JENNA KRISHEREXECUTIVE DIRECTOR

SOUTHEASTERN KIDNEY COUNCIL

Patient Centered Care in the ESRD Network System

Who’s Who in the Network System

Congress

ESRD Networks

CONTRACT

CMS

SOW

HHS/CMS

Network 6

Patients

Congress

1972: Extended Medicare coverage to Persons with ESRD

1977: Amended Social Security Act (The Act) to establish ESRD Network Program

1986: Amended the Act to expand Network responsibilities, add language to fund Networks at 50 cents per dialysis treatment

Congress’ List of Network Responsibilities

Encourage use of treatment settings most compatible with rehabilitation of the patient and the participation of patients, providers of services, in vocational rehabilitation programs

Develop criteria and standards relating to the quality and appropriateness of patient care and with respect to working with encouraging participation in vocational rehabilitation programs;

Develop Network goals with respect to the placement of patients in home therapies, and in-center self-care settings and undergoing or preparing for transplantation

Evaluate the procedure by which facilities assess the appropriateness of patients for proposed treatment modalities

Implement a procedure for evaluating and resolving patient grievances

Conduct on-site reviews of facilities as necessary, utilizing standards of care established by the Network to assure proper medical care

Congress’ List of Network Responsibilities

Collect, validate, and analyze such data as are necessary to assure the maintenance of the registry

Identify facilities and providers not cooperating toward meeting Network goals and assist such facilities and providers in developing appropriate plans for correction and reporting to the Secretary on facilities that are not providing appropriate medical care

Submit an annual report to the Secretary on July 1 of each year which shall include a full statement of the Network’s goals, data on the Network’s performance in meeting its goals including data on the comparative performance of facilities and providers, identification of those facilities that have consistently failed to cooperate with Network goals, and recommendations with respect to the need for additional or alternative services or facilities in the Network area in order to meet the Network goals, including self-dialysis training, transplantation, and organ procurement facilities.

§ 405.2112 ESRD network organizations.

(a) Developing network goals for placing patients in settings for selfcare and transplantation.

(b) Encouraging the use of medically appropriate treatment settings most compatible with patient rehabilitation and the participation of patients, providers of services, and renal disease facilities in vocational rehabilitation programs

(c) Developing criteria and standards relating to the quality and appropriateness of patient are and, with respect to working with patients, facilities, and providers of services, for encouraging participation in vocational rehabilitation programs.

(d) Evaluating the procedures used by facilities in the network in assessing patients for placement in appropriatetreatment modalities.

(e) Making recommendations to member facilities as needed to achieve network goals.

(f) On or before July 1 of each year, submitting to CMS an annual report that contains the following information:

ESRD Network Contract

Improve the quality and safety of dialysis-related services provided for individuals with ESRD.

 Improve the independence, quality of life, and rehabilitation (to the extent possible) of individuals with ESRD through support for transplantation, use of self-care, and in-center self-care, as medically appropriate, through the end of life.

 Improve patient perception of care and experience of care, and resolve patients’ complaints and grievances.

 Improve collaboration with providers and facilities to ensure achievement of goals 1 through 3 through the most efficient and effective means possible, with recognition of the differences among providers and the associated possibilities/capabilities.

 Improve the collection, reliability, timeliness, and use of data to measure processes of care and outcomes; to maintain a patient registry; and to support the goals of the ESRD Network Program.

CONTRACT

SOW

Don Berwick Triple Aims

Better care for individuals Safe Effective Patient-centered Timely Efficient Equitable

Better health for populations, by attacking upstream causes such as poor nutrition physical inactivity substance abuse.

Reducing per-capita costs by improving Quality

CONTRACT

SOW

18 ESRD Networks

Each entity contracts with CMS All have the same Statement of Work and

GoalsCurrent contract through June 2012Most are small, non-profit companiesOur area is ESRD Network area #6

Non-profit organization, based in Raleigh, NCHold the contract with CMS for ESRD

Network 6Volunteer, multi-disciplinary Board of

Directors Consumer Committee Medical Review Board Finance Committee Nominating Committee

14 paid staff members

The Patients We Serve

3 States38,500 people on dialysis11,000 people with a transplant10% of the US ESRD Population68% African American/30% WhiteAverage age: 59 years72% dialyzing in-center8% at home20% with a transplant

The Patients we Serve

590 FacilitiesFMC: 34%DaVita: 33%All others: 33%10% of all facilities nationally

Network Contract by the Numbers

5 Tasks Task 1: Quality Improvement Task 2: Outreach and Patient Services Task 3: Administration Task 4: Information Management Task 5: CROWN Web

Funding CMS collects 50 Cents per treatment SKC receives 26 Cents per treatment

14 SKC Staff members

CONTRACT

SOW

TO IMPROVE THE LIVES OF PEOPLE WITH OR AT RISK FOR END STAGE RENAL DISEASE BY PROMOTING AND

ADVANCING QUALITY OF CARE.

Quality of Care Commitment

Each Facility agrees to…Cooperate with the Network, participate in Network

activities and pursue Network goals to fulfill the terms of the current Network Statement of Work.

Identify a Governing body that receives and acts upon Network recommendations.

Provide the highest quality of care to every patient we treat by striving to meet Network Quality Goals using a data-driven quality assessment and performance improvement plan.

Provide timely and accurate data and information to support the national ESRD registry, to facilitate measurement and improvement of care and to resolve patient complaints.

Quality of Care Commitment

Cooperate with the Network Medical Review Board (MRB) on all QI activities including QI Projects and Focused Review, including submission of information and responding to MRB recommendations.

Cooperate with the Network in prevention and resolution of patient concerns, complaints and grievances. This includes educating patients on the Network’s role in complaint and grievance resolution, posting the Network address and phone number and notifying the Network at least 30 days prior to involuntarily discharging a patient.

Share educational information with patients as requested by the Network and helps educate patients on the role and services of the Network.

Follow all CMS/HIPAA rules for secure transmission of data.

Quality of Care Commitment

Southeastern Kidney Council agrees to… Provide educational resources and technical assistance to

facilities and to patients to help improve the quality of care.

Provide comparative feedback reports that facilities can incorporate into local QI projects.

Provide education, tools and technical assistance to assist facilities and patients to: Prevent and resolve conflict between patients and providers Improve the quality of care Ensure data submission is accurate and timely

Oversee all Network activities through the multidisciplinary Board of Directors and its committees to ensure projects are effective, reasonable and appropriate for patients and providers in the Network 6 area and that activities are conducted in an environment free from conflict of interest.

Task 1: Quality Improvement

Increase fistula useDecrease catheter useImprove anemia managementImprove adequacyIncrease immunizationsReduce health care infections

Task 1 by the Numbers

52.8% of Patients Dialyzing via AV Fistula7.2% of Patients Dialyzing via Catheter > 90

Days28% of Patients Dialyzing via AV Graft

Vascular Access in Network 6 Area

Catheter Use By Network Dec 2010

AVF Use by Network Dec 2010

Facility AVF Rates Dec 2010

66%

51-65%

25546%

41-50%

16430%

<40%

6211%

7113%

Opportunity to Improve - QAPI

Improving AVF Rates for Better Care

All Facilities Resources Technical Assistance Workshops/Education Data Feedback

Improving AVF Rates for Better Care

66%: Great job!51-65%: Include in your QAPI; call us for

help<50%: Complete box and return

We reviewed this report at our QI meeting on __/__/__Signed: Medical Director _________________ Nurse Manager ___________________

We (Check one) ___ Confirmed data is correct ___ Corrected the data in the corporate systems and with the Network

We (check one) ___ Have an AVF QAPI ___ Do not have an AVF QAPIWe plan to increase the # of AVFs each month as follows: _____in 30 days ___ in 60 days ___

in 90 days

• <40%: Focused Review

Focused Review to Improve Care

Letter to Medical Director and Clinical Manager with Agreement of Expectations Data-driven QAPI Send us your progress data SKC will help with tools and feedback

Training manual Educational materials Sample templates

MRB reviews data and provides feedbackPossible site visitsWhen facility hits goal, released and asked to

share best practices

Focused Review to Improve Care

Focused Review to Improve Care

Using March 2010 vascular access data, ranked all providers by catheter use (all catheters)

Selected the 15 facilities with at least 40 patients that had the highest catheter rates

Selected the 5 facilities with < 40 patients with the highest catheter rates

8 Facilities continued from last year

Focused Review to Improve Care

Increasing Immunizations for Better Care

9% 100%

53% >90%

Increasing Immunizations for Better Care

Increasing Immunizations for Better Care

Decreasing Anemia for Better Care

Increasing Adequacy for Better Care

Quality Improvement on the Horizon

Healthcare Acquired InfectionsTransplant

Formed a coalition to study and remove barriers to transplant

Increased patient / provider education Collaboration of transplant centers Increase donors May include transplant measures in future screening

Quality Improvement on the Horizon

377 (82%) Facilities had fewer Transplants than Expected

81 (18%) had more than Expected

Better Care

1,256 more AV Fistulas in use571 fewer catheters in use322 fewer long-term catheters in use1,125 more patients receiving adequate

dialysis2,680 more patients with anemia managed

Educating Patients for Better Care

New Patients receive NEPOP Introduce CMS, Network, State Surveyors Educational materials

All Patients receive newslettersAll Patients receive annual Calendar

Developed by Consumer Committee Each month, facility receives supporting packet

Educating Patients for Better Care

39,665 Calendars mailed in December 2009Survey/analysis conducted in June 201029% of respondents knew ”Network 6”82% knew “Southeastern Kidney Council”When asked for future education topics

Nutrition – 31% Treatment Options – 26% Emergency Preparedness – 12%

When asked how Video – 34% Facility distribution – 27% Mail materials to home – 25% Workshop/meeting – 13%

Educating Providers for Better Care

Network Annual ReportRegional and National patterns of careInformation on Network QI projectsInformation on the importance of

immunizationCQI MaterialsDialysis Facility ReportVISION, CROWN information

Assisting Patients/Providers for Better Care

Identify providers for transient dialysisAssist users with Dialysis Facility CompareAssist with procedures to assess patients for

treatment modalitiesAssist providers in developing rehabilitation

goalsQI Plans / QAPIsAssist in disaster planning and recoveryAssist with community education programsHelp patients and providers resolve issues

Resolving Issues For Better Care

287 complaints in 20109% of all the complaints in the US5.06 complaints per 1000 patientsOther calls

101 Beneficiary inquiries 191 Facility concerns 451 Facility inquiries 1,720 Calls regarding

Resolving Issues For Better Care

Resolving Issues For Better Care

37 Involuntary Discharges in 201032 Averted

Resolving Issues For Better Care

What to do if SKC calls you with a complaint Think positive: you’ve done a good job educating

patients to call us Keep an open mind Send us documentation that helps us understand the

situation Know the conditions for coverage If IVD – 30 day notice and complete IVD packet Keep the patient central to your actions

Maintaining the Registry for Better Care

11,000 CMS 2728 Forms entered in 2010 1,760 had to be returned for correction 88% on time, accurate

7,700 CMS 2746 Forms entered in 2010 230 had to be returned for correction 94% on time, accurate

6,732 NPAR forms with 47,124 events enteredClinical Data

Fistula First – monthly Elab – annual Immunization – annual

Maintaining the Registry for Better Care

Medicare uses data to determine eligibilityClinical indicators profiled to identify trends

in care to be addressedRegistry allows us to know where patients

are dialyzing and help with placement in emergencies

Data analyzed and reported in journals to improve the science of care

Descriptive / demographics help us understand the population served

Questions?