27 06 11 16 15 14
Other3 10 05 30 28 15 16 18
SAMPLE[1] Patient assignment for Tables 1238 and 9 only See Guide Section XIII [2] Values are shown for the average facility [3] Includes patients who recovered renal function discontinued dialysis or were lost to follow-up Also includes dialysis unrelated deaths Dialysis
unrelated deaths are not attributed to any facility for the purposes of the mortality calculations in this report
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 4 Waitlist Summary for Dialysis Patients under Age 70 Treated as of December 31st of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
4a
4b
4c
4d
Eligible patients on 12311 (n)
Patients on the waitlist ( of 4a)
P-value 3 (compared to US value)
Patients on the waitlist by subgroup ( of corresponding value in 4e)
Age lt 40
Age 40-69
96
344
lt01
600
296
87
333
002
600
278
83
337
002
500
320
93
247
025
250
247
502
215
na
364
193
344
222
na
363
199
464
214
na
320
198
Male 327 333 349 239 221 223 220
Female 362 333 325 255 209 219 207
African American 392 308 277 200 197 202 200
AsianPacific Islander
Native American
00
100
284
313
372
220
326
172
White Hispanic
White Non-Hispanic
Otherunknown race
00
310
500
364
500
412
00
308
194
237
86
185
233
136
238
206
261
Diabetes 286 289 356 216 167 173 163
Non-diabetes 404 381 316 286 250 259 255
Previous kidney transplant
No previous kidney transplant
545
318
556
308
429
329
429
233
429
192
430
195
437
192
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
326
333
379
324
320
357
414
240
345
108
367
308
120
287
263
129
286
279
111
268
292
4e Eligible patients in 4a by subgroup (n)
Age lt 40
Age 40-69
15
81
15
72
8
75
8
85
66
435
46
298
63
400
Male 49 45 43 46 286 197 261
Female 47 42 40 47 216 148 202
African American 51 52 47 50 259 137 194
AsianPacific Islander
Native American
0
1
0
0
0
0
1
0
06
03
09
13
22
08
White Hispanic
White Non-Hispanic
Otherunknown race
2
42
0
2
33
0
2
34
0
3
39
0
15
216
02
14
169
02
70
164
06
Diabetes 49 45 45 51 210 148 204
Non-diabetes 47 42 38 42 292 196 259
Previous kidney transplant
No previous kidney transplant
11
85
9
78
7
76
7
86
50
451
39
306
42
422
lt 2 years since start of ESRD
2-4 years since start of ESRD
5+ years since start of ESRD
43
24
29
34
25
28
29
25
29
37
30
26
195
164
143
137
110
97
180
145
139
SAMPLE
na = not applicable [1] See Guide Section VII [2] Values are shown for the average facility [3] Facility waitlist percentage is compared to the US waitlist percentage for that year 226 (2005) 230 (2006) 237 (2007) 214 (2008)
A p-value greater than 005 indicates that the difference between percent of patients waitlisted at the facility and national percentage is plausibly due to random chance
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 918
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 5 Facility Modality Hemoglobin and Urea Reduction Ratio for Medicare Dialysis Patients1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Modality (among all dialysis patients with ESRD for 90+ days and 1+ claim at this facility)
5a Patients treated during year1 (n) 163 162 152 153 843 661 771
5b Modality ( of 5a sums to 100)
Hemodialysis 840 858 862 869 891 896 895
CAPDCCPD 129 80 132 98 47 50 56
Other dialysis3 31 62 07 33 62 54 48
Hemoglobin (among ESA-treated dialysis patients with ESRD for 90+ days and 4+ Hemoglobin claims at this facility)
5c Eligible patients1 (n) 123 119 107 110 571 420 496
5d Average hemoglobin (gdL) 126 119 118 106 116 116 116
5e Hemoglobin categories ( of 5c sums to 100)
lt 10 gdL 16 25 19 164 26 24 23
10-12 gdL 187 429 617 809 684 727 713
gt 12 gdL 797 546 364 27 290 249 264
5f Hemoglobin 10-12 gdL ( of HD pts) 170 416 630 840 682 724 711
Hemoglobin 10-12 gdL ( of PD pts) 286 667 429 00 649 679 689
5g Hemoglobin percentiles for this facility4
In this State 7 48 79 72
In this Network 7 38 61 59
In the US 6 37 62 69
Urea Reduction Ratio (URR among HD patients with ESRD for 183+ days and 4+ URR claims at this facility)6
5h Eligible patients1(n) 95 100 97 113 521 384 454
5i URR categories ( of 5h sums to 100)
lt 600 74 50 31 09 17 19 15
600-649 126 140 52 71 25 30 27
650-699 474 480 515 265 113 130 110
700-749 295 250 309 469 391 391 360
75+ 32 80 93 186 454 430 488
5j URR 65+ ( of 5h meets a KDOQI guideline) 800 810 918 920 958 951 958
5k URR percentiles for this facility5
In this State 4 2 13 17
In this Network 4 2 18 21
In the US 3 3 16 16SAMPLE
na = not applicable [1] See Guide Section VIII [2] Counts are shown for the average facility [3] Other dialysis includes patients who switch between HD and PD during the year and patients for whom modality is unknown [4] Percent of facilities with a smaller percentage of patients with hemoglobin 10-12 gdl [5] Percent of facilities with a smaller percentage of patients with URR 65+ [6] Patients identified in the Standard Information Management System (SIMS) as having dialyzed five or more times per week were excluded from the URR
calculations Among eligible patients in the US 044 were excluded due to frequent dialysis in 2008
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1018
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 6 Vascular Access Information1 (CMS Fistula First) 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Vascular Access
6a Prevalent hemodialysis patient months3 1709 1454 1424 1446
6b Vascular access type in use ( of 6a sums to 100)
Arteriovenous fistula 263 352 410 427 465 483 502
Arteriovenous graft 420 384 361 315 271 214 227
Catheter 314 259 228 258 261 300 267
OtherMissing 03 04 01 00 03 03 04
6c Arteriovenous fistulae in place4 ( of 6a) 317 422 492 512 541 573 581
6d Catheter only ge 90 days5 ( of 6a) 142 94 103 95 116 137 115
Vascular Access at First Treatment 6e Incident hemodialysis patients (n) 26 0 12 23 189 148 173
6f Vascular access type in use6 ( of 6e sums to 100)
Arteriovenous fistula 154 417 217 146 149 158
Arteriovenous graft 115 83 43 53 45 68
Catheter 538 500 739 777 792 749
OtherMissing 192 00 00 23 13 25
6g Arteriovenous fistulae in place4 ( of 6e) 231 583 391 253 288 308
SAMPLE na = not applicable [1] See Guide Section IX [2] Values are shown for the average facility [3] Patients may be counted up to 12 times per year [4] Includes all patients with fistulae regardless of whether or not they received their hemodialysis treatments using their fistulae [5] Catheter was used for treatment and has been in place for 90 days or more prior to treatment Patient does not have an fistula or graft in place Catheter is
only access Port access devices are reported as catheters for this project [6] Patients listed as graft or catheter may have had fistulae in place for future use but they actually received their treatment through a graft or catheter
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1118
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patient Characteristics3
7a Total number of patients with forms (n) 53 12 10 11 350 304 319
7b Average age (years [0-95]) 632 658 732 612 643 648 633
7c Female ( of 7a) 434 500 400 455 448 442 440
7d Race4 ( of 7a sums to 100)
African-American 358 167 100 364 335 233 284
AsianPacific Islander 00 00 00 00 11 18 42
Native American 00 00 00 00 05 24 11
White 642 833 900 636 641 717 658
OtherUnknownMissing 00 00 00 00 08 08 05
7e Hispanic ( of 7a) 19 00 00 91 30 32 134
7f Primary cause of ESRD ( of 7a sums to 100)
Diabetes 509 417 300 545 408 403 451
Hypertension 189 167 400 364 304 272 287
Primary Glomerulonephritis 132 167 200 91 63 67 64
OtherMissing 170 250 100 00 226 258 199
7g Medical coverage ( of 7a sums to 100)
Employer group only 38 333 100 182 178 162 161
Medicare only 113 00 100 91 162 163 204
Medicaid only 75 00 00 91 103 100 114
Medicare and Medicaid only 226 00 00 91 112 102 126
Medicare and Other 377 500 800 455 360 370 238
OtherUnknown 151 167 00 91 40 60 86
None 19 00 00 00 46 43 71
7h Body Mass Index5
Male 287 242 281 227 268 269 266
Female 261 335 276 328 288 287 280
7i Employment6
Six months prior to ESRD treatment 190 667 333 400 348 387 362
At first ESRD treatment 95 667 333 400 181 225 220
7j Primary modality7 ( of 7a sums to 100)
Hemodialysis 500 444 500 944 945 939
CAPDCCPD 500 556 500 56 55 61
OtherUnknownMissing 00 00 00 00 00 00
7k Number of incident hemodialysis patients7 (n) 6 4 5 332 286 298
7l Access used at first outpatient dialysis7 ( of 7k sums to 100)
Arteriovenous fistula 00 500 00 127 141 136
Arteriovenous graft 00 00 00 29 27 33
Catheter 100 500 100 843 832 819
OtherUnknownMissing 00 00 00 01 00 12
7m Arteriovenous fistulae placed7 ( of 7k) 167 750 00 229 270 292
Average Lab Values Prior to Dialysis3
7n Hemoglobin (gdL [3-18]) 105 112 120 105 99 100 99
7o Serum Albumin (gdL [08-60]) 32 35 36 33 32 32 31
SAMPLE
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1218
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 (cont) Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Average Lab Values Prior to Dialysis3
7p Serum Creatinine (mgdL [2-33]) 70 50 54 51 58 58 63
7q GFR (mLmin [0-60]) 103 124 119 140 119 118 110
Care Prior to ESRD Therapy 7r Received ESA prior to ESRD ( of 7a) 472 333 700 364 261 295 263
7s Pre-ESRD nephrologist care7 ( of 7a sums to 100)
No 250 200 91 330 321 310
Yes lt 6 months 00 00 00 38 48 116
Yes 6-12 months 417 300 545 201 215 208
Yes gt 12 months 333 500 364 328 341 242
Unknown 00 00 00 103 76 124
7t Informed of transplant options7 ( of 7a) 917 900 636 690 710 724
7u Patients not informed of transplant options7 (n) 1 0 3 102 87 92
7v Reason not informed7 ( of 7u may not sum to 100)
Medically unfit 00 100 384 439 309
Unsuitable due to age 00 00 334 320 239
Psychologically unfit 00 00 21 30 28
Patient declined information 00 00 13 12 13
Patient has not been assessed 100 00 332 294 449
Comorbid Conditions 7w Pre-existing Comorbidity ( yes of 7a)
Congestive heart failure 566 250 400 273 415 374 328
Atherosclerotic heart disease8 340 417 400 364 268 268 210
Other cardiac disorder8 00 00 100 00 198 197 171
CVD CVA TIA 57 00 00 182 107 103 95
Peripheral vascular disease 189 333 100 182 154 155 140
History of hypertension 981 917 100 909 861 845 847
Diabetes8 566 417 300 636 574 560 578
Diabetes on insulin 170 250 300 455 383 380 363
COPD 57 333 00 182 130 123 93
Current smoker 57 00 00 91 82 77 62
Cancer 00 00 00 182 112 109 74
Alcohol dependence 00 00 00 00 21 23 16
Drug dependence 00 00 00 00 18 15 13
Inability to ambulate 00 00 00 91 88 75 69
Inability to transfer 00 00 00 00 51 38 35
7x Average number of comorbid conditions 30 29 26 35 35 33 31 SAMPLE
na= not applicable [1] See Guide Section X [2] Values are shown for the average facility [3] For continuous variables summaries include only responses in range indicated in brackets [4] Asian includes Indian sub-continent Native American includes Alaskan Native White includes Middle Eastern and Arabian [5] The median BMI is computed for adult patients at least 20 years old [6] Full-time part-time or student ( of 18-60 year olds) [7] Data collection for these items began mid-year 2005 Summaries for these items shown starting in 2006 [8] AHD includes ischemic heart disease (coronary artery disease) and myocardial infarction Other cardiac disorder includes cardiac arrest cardiac
dysrhythmia and pericarditis Diabetes includes patients with diabetes as the primary cause of ESRD
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1318
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 8 Summaries for All Dialysis Patients Treated as of December 31 of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
8a
8b
8c
Patients treated on 1231 (n)
Average age (years)
Age ( of 8a sums to 100)
lt 20
141
601
07
123
616
00
127
636
00
130
627
00
712
616
05
523
626
05
652
609
05
20-64 574 593 551 585 549 513 562
65+ 418 407 449 415 446 481 433
8d Female ( of 8a) 489 472 512 515 454 449 453
8e Race ( of 8a sums to 100)
African American 447 553 543 554 452 327 374
AsianPacific Islander
Native American
00
07
00
00
00
00
08
00
13
05
24
30
48
15
White 546 447 457 438 526 615 551
OtherUnknownMissing 00 00 00 00 04 05 12
8f Ethnicity ( of 8a sums to 100)
Hispanic
Non-Hispanic
Unknown
21
950
28
24
943
33
24
953
24
23
962
15
33
953
14
38
950
12
153
827
19
8g Cause of ESRD ( of 8a sums to 100)
Diabetes 475 472 480 538 410 415 437
Hypertension
Glomerulonephritis
OtherUnknown
Missing
199
163
135
28
220
154
114
41
252
118
118
31
215
115
108
23
298
100
168
23
267
106
190
22
277
102
173
11
8h Average duration of ESRD (years) 45 48 47 43 43 42 43
8i Years since start of ESRD ( of 8a sums to 100)
lt 1 220 163 134 123 185 191 181
1-2 255 211 189 269 186 189 187
2-3 106 187 142 154 153 158 149
3-6 206 187 291 208 265 258 259
6+ 213 252 244 246 211 204 224
8j Nursing home patients3 ( of 8a) 64 130 87 62 142 162 133
8k Modality ( of 8a sums to 100)
In-center hemodialysis
In-center self hemodialysis
Home hemodialysis
Continuous ambulatory peritoneal dialysis
Continuous cycling peritoneal dialysis
Other modality4
837
00
00
142
14
07
902
00
00
73
16
08
858
00
00
110
31
00
869
00
00
38
92
00
909
00
15
38
32
07
908
00
15
34
37
07
906
00
11
27
49
07SAMPLE
na = not applicable [1] See Guide Section XI [2] Values are shown for the average facility [3] Includes patients who were also treated by a nursing facility at any time during the year The source of nursing facility history of patients is the Nursing
Home Minimum Dataset [4] Other modality includes other dialysis uncertain modality and patients not on dialysis but still temporarily assigned to the facility (discontinued dialysis
recovered renal function and lost to follow up)
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 9 Comorbidities Reported on Medicare Claims for Medicare Dialysis Patients Treated as of December 31 of Each Year1 2005-2007
This Facility Regional Averages2 2007 Measure Name 2005 2006 2007 State Network US
9a Medicare dialysis patients on 1231 (n) 112 103 107 556 401 473
9b Comorbidity ( yes of 9a)
AIDSHIV positive 00 00 09 12 10 18
Alcohol dependence 36 29 19 24 27 22
Anemia 54 49 37 98 79 73
Cancer 125 107 103 121 119 107
Cardiac arrest 09 10 19 15 14 15
Cardiac dysrhythmia 241 233 224 434 416 351
Cerebrovascular disease 259 252 262 309 274 273
Chronic obstructive pulmonary disease 232 282 243 359 328 296
Congestive heart failure 438 417 495 576 542 518
Diabetes 554 573 636 632 621 623
Drug dependence 00 10 00 24 26 19
Gastrointestinal tract bleeding 36 68 09 34 32 29
Hepatitis B 09 10 09 13 10 12
Hepatitis other 45 29 28 46 36 38
Hyperparathyroidism 63 58 75 80 132 88
Infection 563 476 477 554 506 511
Ischemic heart disease 527 495 495 597 562 510
Myocardial infarction 54 117 37 115 98 85
Peripheral vascular disease3 536 447 533 498 476 465
Pneumonia 63 29 19 55 50 53
9c Average number of comorbid conditions 38 37 37 46 44 41
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer on 1231 each year See Guide Section XII [2] Values are shown for the average facility [3] Peripheral vascular disease includes both venous and arterial diseases
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 10 How Patients Were Assigned to This Facility and End of Year Patient Status1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
10a Number of patients placed in facility1 (n) 205 184 166 177 1015 749 911
10b Initial patient placement for the year in this facility
( of 10a sums to 100)
Continuing at facility on 0101 698 766 741 718 686 679 691
Incident (new to ESRD) 263 163 133 51 199 206 199
Transferred into facility 39 71 127 232 115 114 110
10c Patient status at end of year ( of 10a sums to 100)
Alive in this facility on 1231 688 668 765 734 702 698 716
Alive in another facility on 1231 93 65 36 34 86 85 82
Received a transplant 29 33 42 23 31 35 28
Died death attributed to this facility 171 201 120 169 150 152 142
Died death attributed to another facility 10 27 06 11 16 15 14
Other3 10 05 30 28 15 16 18
SAMPLE[1] Patient assignment for Tables 1238 and 9 only See Guide Section XIII [2] Values are shown for the average facility [3] Includes patients who recovered renal function discontinued dialysis or were lost to follow-up Also includes dialysis unrelated deaths Dialysis
unrelated deaths are not attributed to any facility for the purposes of the mortality calculations in this report
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 5 Facility Modality Hemoglobin and Urea Reduction Ratio for Medicare Dialysis Patients1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Modality (among all dialysis patients with ESRD for 90+ days and 1+ claim at this facility)
5a Patients treated during year1 (n) 163 162 152 153 843 661 771
5b Modality ( of 5a sums to 100)
Hemodialysis 840 858 862 869 891 896 895
CAPDCCPD 129 80 132 98 47 50 56
Other dialysis3 31 62 07 33 62 54 48
Hemoglobin (among ESA-treated dialysis patients with ESRD for 90+ days and 4+ Hemoglobin claims at this facility)
5c Eligible patients1 (n) 123 119 107 110 571 420 496
5d Average hemoglobin (gdL) 126 119 118 106 116 116 116
5e Hemoglobin categories ( of 5c sums to 100)
lt 10 gdL 16 25 19 164 26 24 23
10-12 gdL 187 429 617 809 684 727 713
gt 12 gdL 797 546 364 27 290 249 264
5f Hemoglobin 10-12 gdL ( of HD pts) 170 416 630 840 682 724 711
Hemoglobin 10-12 gdL ( of PD pts) 286 667 429 00 649 679 689
5g Hemoglobin percentiles for this facility4
In this State 7 48 79 72
In this Network 7 38 61 59
In the US 6 37 62 69
Urea Reduction Ratio (URR among HD patients with ESRD for 183+ days and 4+ URR claims at this facility)6
5h Eligible patients1(n) 95 100 97 113 521 384 454
5i URR categories ( of 5h sums to 100)
lt 600 74 50 31 09 17 19 15
600-649 126 140 52 71 25 30 27
650-699 474 480 515 265 113 130 110
700-749 295 250 309 469 391 391 360
75+ 32 80 93 186 454 430 488
5j URR 65+ ( of 5h meets a KDOQI guideline) 800 810 918 920 958 951 958
5k URR percentiles for this facility5
In this State 4 2 13 17
In this Network 4 2 18 21
In the US 3 3 16 16SAMPLE
na = not applicable [1] See Guide Section VIII [2] Counts are shown for the average facility [3] Other dialysis includes patients who switch between HD and PD during the year and patients for whom modality is unknown [4] Percent of facilities with a smaller percentage of patients with hemoglobin 10-12 gdl [5] Percent of facilities with a smaller percentage of patients with URR 65+ [6] Patients identified in the Standard Information Management System (SIMS) as having dialyzed five or more times per week were excluded from the URR
calculations Among eligible patients in the US 044 were excluded due to frequent dialysis in 2008
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1018
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 6 Vascular Access Information1 (CMS Fistula First) 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Vascular Access
6a Prevalent hemodialysis patient months3 1709 1454 1424 1446
6b Vascular access type in use ( of 6a sums to 100)
Arteriovenous fistula 263 352 410 427 465 483 502
Arteriovenous graft 420 384 361 315 271 214 227
Catheter 314 259 228 258 261 300 267
OtherMissing 03 04 01 00 03 03 04
6c Arteriovenous fistulae in place4 ( of 6a) 317 422 492 512 541 573 581
6d Catheter only ge 90 days5 ( of 6a) 142 94 103 95 116 137 115
Vascular Access at First Treatment 6e Incident hemodialysis patients (n) 26 0 12 23 189 148 173
6f Vascular access type in use6 ( of 6e sums to 100)
Arteriovenous fistula 154 417 217 146 149 158
Arteriovenous graft 115 83 43 53 45 68
Catheter 538 500 739 777 792 749
OtherMissing 192 00 00 23 13 25
6g Arteriovenous fistulae in place4 ( of 6e) 231 583 391 253 288 308
SAMPLE na = not applicable [1] See Guide Section IX [2] Values are shown for the average facility [3] Patients may be counted up to 12 times per year [4] Includes all patients with fistulae regardless of whether or not they received their hemodialysis treatments using their fistulae [5] Catheter was used for treatment and has been in place for 90 days or more prior to treatment Patient does not have an fistula or graft in place Catheter is
only access Port access devices are reported as catheters for this project [6] Patients listed as graft or catheter may have had fistulae in place for future use but they actually received their treatment through a graft or catheter
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1118
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patient Characteristics3
7a Total number of patients with forms (n) 53 12 10 11 350 304 319
7b Average age (years [0-95]) 632 658 732 612 643 648 633
7c Female ( of 7a) 434 500 400 455 448 442 440
7d Race4 ( of 7a sums to 100)
African-American 358 167 100 364 335 233 284
AsianPacific Islander 00 00 00 00 11 18 42
Native American 00 00 00 00 05 24 11
White 642 833 900 636 641 717 658
OtherUnknownMissing 00 00 00 00 08 08 05
7e Hispanic ( of 7a) 19 00 00 91 30 32 134
7f Primary cause of ESRD ( of 7a sums to 100)
Diabetes 509 417 300 545 408 403 451
Hypertension 189 167 400 364 304 272 287
Primary Glomerulonephritis 132 167 200 91 63 67 64
OtherMissing 170 250 100 00 226 258 199
7g Medical coverage ( of 7a sums to 100)
Employer group only 38 333 100 182 178 162 161
Medicare only 113 00 100 91 162 163 204
Medicaid only 75 00 00 91 103 100 114
Medicare and Medicaid only 226 00 00 91 112 102 126
Medicare and Other 377 500 800 455 360 370 238
OtherUnknown 151 167 00 91 40 60 86
None 19 00 00 00 46 43 71
7h Body Mass Index5
Male 287 242 281 227 268 269 266
Female 261 335 276 328 288 287 280
7i Employment6
Six months prior to ESRD treatment 190 667 333 400 348 387 362
At first ESRD treatment 95 667 333 400 181 225 220
7j Primary modality7 ( of 7a sums to 100)
Hemodialysis 500 444 500 944 945 939
CAPDCCPD 500 556 500 56 55 61
OtherUnknownMissing 00 00 00 00 00 00
7k Number of incident hemodialysis patients7 (n) 6 4 5 332 286 298
7l Access used at first outpatient dialysis7 ( of 7k sums to 100)
Arteriovenous fistula 00 500 00 127 141 136
Arteriovenous graft 00 00 00 29 27 33
Catheter 100 500 100 843 832 819
OtherUnknownMissing 00 00 00 01 00 12
7m Arteriovenous fistulae placed7 ( of 7k) 167 750 00 229 270 292
Average Lab Values Prior to Dialysis3
7n Hemoglobin (gdL [3-18]) 105 112 120 105 99 100 99
7o Serum Albumin (gdL [08-60]) 32 35 36 33 32 32 31
SAMPLE
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1218
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 (cont) Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Average Lab Values Prior to Dialysis3
7p Serum Creatinine (mgdL [2-33]) 70 50 54 51 58 58 63
7q GFR (mLmin [0-60]) 103 124 119 140 119 118 110
Care Prior to ESRD Therapy 7r Received ESA prior to ESRD ( of 7a) 472 333 700 364 261 295 263
7s Pre-ESRD nephrologist care7 ( of 7a sums to 100)
No 250 200 91 330 321 310
Yes lt 6 months 00 00 00 38 48 116
Yes 6-12 months 417 300 545 201 215 208
Yes gt 12 months 333 500 364 328 341 242
Unknown 00 00 00 103 76 124
7t Informed of transplant options7 ( of 7a) 917 900 636 690 710 724
7u Patients not informed of transplant options7 (n) 1 0 3 102 87 92
7v Reason not informed7 ( of 7u may not sum to 100)
Medically unfit 00 100 384 439 309
Unsuitable due to age 00 00 334 320 239
Psychologically unfit 00 00 21 30 28
Patient declined information 00 00 13 12 13
Patient has not been assessed 100 00 332 294 449
Comorbid Conditions 7w Pre-existing Comorbidity ( yes of 7a)
Congestive heart failure 566 250 400 273 415 374 328
Atherosclerotic heart disease8 340 417 400 364 268 268 210
Other cardiac disorder8 00 00 100 00 198 197 171
CVD CVA TIA 57 00 00 182 107 103 95
Peripheral vascular disease 189 333 100 182 154 155 140
History of hypertension 981 917 100 909 861 845 847
Diabetes8 566 417 300 636 574 560 578
Diabetes on insulin 170 250 300 455 383 380 363
COPD 57 333 00 182 130 123 93
Current smoker 57 00 00 91 82 77 62
Cancer 00 00 00 182 112 109 74
Alcohol dependence 00 00 00 00 21 23 16
Drug dependence 00 00 00 00 18 15 13
Inability to ambulate 00 00 00 91 88 75 69
Inability to transfer 00 00 00 00 51 38 35
7x Average number of comorbid conditions 30 29 26 35 35 33 31 SAMPLE
na= not applicable [1] See Guide Section X [2] Values are shown for the average facility [3] For continuous variables summaries include only responses in range indicated in brackets [4] Asian includes Indian sub-continent Native American includes Alaskan Native White includes Middle Eastern and Arabian [5] The median BMI is computed for adult patients at least 20 years old [6] Full-time part-time or student ( of 18-60 year olds) [7] Data collection for these items began mid-year 2005 Summaries for these items shown starting in 2006 [8] AHD includes ischemic heart disease (coronary artery disease) and myocardial infarction Other cardiac disorder includes cardiac arrest cardiac
dysrhythmia and pericarditis Diabetes includes patients with diabetes as the primary cause of ESRD
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1318
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 8 Summaries for All Dialysis Patients Treated as of December 31 of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
8a
8b
8c
Patients treated on 1231 (n)
Average age (years)
Age ( of 8a sums to 100)
lt 20
141
601
07
123
616
00
127
636
00
130
627
00
712
616
05
523
626
05
652
609
05
20-64 574 593 551 585 549 513 562
65+ 418 407 449 415 446 481 433
8d Female ( of 8a) 489 472 512 515 454 449 453
8e Race ( of 8a sums to 100)
African American 447 553 543 554 452 327 374
AsianPacific Islander
Native American
00
07
00
00
00
00
08
00
13
05
24
30
48
15
White 546 447 457 438 526 615 551
OtherUnknownMissing 00 00 00 00 04 05 12
8f Ethnicity ( of 8a sums to 100)
Hispanic
Non-Hispanic
Unknown
21
950
28
24
943
33
24
953
24
23
962
15
33
953
14
38
950
12
153
827
19
8g Cause of ESRD ( of 8a sums to 100)
Diabetes 475 472 480 538 410 415 437
Hypertension
Glomerulonephritis
OtherUnknown
Missing
199
163
135
28
220
154
114
41
252
118
118
31
215
115
108
23
298
100
168
23
267
106
190
22
277
102
173
11
8h Average duration of ESRD (years) 45 48 47 43 43 42 43
8i Years since start of ESRD ( of 8a sums to 100)
lt 1 220 163 134 123 185 191 181
1-2 255 211 189 269 186 189 187
2-3 106 187 142 154 153 158 149
3-6 206 187 291 208 265 258 259
6+ 213 252 244 246 211 204 224
8j Nursing home patients3 ( of 8a) 64 130 87 62 142 162 133
8k Modality ( of 8a sums to 100)
In-center hemodialysis
In-center self hemodialysis
Home hemodialysis
Continuous ambulatory peritoneal dialysis
Continuous cycling peritoneal dialysis
Other modality4
837
00
00
142
14
07
902
00
00
73
16
08
858
00
00
110
31
00
869
00
00
38
92
00
909
00
15
38
32
07
908
00
15
34
37
07
906
00
11
27
49
07SAMPLE
na = not applicable [1] See Guide Section XI [2] Values are shown for the average facility [3] Includes patients who were also treated by a nursing facility at any time during the year The source of nursing facility history of patients is the Nursing
Home Minimum Dataset [4] Other modality includes other dialysis uncertain modality and patients not on dialysis but still temporarily assigned to the facility (discontinued dialysis
recovered renal function and lost to follow up)
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 9 Comorbidities Reported on Medicare Claims for Medicare Dialysis Patients Treated as of December 31 of Each Year1 2005-2007
This Facility Regional Averages2 2007 Measure Name 2005 2006 2007 State Network US
9a Medicare dialysis patients on 1231 (n) 112 103 107 556 401 473
9b Comorbidity ( yes of 9a)
AIDSHIV positive 00 00 09 12 10 18
Alcohol dependence 36 29 19 24 27 22
Anemia 54 49 37 98 79 73
Cancer 125 107 103 121 119 107
Cardiac arrest 09 10 19 15 14 15
Cardiac dysrhythmia 241 233 224 434 416 351
Cerebrovascular disease 259 252 262 309 274 273
Chronic obstructive pulmonary disease 232 282 243 359 328 296
Congestive heart failure 438 417 495 576 542 518
Diabetes 554 573 636 632 621 623
Drug dependence 00 10 00 24 26 19
Gastrointestinal tract bleeding 36 68 09 34 32 29
Hepatitis B 09 10 09 13 10 12
Hepatitis other 45 29 28 46 36 38
Hyperparathyroidism 63 58 75 80 132 88
Infection 563 476 477 554 506 511
Ischemic heart disease 527 495 495 597 562 510
Myocardial infarction 54 117 37 115 98 85
Peripheral vascular disease3 536 447 533 498 476 465
Pneumonia 63 29 19 55 50 53
9c Average number of comorbid conditions 38 37 37 46 44 41
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer on 1231 each year See Guide Section XII [2] Values are shown for the average facility [3] Peripheral vascular disease includes both venous and arterial diseases
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 10 How Patients Were Assigned to This Facility and End of Year Patient Status1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
10a Number of patients placed in facility1 (n) 205 184 166 177 1015 749 911
10b Initial patient placement for the year in this facility
( of 10a sums to 100)
Continuing at facility on 0101 698 766 741 718 686 679 691
Incident (new to ESRD) 263 163 133 51 199 206 199
Transferred into facility 39 71 127 232 115 114 110
10c Patient status at end of year ( of 10a sums to 100)
Alive in this facility on 1231 688 668 765 734 702 698 716
Alive in another facility on 1231 93 65 36 34 86 85 82
Received a transplant 29 33 42 23 31 35 28
Died death attributed to this facility 171 201 120 169 150 152 142
Died death attributed to another facility 10 27 06 11 16 15 14
Other3 10 05 30 28 15 16 18
SAMPLE[1] Patient assignment for Tables 1238 and 9 only See Guide Section XIII [2] Values are shown for the average facility [3] Includes patients who recovered renal function discontinued dialysis or were lost to follow-up Also includes dialysis unrelated deaths Dialysis
unrelated deaths are not attributed to any facility for the purposes of the mortality calculations in this report
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 6 Vascular Access Information1 (CMS Fistula First) 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Vascular Access
6a Prevalent hemodialysis patient months3 1709 1454 1424 1446
6b Vascular access type in use ( of 6a sums to 100)
Arteriovenous fistula 263 352 410 427 465 483 502
Arteriovenous graft 420 384 361 315 271 214 227
Catheter 314 259 228 258 261 300 267
OtherMissing 03 04 01 00 03 03 04
6c Arteriovenous fistulae in place4 ( of 6a) 317 422 492 512 541 573 581
6d Catheter only ge 90 days5 ( of 6a) 142 94 103 95 116 137 115
Vascular Access at First Treatment 6e Incident hemodialysis patients (n) 26 0 12 23 189 148 173
6f Vascular access type in use6 ( of 6e sums to 100)
Arteriovenous fistula 154 417 217 146 149 158
Arteriovenous graft 115 83 43 53 45 68
Catheter 538 500 739 777 792 749
OtherMissing 192 00 00 23 13 25
6g Arteriovenous fistulae in place4 ( of 6e) 231 583 391 253 288 308
SAMPLE na = not applicable [1] See Guide Section IX [2] Values are shown for the average facility [3] Patients may be counted up to 12 times per year [4] Includes all patients with fistulae regardless of whether or not they received their hemodialysis treatments using their fistulae [5] Catheter was used for treatment and has been in place for 90 days or more prior to treatment Patient does not have an fistula or graft in place Catheter is
only access Port access devices are reported as catheters for this project [6] Patients listed as graft or catheter may have had fistulae in place for future use but they actually received their treatment through a graft or catheter
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1118
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patient Characteristics3
7a Total number of patients with forms (n) 53 12 10 11 350 304 319
7b Average age (years [0-95]) 632 658 732 612 643 648 633
7c Female ( of 7a) 434 500 400 455 448 442 440
7d Race4 ( of 7a sums to 100)
African-American 358 167 100 364 335 233 284
AsianPacific Islander 00 00 00 00 11 18 42
Native American 00 00 00 00 05 24 11
White 642 833 900 636 641 717 658
OtherUnknownMissing 00 00 00 00 08 08 05
7e Hispanic ( of 7a) 19 00 00 91 30 32 134
7f Primary cause of ESRD ( of 7a sums to 100)
Diabetes 509 417 300 545 408 403 451
Hypertension 189 167 400 364 304 272 287
Primary Glomerulonephritis 132 167 200 91 63 67 64
OtherMissing 170 250 100 00 226 258 199
7g Medical coverage ( of 7a sums to 100)
Employer group only 38 333 100 182 178 162 161
Medicare only 113 00 100 91 162 163 204
Medicaid only 75 00 00 91 103 100 114
Medicare and Medicaid only 226 00 00 91 112 102 126
Medicare and Other 377 500 800 455 360 370 238
OtherUnknown 151 167 00 91 40 60 86
None 19 00 00 00 46 43 71
7h Body Mass Index5
Male 287 242 281 227 268 269 266
Female 261 335 276 328 288 287 280
7i Employment6
Six months prior to ESRD treatment 190 667 333 400 348 387 362
At first ESRD treatment 95 667 333 400 181 225 220
7j Primary modality7 ( of 7a sums to 100)
Hemodialysis 500 444 500 944 945 939
CAPDCCPD 500 556 500 56 55 61
OtherUnknownMissing 00 00 00 00 00 00
7k Number of incident hemodialysis patients7 (n) 6 4 5 332 286 298
7l Access used at first outpatient dialysis7 ( of 7k sums to 100)
Arteriovenous fistula 00 500 00 127 141 136
Arteriovenous graft 00 00 00 29 27 33
Catheter 100 500 100 843 832 819
OtherUnknownMissing 00 00 00 01 00 12
7m Arteriovenous fistulae placed7 ( of 7k) 167 750 00 229 270 292
Average Lab Values Prior to Dialysis3
7n Hemoglobin (gdL [3-18]) 105 112 120 105 99 100 99
7o Serum Albumin (gdL [08-60]) 32 35 36 33 32 32 31
SAMPLE
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1218
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 (cont) Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Average Lab Values Prior to Dialysis3
7p Serum Creatinine (mgdL [2-33]) 70 50 54 51 58 58 63
7q GFR (mLmin [0-60]) 103 124 119 140 119 118 110
Care Prior to ESRD Therapy 7r Received ESA prior to ESRD ( of 7a) 472 333 700 364 261 295 263
7s Pre-ESRD nephrologist care7 ( of 7a sums to 100)
No 250 200 91 330 321 310
Yes lt 6 months 00 00 00 38 48 116
Yes 6-12 months 417 300 545 201 215 208
Yes gt 12 months 333 500 364 328 341 242
Unknown 00 00 00 103 76 124
7t Informed of transplant options7 ( of 7a) 917 900 636 690 710 724
7u Patients not informed of transplant options7 (n) 1 0 3 102 87 92
7v Reason not informed7 ( of 7u may not sum to 100)
Medically unfit 00 100 384 439 309
Unsuitable due to age 00 00 334 320 239
Psychologically unfit 00 00 21 30 28
Patient declined information 00 00 13 12 13
Patient has not been assessed 100 00 332 294 449
Comorbid Conditions 7w Pre-existing Comorbidity ( yes of 7a)
Congestive heart failure 566 250 400 273 415 374 328
Atherosclerotic heart disease8 340 417 400 364 268 268 210
Other cardiac disorder8 00 00 100 00 198 197 171
CVD CVA TIA 57 00 00 182 107 103 95
Peripheral vascular disease 189 333 100 182 154 155 140
History of hypertension 981 917 100 909 861 845 847
Diabetes8 566 417 300 636 574 560 578
Diabetes on insulin 170 250 300 455 383 380 363
COPD 57 333 00 182 130 123 93
Current smoker 57 00 00 91 82 77 62
Cancer 00 00 00 182 112 109 74
Alcohol dependence 00 00 00 00 21 23 16
Drug dependence 00 00 00 00 18 15 13
Inability to ambulate 00 00 00 91 88 75 69
Inability to transfer 00 00 00 00 51 38 35
7x Average number of comorbid conditions 30 29 26 35 35 33 31 SAMPLE
na= not applicable [1] See Guide Section X [2] Values are shown for the average facility [3] For continuous variables summaries include only responses in range indicated in brackets [4] Asian includes Indian sub-continent Native American includes Alaskan Native White includes Middle Eastern and Arabian [5] The median BMI is computed for adult patients at least 20 years old [6] Full-time part-time or student ( of 18-60 year olds) [7] Data collection for these items began mid-year 2005 Summaries for these items shown starting in 2006 [8] AHD includes ischemic heart disease (coronary artery disease) and myocardial infarction Other cardiac disorder includes cardiac arrest cardiac
dysrhythmia and pericarditis Diabetes includes patients with diabetes as the primary cause of ESRD
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1318
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 8 Summaries for All Dialysis Patients Treated as of December 31 of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
8a
8b
8c
Patients treated on 1231 (n)
Average age (years)
Age ( of 8a sums to 100)
lt 20
141
601
07
123
616
00
127
636
00
130
627
00
712
616
05
523
626
05
652
609
05
20-64 574 593 551 585 549 513 562
65+ 418 407 449 415 446 481 433
8d Female ( of 8a) 489 472 512 515 454 449 453
8e Race ( of 8a sums to 100)
African American 447 553 543 554 452 327 374
AsianPacific Islander
Native American
00
07
00
00
00
00
08
00
13
05
24
30
48
15
White 546 447 457 438 526 615 551
OtherUnknownMissing 00 00 00 00 04 05 12
8f Ethnicity ( of 8a sums to 100)
Hispanic
Non-Hispanic
Unknown
21
950
28
24
943
33
24
953
24
23
962
15
33
953
14
38
950
12
153
827
19
8g Cause of ESRD ( of 8a sums to 100)
Diabetes 475 472 480 538 410 415 437
Hypertension
Glomerulonephritis
OtherUnknown
Missing
199
163
135
28
220
154
114
41
252
118
118
31
215
115
108
23
298
100
168
23
267
106
190
22
277
102
173
11
8h Average duration of ESRD (years) 45 48 47 43 43 42 43
8i Years since start of ESRD ( of 8a sums to 100)
lt 1 220 163 134 123 185 191 181
1-2 255 211 189 269 186 189 187
2-3 106 187 142 154 153 158 149
3-6 206 187 291 208 265 258 259
6+ 213 252 244 246 211 204 224
8j Nursing home patients3 ( of 8a) 64 130 87 62 142 162 133
8k Modality ( of 8a sums to 100)
In-center hemodialysis
In-center self hemodialysis
Home hemodialysis
Continuous ambulatory peritoneal dialysis
Continuous cycling peritoneal dialysis
Other modality4
837
00
00
142
14
07
902
00
00
73
16
08
858
00
00
110
31
00
869
00
00
38
92
00
909
00
15
38
32
07
908
00
15
34
37
07
906
00
11
27
49
07SAMPLE
na = not applicable [1] See Guide Section XI [2] Values are shown for the average facility [3] Includes patients who were also treated by a nursing facility at any time during the year The source of nursing facility history of patients is the Nursing
Home Minimum Dataset [4] Other modality includes other dialysis uncertain modality and patients not on dialysis but still temporarily assigned to the facility (discontinued dialysis
recovered renal function and lost to follow up)
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 9 Comorbidities Reported on Medicare Claims for Medicare Dialysis Patients Treated as of December 31 of Each Year1 2005-2007
This Facility Regional Averages2 2007 Measure Name 2005 2006 2007 State Network US
9a Medicare dialysis patients on 1231 (n) 112 103 107 556 401 473
9b Comorbidity ( yes of 9a)
AIDSHIV positive 00 00 09 12 10 18
Alcohol dependence 36 29 19 24 27 22
Anemia 54 49 37 98 79 73
Cancer 125 107 103 121 119 107
Cardiac arrest 09 10 19 15 14 15
Cardiac dysrhythmia 241 233 224 434 416 351
Cerebrovascular disease 259 252 262 309 274 273
Chronic obstructive pulmonary disease 232 282 243 359 328 296
Congestive heart failure 438 417 495 576 542 518
Diabetes 554 573 636 632 621 623
Drug dependence 00 10 00 24 26 19
Gastrointestinal tract bleeding 36 68 09 34 32 29
Hepatitis B 09 10 09 13 10 12
Hepatitis other 45 29 28 46 36 38
Hyperparathyroidism 63 58 75 80 132 88
Infection 563 476 477 554 506 511
Ischemic heart disease 527 495 495 597 562 510
Myocardial infarction 54 117 37 115 98 85
Peripheral vascular disease3 536 447 533 498 476 465
Pneumonia 63 29 19 55 50 53
9c Average number of comorbid conditions 38 37 37 46 44 41
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer on 1231 each year See Guide Section XII [2] Values are shown for the average facility [3] Peripheral vascular disease includes both venous and arterial diseases
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 10 How Patients Were Assigned to This Facility and End of Year Patient Status1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
10a Number of patients placed in facility1 (n) 205 184 166 177 1015 749 911
10b Initial patient placement for the year in this facility
( of 10a sums to 100)
Continuing at facility on 0101 698 766 741 718 686 679 691
Incident (new to ESRD) 263 163 133 51 199 206 199
Transferred into facility 39 71 127 232 115 114 110
10c Patient status at end of year ( of 10a sums to 100)
Alive in this facility on 1231 688 668 765 734 702 698 716
Alive in another facility on 1231 93 65 36 34 86 85 82
Received a transplant 29 33 42 23 31 35 28
Died death attributed to this facility 171 201 120 169 150 152 142
Died death attributed to another facility 10 27 06 11 16 15 14
Other3 10 05 30 28 15 16 18
SAMPLE[1] Patient assignment for Tables 1238 and 9 only See Guide Section XIII [2] Values are shown for the average facility [3] Includes patients who recovered renal function discontinued dialysis or were lost to follow-up Also includes dialysis unrelated deaths Dialysis
unrelated deaths are not attributed to any facility for the purposes of the mortality calculations in this report
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patient Characteristics3
7a Total number of patients with forms (n) 53 12 10 11 350 304 319
7b Average age (years [0-95]) 632 658 732 612 643 648 633
7c Female ( of 7a) 434 500 400 455 448 442 440
7d Race4 ( of 7a sums to 100)
African-American 358 167 100 364 335 233 284
AsianPacific Islander 00 00 00 00 11 18 42
Native American 00 00 00 00 05 24 11
White 642 833 900 636 641 717 658
OtherUnknownMissing 00 00 00 00 08 08 05
7e Hispanic ( of 7a) 19 00 00 91 30 32 134
7f Primary cause of ESRD ( of 7a sums to 100)
Diabetes 509 417 300 545 408 403 451
Hypertension 189 167 400 364 304 272 287
Primary Glomerulonephritis 132 167 200 91 63 67 64
OtherMissing 170 250 100 00 226 258 199
7g Medical coverage ( of 7a sums to 100)
Employer group only 38 333 100 182 178 162 161
Medicare only 113 00 100 91 162 163 204
Medicaid only 75 00 00 91 103 100 114
Medicare and Medicaid only 226 00 00 91 112 102 126
Medicare and Other 377 500 800 455 360 370 238
OtherUnknown 151 167 00 91 40 60 86
None 19 00 00 00 46 43 71
7h Body Mass Index5
Male 287 242 281 227 268 269 266
Female 261 335 276 328 288 287 280
7i Employment6
Six months prior to ESRD treatment 190 667 333 400 348 387 362
At first ESRD treatment 95 667 333 400 181 225 220
7j Primary modality7 ( of 7a sums to 100)
Hemodialysis 500 444 500 944 945 939
CAPDCCPD 500 556 500 56 55 61
OtherUnknownMissing 00 00 00 00 00 00
7k Number of incident hemodialysis patients7 (n) 6 4 5 332 286 298
7l Access used at first outpatient dialysis7 ( of 7k sums to 100)
Arteriovenous fistula 00 500 00 127 141 136
Arteriovenous graft 00 00 00 29 27 33
Catheter 100 500 100 843 832 819
OtherUnknownMissing 00 00 00 01 00 12
7m Arteriovenous fistulae placed7 ( of 7k) 167 750 00 229 270 292
Average Lab Values Prior to Dialysis3
7n Hemoglobin (gdL [3-18]) 105 112 120 105 99 100 99
7o Serum Albumin (gdL [08-60]) 32 35 36 33 32 32 31
SAMPLE
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1218
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 (cont) Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Average Lab Values Prior to Dialysis3
7p Serum Creatinine (mgdL [2-33]) 70 50 54 51 58 58 63
7q GFR (mLmin [0-60]) 103 124 119 140 119 118 110
Care Prior to ESRD Therapy 7r Received ESA prior to ESRD ( of 7a) 472 333 700 364 261 295 263
7s Pre-ESRD nephrologist care7 ( of 7a sums to 100)
No 250 200 91 330 321 310
Yes lt 6 months 00 00 00 38 48 116
Yes 6-12 months 417 300 545 201 215 208
Yes gt 12 months 333 500 364 328 341 242
Unknown 00 00 00 103 76 124
7t Informed of transplant options7 ( of 7a) 917 900 636 690 710 724
7u Patients not informed of transplant options7 (n) 1 0 3 102 87 92
7v Reason not informed7 ( of 7u may not sum to 100)
Medically unfit 00 100 384 439 309
Unsuitable due to age 00 00 334 320 239
Psychologically unfit 00 00 21 30 28
Patient declined information 00 00 13 12 13
Patient has not been assessed 100 00 332 294 449
Comorbid Conditions 7w Pre-existing Comorbidity ( yes of 7a)
Congestive heart failure 566 250 400 273 415 374 328
Atherosclerotic heart disease8 340 417 400 364 268 268 210
Other cardiac disorder8 00 00 100 00 198 197 171
CVD CVA TIA 57 00 00 182 107 103 95
Peripheral vascular disease 189 333 100 182 154 155 140
History of hypertension 981 917 100 909 861 845 847
Diabetes8 566 417 300 636 574 560 578
Diabetes on insulin 170 250 300 455 383 380 363
COPD 57 333 00 182 130 123 93
Current smoker 57 00 00 91 82 77 62
Cancer 00 00 00 182 112 109 74
Alcohol dependence 00 00 00 00 21 23 16
Drug dependence 00 00 00 00 18 15 13
Inability to ambulate 00 00 00 91 88 75 69
Inability to transfer 00 00 00 00 51 38 35
7x Average number of comorbid conditions 30 29 26 35 35 33 31 SAMPLE
na= not applicable [1] See Guide Section X [2] Values are shown for the average facility [3] For continuous variables summaries include only responses in range indicated in brackets [4] Asian includes Indian sub-continent Native American includes Alaskan Native White includes Middle Eastern and Arabian [5] The median BMI is computed for adult patients at least 20 years old [6] Full-time part-time or student ( of 18-60 year olds) [7] Data collection for these items began mid-year 2005 Summaries for these items shown starting in 2006 [8] AHD includes ischemic heart disease (coronary artery disease) and myocardial infarction Other cardiac disorder includes cardiac arrest cardiac
dysrhythmia and pericarditis Diabetes includes patients with diabetes as the primary cause of ESRD
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1318
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 8 Summaries for All Dialysis Patients Treated as of December 31 of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
8a
8b
8c
Patients treated on 1231 (n)
Average age (years)
Age ( of 8a sums to 100)
lt 20
141
601
07
123
616
00
127
636
00
130
627
00
712
616
05
523
626
05
652
609
05
20-64 574 593 551 585 549 513 562
65+ 418 407 449 415 446 481 433
8d Female ( of 8a) 489 472 512 515 454 449 453
8e Race ( of 8a sums to 100)
African American 447 553 543 554 452 327 374
AsianPacific Islander
Native American
00
07
00
00
00
00
08
00
13
05
24
30
48
15
White 546 447 457 438 526 615 551
OtherUnknownMissing 00 00 00 00 04 05 12
8f Ethnicity ( of 8a sums to 100)
Hispanic
Non-Hispanic
Unknown
21
950
28
24
943
33
24
953
24
23
962
15
33
953
14
38
950
12
153
827
19
8g Cause of ESRD ( of 8a sums to 100)
Diabetes 475 472 480 538 410 415 437
Hypertension
Glomerulonephritis
OtherUnknown
Missing
199
163
135
28
220
154
114
41
252
118
118
31
215
115
108
23
298
100
168
23
267
106
190
22
277
102
173
11
8h Average duration of ESRD (years) 45 48 47 43 43 42 43
8i Years since start of ESRD ( of 8a sums to 100)
lt 1 220 163 134 123 185 191 181
1-2 255 211 189 269 186 189 187
2-3 106 187 142 154 153 158 149
3-6 206 187 291 208 265 258 259
6+ 213 252 244 246 211 204 224
8j Nursing home patients3 ( of 8a) 64 130 87 62 142 162 133
8k Modality ( of 8a sums to 100)
In-center hemodialysis
In-center self hemodialysis
Home hemodialysis
Continuous ambulatory peritoneal dialysis
Continuous cycling peritoneal dialysis
Other modality4
837
00
00
142
14
07
902
00
00
73
16
08
858
00
00
110
31
00
869
00
00
38
92
00
909
00
15
38
32
07
908
00
15
34
37
07
906
00
11
27
49
07SAMPLE
na = not applicable [1] See Guide Section XI [2] Values are shown for the average facility [3] Includes patients who were also treated by a nursing facility at any time during the year The source of nursing facility history of patients is the Nursing
Home Minimum Dataset [4] Other modality includes other dialysis uncertain modality and patients not on dialysis but still temporarily assigned to the facility (discontinued dialysis
recovered renal function and lost to follow up)
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 9 Comorbidities Reported on Medicare Claims for Medicare Dialysis Patients Treated as of December 31 of Each Year1 2005-2007
This Facility Regional Averages2 2007 Measure Name 2005 2006 2007 State Network US
9a Medicare dialysis patients on 1231 (n) 112 103 107 556 401 473
9b Comorbidity ( yes of 9a)
AIDSHIV positive 00 00 09 12 10 18
Alcohol dependence 36 29 19 24 27 22
Anemia 54 49 37 98 79 73
Cancer 125 107 103 121 119 107
Cardiac arrest 09 10 19 15 14 15
Cardiac dysrhythmia 241 233 224 434 416 351
Cerebrovascular disease 259 252 262 309 274 273
Chronic obstructive pulmonary disease 232 282 243 359 328 296
Congestive heart failure 438 417 495 576 542 518
Diabetes 554 573 636 632 621 623
Drug dependence 00 10 00 24 26 19
Gastrointestinal tract bleeding 36 68 09 34 32 29
Hepatitis B 09 10 09 13 10 12
Hepatitis other 45 29 28 46 36 38
Hyperparathyroidism 63 58 75 80 132 88
Infection 563 476 477 554 506 511
Ischemic heart disease 527 495 495 597 562 510
Myocardial infarction 54 117 37 115 98 85
Peripheral vascular disease3 536 447 533 498 476 465
Pneumonia 63 29 19 55 50 53
9c Average number of comorbid conditions 38 37 37 46 44 41
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer on 1231 each year See Guide Section XII [2] Values are shown for the average facility [3] Peripheral vascular disease includes both venous and arterial diseases
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 10 How Patients Were Assigned to This Facility and End of Year Patient Status1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
10a Number of patients placed in facility1 (n) 205 184 166 177 1015 749 911
10b Initial patient placement for the year in this facility
( of 10a sums to 100)
Continuing at facility on 0101 698 766 741 718 686 679 691
Incident (new to ESRD) 263 163 133 51 199 206 199
Transferred into facility 39 71 127 232 115 114 110
10c Patient status at end of year ( of 10a sums to 100)
Alive in this facility on 1231 688 668 765 734 702 698 716
Alive in another facility on 1231 93 65 36 34 86 85 82
Received a transplant 29 33 42 23 31 35 28
Died death attributed to this facility 171 201 120 169 150 152 142
Died death attributed to another facility 10 27 06 11 16 15 14
Other3 10 05 30 28 15 16 18
SAMPLE[1] Patient assignment for Tables 1238 and 9 only See Guide Section XIII [2] Values are shown for the average facility [3] Includes patients who recovered renal function discontinued dialysis or were lost to follow-up Also includes dialysis unrelated deaths Dialysis
unrelated deaths are not attributed to any facility for the purposes of the mortality calculations in this report
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 7 (cont) Characteristics of New Dialysis Patients1 2005-2008 (Form CMS-2728)
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Average Lab Values Prior to Dialysis3
7p Serum Creatinine (mgdL [2-33]) 70 50 54 51 58 58 63
7q GFR (mLmin [0-60]) 103 124 119 140 119 118 110
Care Prior to ESRD Therapy 7r Received ESA prior to ESRD ( of 7a) 472 333 700 364 261 295 263
7s Pre-ESRD nephrologist care7 ( of 7a sums to 100)
No 250 200 91 330 321 310
Yes lt 6 months 00 00 00 38 48 116
Yes 6-12 months 417 300 545 201 215 208
Yes gt 12 months 333 500 364 328 341 242
Unknown 00 00 00 103 76 124
7t Informed of transplant options7 ( of 7a) 917 900 636 690 710 724
7u Patients not informed of transplant options7 (n) 1 0 3 102 87 92
7v Reason not informed7 ( of 7u may not sum to 100)
Medically unfit 00 100 384 439 309
Unsuitable due to age 00 00 334 320 239
Psychologically unfit 00 00 21 30 28
Patient declined information 00 00 13 12 13
Patient has not been assessed 100 00 332 294 449
Comorbid Conditions 7w Pre-existing Comorbidity ( yes of 7a)
Congestive heart failure 566 250 400 273 415 374 328
Atherosclerotic heart disease8 340 417 400 364 268 268 210
Other cardiac disorder8 00 00 100 00 198 197 171
CVD CVA TIA 57 00 00 182 107 103 95
Peripheral vascular disease 189 333 100 182 154 155 140
History of hypertension 981 917 100 909 861 845 847
Diabetes8 566 417 300 636 574 560 578
Diabetes on insulin 170 250 300 455 383 380 363
COPD 57 333 00 182 130 123 93
Current smoker 57 00 00 91 82 77 62
Cancer 00 00 00 182 112 109 74
Alcohol dependence 00 00 00 00 21 23 16
Drug dependence 00 00 00 00 18 15 13
Inability to ambulate 00 00 00 91 88 75 69
Inability to transfer 00 00 00 00 51 38 35
7x Average number of comorbid conditions 30 29 26 35 35 33 31 SAMPLE
na= not applicable [1] See Guide Section X [2] Values are shown for the average facility [3] For continuous variables summaries include only responses in range indicated in brackets [4] Asian includes Indian sub-continent Native American includes Alaskan Native White includes Middle Eastern and Arabian [5] The median BMI is computed for adult patients at least 20 years old [6] Full-time part-time or student ( of 18-60 year olds) [7] Data collection for these items began mid-year 2005 Summaries for these items shown starting in 2006 [8] AHD includes ischemic heart disease (coronary artery disease) and myocardial infarction Other cardiac disorder includes cardiac arrest cardiac
dysrhythmia and pericarditis Diabetes includes patients with diabetes as the primary cause of ESRD
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1318
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 8 Summaries for All Dialysis Patients Treated as of December 31 of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
8a
8b
8c
Patients treated on 1231 (n)
Average age (years)
Age ( of 8a sums to 100)
lt 20
141
601
07
123
616
00
127
636
00
130
627
00
712
616
05
523
626
05
652
609
05
20-64 574 593 551 585 549 513 562
65+ 418 407 449 415 446 481 433
8d Female ( of 8a) 489 472 512 515 454 449 453
8e Race ( of 8a sums to 100)
African American 447 553 543 554 452 327 374
AsianPacific Islander
Native American
00
07
00
00
00
00
08
00
13
05
24
30
48
15
White 546 447 457 438 526 615 551
OtherUnknownMissing 00 00 00 00 04 05 12
8f Ethnicity ( of 8a sums to 100)
Hispanic
Non-Hispanic
Unknown
21
950
28
24
943
33
24
953
24
23
962
15
33
953
14
38
950
12
153
827
19
8g Cause of ESRD ( of 8a sums to 100)
Diabetes 475 472 480 538 410 415 437
Hypertension
Glomerulonephritis
OtherUnknown
Missing
199
163
135
28
220
154
114
41
252
118
118
31
215
115
108
23
298
100
168
23
267
106
190
22
277
102
173
11
8h Average duration of ESRD (years) 45 48 47 43 43 42 43
8i Years since start of ESRD ( of 8a sums to 100)
lt 1 220 163 134 123 185 191 181
1-2 255 211 189 269 186 189 187
2-3 106 187 142 154 153 158 149
3-6 206 187 291 208 265 258 259
6+ 213 252 244 246 211 204 224
8j Nursing home patients3 ( of 8a) 64 130 87 62 142 162 133
8k Modality ( of 8a sums to 100)
In-center hemodialysis
In-center self hemodialysis
Home hemodialysis
Continuous ambulatory peritoneal dialysis
Continuous cycling peritoneal dialysis
Other modality4
837
00
00
142
14
07
902
00
00
73
16
08
858
00
00
110
31
00
869
00
00
38
92
00
909
00
15
38
32
07
908
00
15
34
37
07
906
00
11
27
49
07SAMPLE
na = not applicable [1] See Guide Section XI [2] Values are shown for the average facility [3] Includes patients who were also treated by a nursing facility at any time during the year The source of nursing facility history of patients is the Nursing
Home Minimum Dataset [4] Other modality includes other dialysis uncertain modality and patients not on dialysis but still temporarily assigned to the facility (discontinued dialysis
recovered renal function and lost to follow up)
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 9 Comorbidities Reported on Medicare Claims for Medicare Dialysis Patients Treated as of December 31 of Each Year1 2005-2007
This Facility Regional Averages2 2007 Measure Name 2005 2006 2007 State Network US
9a Medicare dialysis patients on 1231 (n) 112 103 107 556 401 473
9b Comorbidity ( yes of 9a)
AIDSHIV positive 00 00 09 12 10 18
Alcohol dependence 36 29 19 24 27 22
Anemia 54 49 37 98 79 73
Cancer 125 107 103 121 119 107
Cardiac arrest 09 10 19 15 14 15
Cardiac dysrhythmia 241 233 224 434 416 351
Cerebrovascular disease 259 252 262 309 274 273
Chronic obstructive pulmonary disease 232 282 243 359 328 296
Congestive heart failure 438 417 495 576 542 518
Diabetes 554 573 636 632 621 623
Drug dependence 00 10 00 24 26 19
Gastrointestinal tract bleeding 36 68 09 34 32 29
Hepatitis B 09 10 09 13 10 12
Hepatitis other 45 29 28 46 36 38
Hyperparathyroidism 63 58 75 80 132 88
Infection 563 476 477 554 506 511
Ischemic heart disease 527 495 495 597 562 510
Myocardial infarction 54 117 37 115 98 85
Peripheral vascular disease3 536 447 533 498 476 465
Pneumonia 63 29 19 55 50 53
9c Average number of comorbid conditions 38 37 37 46 44 41
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer on 1231 each year See Guide Section XII [2] Values are shown for the average facility [3] Peripheral vascular disease includes both venous and arterial diseases
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 10 How Patients Were Assigned to This Facility and End of Year Patient Status1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
10a Number of patients placed in facility1 (n) 205 184 166 177 1015 749 911
10b Initial patient placement for the year in this facility
( of 10a sums to 100)
Continuing at facility on 0101 698 766 741 718 686 679 691
Incident (new to ESRD) 263 163 133 51 199 206 199
Transferred into facility 39 71 127 232 115 114 110
10c Patient status at end of year ( of 10a sums to 100)
Alive in this facility on 1231 688 668 765 734 702 698 716
Alive in another facility on 1231 93 65 36 34 86 85 82
Received a transplant 29 33 42 23 31 35 28
Died death attributed to this facility 171 201 120 169 150 152 142
Died death attributed to another facility 10 27 06 11 16 15 14
Other3 10 05 30 28 15 16 18
SAMPLE[1] Patient assignment for Tables 1238 and 9 only See Guide Section XIII [2] Values are shown for the average facility [3] Includes patients who recovered renal function discontinued dialysis or were lost to follow-up Also includes dialysis unrelated deaths Dialysis
unrelated deaths are not attributed to any facility for the purposes of the mortality calculations in this report
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 8 Summaries for All Dialysis Patients Treated as of December 31 of Each Year1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
8a
8b
8c
Patients treated on 1231 (n)
Average age (years)
Age ( of 8a sums to 100)
lt 20
141
601
07
123
616
00
127
636
00
130
627
00
712
616
05
523
626
05
652
609
05
20-64 574 593 551 585 549 513 562
65+ 418 407 449 415 446 481 433
8d Female ( of 8a) 489 472 512 515 454 449 453
8e Race ( of 8a sums to 100)
African American 447 553 543 554 452 327 374
AsianPacific Islander
Native American
00
07
00
00
00
00
08
00
13
05
24
30
48
15
White 546 447 457 438 526 615 551
OtherUnknownMissing 00 00 00 00 04 05 12
8f Ethnicity ( of 8a sums to 100)
Hispanic
Non-Hispanic
Unknown
21
950
28
24
943
33
24
953
24
23
962
15
33
953
14
38
950
12
153
827
19
8g Cause of ESRD ( of 8a sums to 100)
Diabetes 475 472 480 538 410 415 437
Hypertension
Glomerulonephritis
OtherUnknown
Missing
199
163
135
28
220
154
114
41
252
118
118
31
215
115
108
23
298
100
168
23
267
106
190
22
277
102
173
11
8h Average duration of ESRD (years) 45 48 47 43 43 42 43
8i Years since start of ESRD ( of 8a sums to 100)
lt 1 220 163 134 123 185 191 181
1-2 255 211 189 269 186 189 187
2-3 106 187 142 154 153 158 149
3-6 206 187 291 208 265 258 259
6+ 213 252 244 246 211 204 224
8j Nursing home patients3 ( of 8a) 64 130 87 62 142 162 133
8k Modality ( of 8a sums to 100)
In-center hemodialysis
In-center self hemodialysis
Home hemodialysis
Continuous ambulatory peritoneal dialysis
Continuous cycling peritoneal dialysis
Other modality4
837
00
00
142
14
07
902
00
00
73
16
08
858
00
00
110
31
00
869
00
00
38
92
00
909
00
15
38
32
07
908
00
15
34
37
07
906
00
11
27
49
07SAMPLE
na = not applicable [1] See Guide Section XI [2] Values are shown for the average facility [3] Includes patients who were also treated by a nursing facility at any time during the year The source of nursing facility history of patients is the Nursing
Home Minimum Dataset [4] Other modality includes other dialysis uncertain modality and patients not on dialysis but still temporarily assigned to the facility (discontinued dialysis
recovered renal function and lost to follow up)
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1418
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 9 Comorbidities Reported on Medicare Claims for Medicare Dialysis Patients Treated as of December 31 of Each Year1 2005-2007
This Facility Regional Averages2 2007 Measure Name 2005 2006 2007 State Network US
9a Medicare dialysis patients on 1231 (n) 112 103 107 556 401 473
9b Comorbidity ( yes of 9a)
AIDSHIV positive 00 00 09 12 10 18
Alcohol dependence 36 29 19 24 27 22
Anemia 54 49 37 98 79 73
Cancer 125 107 103 121 119 107
Cardiac arrest 09 10 19 15 14 15
Cardiac dysrhythmia 241 233 224 434 416 351
Cerebrovascular disease 259 252 262 309 274 273
Chronic obstructive pulmonary disease 232 282 243 359 328 296
Congestive heart failure 438 417 495 576 542 518
Diabetes 554 573 636 632 621 623
Drug dependence 00 10 00 24 26 19
Gastrointestinal tract bleeding 36 68 09 34 32 29
Hepatitis B 09 10 09 13 10 12
Hepatitis other 45 29 28 46 36 38
Hyperparathyroidism 63 58 75 80 132 88
Infection 563 476 477 554 506 511
Ischemic heart disease 527 495 495 597 562 510
Myocardial infarction 54 117 37 115 98 85
Peripheral vascular disease3 536 447 533 498 476 465
Pneumonia 63 29 19 55 50 53
9c Average number of comorbid conditions 38 37 37 46 44 41
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer on 1231 each year See Guide Section XII [2] Values are shown for the average facility [3] Peripheral vascular disease includes both venous and arterial diseases
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 10 How Patients Were Assigned to This Facility and End of Year Patient Status1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
10a Number of patients placed in facility1 (n) 205 184 166 177 1015 749 911
10b Initial patient placement for the year in this facility
( of 10a sums to 100)
Continuing at facility on 0101 698 766 741 718 686 679 691
Incident (new to ESRD) 263 163 133 51 199 206 199
Transferred into facility 39 71 127 232 115 114 110
10c Patient status at end of year ( of 10a sums to 100)
Alive in this facility on 1231 688 668 765 734 702 698 716
Alive in another facility on 1231 93 65 36 34 86 85 82
Received a transplant 29 33 42 23 31 35 28
Died death attributed to this facility 171 201 120 169 150 152 142
Died death attributed to another facility 10 27 06 11 16 15 14
Other3 10 05 30 28 15 16 18
SAMPLE[1] Patient assignment for Tables 1238 and 9 only See Guide Section XIII [2] Values are shown for the average facility [3] Includes patients who recovered renal function discontinued dialysis or were lost to follow-up Also includes dialysis unrelated deaths Dialysis
unrelated deaths are not attributed to any facility for the purposes of the mortality calculations in this report
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 9 Comorbidities Reported on Medicare Claims for Medicare Dialysis Patients Treated as of December 31 of Each Year1 2005-2007
This Facility Regional Averages2 2007 Measure Name 2005 2006 2007 State Network US
9a Medicare dialysis patients on 1231 (n) 112 103 107 556 401 473
9b Comorbidity ( yes of 9a)
AIDSHIV positive 00 00 09 12 10 18
Alcohol dependence 36 29 19 24 27 22
Anemia 54 49 37 98 79 73
Cancer 125 107 103 121 119 107
Cardiac arrest 09 10 19 15 14 15
Cardiac dysrhythmia 241 233 224 434 416 351
Cerebrovascular disease 259 252 262 309 274 273
Chronic obstructive pulmonary disease 232 282 243 359 328 296
Congestive heart failure 438 417 495 576 542 518
Diabetes 554 573 636 632 621 623
Drug dependence 00 10 00 24 26 19
Gastrointestinal tract bleeding 36 68 09 34 32 29
Hepatitis B 09 10 09 13 10 12
Hepatitis other 45 29 28 46 36 38
Hyperparathyroidism 63 58 75 80 132 88
Infection 563 476 477 554 506 511
Ischemic heart disease 527 495 495 597 562 510
Myocardial infarction 54 117 37 115 98 85
Peripheral vascular disease3 536 447 533 498 476 465
Pneumonia 63 29 19 55 50 53
9c Average number of comorbid conditions 38 37 37 46 44 41
SAMPLE na = not applicable [1] Based on patients with Medicare as primary insurer on 1231 each year See Guide Section XII [2] Values are shown for the average facility [3] Peripheral vascular disease includes both venous and arterial diseases
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1518
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 10 How Patients Were Assigned to This Facility and End of Year Patient Status1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
10a Number of patients placed in facility1 (n) 205 184 166 177 1015 749 911
10b Initial patient placement for the year in this facility
( of 10a sums to 100)
Continuing at facility on 0101 698 766 741 718 686 679 691
Incident (new to ESRD) 263 163 133 51 199 206 199
Transferred into facility 39 71 127 232 115 114 110
10c Patient status at end of year ( of 10a sums to 100)
Alive in this facility on 1231 688 668 765 734 702 698 716
Alive in another facility on 1231 93 65 36 34 86 85 82
Received a transplant 29 33 42 23 31 35 28
Died death attributed to this facility 171 201 120 169 150 152 142
Died death attributed to another facility 10 27 06 11 16 15 14
Other3 10 05 30 28 15 16 18
SAMPLE[1] Patient assignment for Tables 1238 and 9 only See Guide Section XIII [2] Values are shown for the average facility [3] Includes patients who recovered renal function discontinued dialysis or were lost to follow-up Also includes dialysis unrelated deaths Dialysis
unrelated deaths are not attributed to any facility for the purposes of the mortality calculations in this report
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 10 How Patients Were Assigned to This Facility and End of Year Patient Status1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
10a Number of patients placed in facility1 (n) 205 184 166 177 1015 749 911
10b Initial patient placement for the year in this facility
( of 10a sums to 100)
Continuing at facility on 0101 698 766 741 718 686 679 691
Incident (new to ESRD) 263 163 133 51 199 206 199
Transferred into facility 39 71 127 232 115 114 110
10c Patient status at end of year ( of 10a sums to 100)
Alive in this facility on 1231 688 668 765 734 702 698 716
Alive in another facility on 1231 93 65 36 34 86 85 82
Received a transplant 29 33 42 23 31 35 28
Died death attributed to this facility 171 201 120 169 150 152 142
Died death attributed to another facility 10 27 06 11 16 15 14
Other3 10 05 30 28 15 16 18
SAMPLE[1] Patient assignment for Tables 1238 and 9 only See Guide Section XIII [2] Values are shown for the average facility [3] Includes patients who recovered renal function discontinued dialysis or were lost to follow-up Also includes dialysis unrelated deaths Dialysis
unrelated deaths are not attributed to any facility for the purposes of the mortality calculations in this report
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1618
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 11 Patient and Staff Counts from the Annual Facility Survey (Form CMS-2744)1 2005-2008
This Facility Regional Averages2 2008 Measure Name 2005 2006 2007 2008 State Network US
Patients Treated During the Year 11a Patients treated during year (n) 227 200 176 197 1138 832 993
11b Incident patients ( of 11a) 242 70 51 51 201 203 197
11c Transferred into facility ( of 11a) 48 210 188 264 133 143 136
11d Transferred out of facility ( of 11a) 150 100 74 91 138 147 141
Patients Treated as of 1231 11e Patients treated as of 1231 (n) 144 133 132 140 755 542 669
11f Patient modality as of 1231 (n sums to 11e)
In-center HD 122 118 115 120 709 519 648
In-center CAPD 0 0 0 0 00 00 00
In-center CCPD 0 0 0 0 00 00 00
In-center Other 0 0 0 0 00 00 00
Home HD 0 0 0 0 11 08 08
Home CAPD 20 15 17 7 30 20 19
Home CCPD 2 0 0 13 23 19 34
Home Other 0 0 0 0 00 00 00
11g Medicare eligibility status as of 1231 ( of 11e sums to 100)
Medicare 924 947 932 936 870 874 869
Medicare application pending 76 53 68 64 103 92 89
Non-Medicare 00 00 00 00 28 34 42
Facility Staffing as of 12313
11h Total full and part time staff positions (n) 33 23 26 28 146 128 145
11i Staff positions by type (n sums to 11h)
Full time nurse4 12 7 8 7 40 36 47
Full time patient care technician 14 9 12 10 60 40 55
Full time renal dietician 1 1 1 0 04 03 05
Full time social worker 1 1 1 1 05 04 05
Part time nurse4 2 1 1 6 12 16 12
Part time patient care technician 1 2 2 2 11 12 09
Part time renal dietician 1 1 0 1 08 08 06
Part time social worker 1 1 1 1 07 07 06
SAMPLE[1] See Guide Section XIV [2] Values are shown for the average facility [3] Staffing data as of March 31 2009 A full time position is defined as a position with at least 32 hours of employment a week and a part time position is defined as a position with less than 32 hours of employment a week (includes positions that were opened but not filled on this date) [4] Nursing staff includes registered nurse licensed practical nurse vocational nurse or advanced practical nurse degree
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1718
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818
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2009 Dialysis Facility Report Mock Dialysis Facility State XX Network 99 CMS Provider SAMPLE
TABLE 12 Survey and Certification Activity1 January 2005-June 2009
Regional Averages2 This Facility Jan 2005-June 2009
Measure Name Survey State Network US 12a Date of last survey 01012005 na na na
12b Type of last survey RECERTIFICATION na na na
12c Compliance condition after last survey Acceptable plan of correction na na na
12d Number of deficiencies cited at last survey3
Condition for coverage (CfC) deficiencies 1 01 01 02
Standard deficiencies 8 21 42 47
12e CfC deficiencies cited at last survey3
V100 Compliance with Fed State and local No not cited 00 03 02
V110 Governing body and management Yes cited 42 25 75
V185 Long term program and care plan No not cited 21 08 20
V215 Patient rights and responsibilities No not cited 00 00 03
V230 Medical records No not cited 00 00 09
V255 Physical environment No not cited 14 19 47
V300 Reuse No not cited 07 03 11
V410 Affiliation agreement-arrangement No not cited 00 03 04
V420 Director of a renal dialysis facility No not cited 07 14 21
V430 Staff of a renal dialysis facility No not cited 00 00 13
V440 Minimal service requirements No not cited 00 00 09
SAMPLE[1] See Guide Section XV [2] Average values are shown for the latest survey at each facility during the period January 2005 through June 2009 Some surveys from April through June
of 2009 may not be included [3] Values are shown for this facility only if the most recent survey was in 2005 or later
TABLE 13 Facility Information1 2009
Ownership Non-profit
Organization Not applicable
Initial Medicare certification date 01012007
Number of stations 21
Services provided Hemodialysis and Peritoneal Dialysis
Provider numbers included in this report 999999
National Provider Identifier (NPI)2
[1] Information based on SIMS data as of March 31 2009 See Guide Section XVI [2] Information based on CROWNWEB data as of April 2009 If missing data was not available
Produced by The University of Michigan Kidney Epidemiology and Cost Center (September 2009) 1818