Entering A New Era Together
NEW Expectations, Activities and
OPPORTUNITIES
March 7, 2013
Today's presenters
Glenda Harbert, RN, CNN, CPHQ
Executive Director
Anna Ramirez, MPH, CPH
Community Outreach Coordinator
Kelly Shipley, RHIA
Quality Improvement Director
Treneva Butler, LCSW
Patient Services Director
Nathan Muzos, BS
Information Management Director
Today’s Objectives for Participants
• Identify CMS’ vision for ESRD oversight
• Describe the projects in the Network contract
• Explain the role of the dialysis and transplant
facility in the new projects
• Offer input and feedback on the Network
projects (via feedback at the end)
US Department of Health and Human
Services (HHS)
• Created National Quality Strategy (NQS) to
promote quality health care focused on the
needs of patients, families and communities
• Identified 3 Aims for Healthcare
– Better Care
– Healthy People and Communities
– Affordable Care
US Department of Health and Human
Services (HHS)
The Affordable Care Act sets
America on a path toward a
higher quality health care
system so we stop doing things
that don’t work for patients
and start doing more of the
things that do work.
HHS Secretary
Kathleen Sebelius
Centers for Medicare & Medicaid
Services (CMS)
• CMS, 1 of 11 HHS Divisions, administers the
ESRD Medicare Program
• CMS’ Aims for the ESRD Program
1. Better Care for the Individual through
Beneficiary and Family Centered Care
2. Better Health for the ESRD Population
3. Reduce ESRD Costs Improving Care
USRDS 2012
Annual
Report
Centers for Medicare & Medicaid
Services (CMS)
• CMS uses two external groups to provide ESRD
oversight
– State Survey Agencies
– ESRD
Networks
(i) Standard:
Relationship with the ESRD network.
governingwith
body 18
receives
andNetworks
acts upon to
• CMS The
contracts
ESRD
recommendations
the ESRD network. The
oversee
ESRD care from
nationally
dialysis facility must cooperate with the ESRD
• Network
Contract/Statement
of Work
network
designated for its geographic
area, in
fulfillingprojects
the termsrequired
of the Network’s
current
describes
to accomplish
the
statement
of work.
Each facility
must
participate in
3 aims
and the
national
quality
goals
ESRD network activities and pursue network goals.
§494.180
Centers for Medicare & Medicaid
Services (CMS)
The Networks are uniquely
positioned to ensure full
participation of the ESRD
community in achieving the AIMS
of the NQS. The Networks shall
assist providers in adjusting to the
heightened focus on patient and
family centered care, aiming to help
them optimize customer service.
CMS Chief Operating Officer
and Acting Administrator
Marilyn Tavenner
ESRD Network of Texas, Inc.
• Nonprofit organization, volunteer Boards
• ESRD NW of TX, Inc. holds the contract with
CMS for ESRD Network #14, the state of Texas
• Office in Dallas
• The largest Network in the US based on
numbers of dialysis and transplant patients
• 3rd largest in number of providers
• 13 Staff members
2012 Network Coordinating Council Input Scan
Evaluation of achieving
Our Mission
To support quality dialysis and
kidney transplant healthcare through
the provision of patient services,
education, quality improvement, and
information management.
ESRD Network 14 – New
Communications Policy
• Most Network 14 to Dialysis Facility
correspondence will be sent via email
to all registered QIMS users of the
facility
• Essential to keep email address
updated in QIMS
• Disable accounts for personnel when
they leave your facility
2013 Network #14
Growth & Trends
• CMS Certified Facilities
• Facility Ownership
• Growth in Patient Census
• Patients Transplanted
NETWORK GROWTH
Number of Medicare Certified Providers
44 facilities awaiting
Medicare Certification
at end of Feb. 2013
National Chain Ownership TX Dialysis facilities
Feb. 2013
Number of Patients 12/31/12
40, 082
9,103
6,234
ESRD Network 14
• Currently providing care and oversight for
>50,000 people receiving Renal Replacement
Therapies
– 40,082 people on dialysis
– 54.1% Male
– 28.9% African American
– 43.2% Hispanic
– 70.1% between 50 and 79 years old
Themes of the New ESRD Plan/SOW
• Patient and Family Engagement
• Reducing Disparities in Healthcare
• Connecting communities, sharing best
practices
• Performance-Based Measures
AIM 1: Better Care for the Individual through
Beneficiary and Family Centered Care
AIM 1: Better Care for the Individual through
Beneficiary and Family Centered Care
Domain
Vascular Access
Management
Patient Safety:
Healthcare-Acquired
Infections (HAIs)
Sub-Domain
Reduce Catheter Rates for
Prevalent Patients
Support Facility Vascular Access
Reporting
Spread Best Practices
Provide Technical Support in the
Area of Vascular Access
Recommend Sanctions
Support National Healthcare
Safety Network (NHSN)
Establish HAI LAN
Reduce Rates of Dialysis Facility
Events
AIM 2: Better Health for the
ESRD Population
Domain
Sub-Domain
Reduce Identified Disparity
Population
Health
Innovation
Pilot Project
Increase Hepatitis B (HBV), staff & Patient
Influenza, and Pneumococcal Vaccination
Rates
AIM 3: Reduce Costs of ESRD Care by
Improving Care
Domain
Support for ESRD Quality
Incentive Program (QIP) &
Performance Improvement on
QIP Measures,
Support for Facility Data
Submission to CW, NHSN,
and/or Other CMS- Designated
Data Collection System(s)
Sub-Domain
Assist Facilities in
Understanding and Complying
with QIP Processes and
Requirements
Assist Beneficiaries and
Caregivers in Understanding the
QIP
Assist Facilities in Improving
their Performance on QIP
Measures
CMS directed organizational changes
• Network Council
– Currently 1 representative from all Medicare Certified
Facilities
– Divide stat into 5 RAC regions with one representative
from each
• Board of Directors
– Non renal healthcare members
– Non Healthcare members
– 2 patients
• Bylaws revision in progress with Electronic bylaws
change and election of new Network Council in next 2
months
AIM 1: Better Care for the Individual
through Beneficiary and Family
Centered Care
Two Tier Approach to Patient and Family Engagement
Tier 1: Engagement at the dialysis facility level to foster
patient and family involvement
Tier 2: Development and implementation of a beneficiary
and family centered care focused Learning and Action
Network to promote patient and family involvement at the
Network level.
Patient and Family Involvement at the
Facility Level
•Webinar on Patient Centered Care (PCC) and Patient Engagement (PE)
March 22, 2013 from 12:00 – 1:15pm.
•Free CEUs for nurses, dietitians, social workers & technicians
•Registration information available:
http://www.esrdnetwork.org/network/calendar.asp
•PCC and PE Mail Out
•Facility onsite visits, the Network will assess whether
•The QAPI program includes patient and family participation
•Patient and family meetings exist (patient council, support groups,
vocational rehabilitation groups, new patient adjustment groups)
•Patients and families are involved in the governing body of the
facility
•Patient’s involvement in plan of care meetings
Patient and Family Engagement – Aim
LAN
1
• Uses change methodologies, tools, and/or
time-bounded initiatives.
• “In CMS’ view, most •Network
activities
will be
Engages leaders
around an action-based
Patient SMEs by the Patient’s
agenda. voice”
enhanced
• Creates opportunities for in-depth learning
and problem
solving.
anda Patient Learning
•• Committed
Establish
and
Action
• Creates an opportunity for communities,
informed patients
Network
(LAN)
with assistance and guidance from the
• Representative of the
demographic
– Patient Subject Matterskills,
Experts
and abilities of community partners
characteristics of the
to reach a critical mass of the appropriate
–
Family
members
Network area
stakeholders in the community concerned
ESRD Network, to harness the knowledge,
– Dialysis Facilities
– State Surveyors
– Other stakeholders
with a common aim(s).
Aim 1-Patient and Family Engagement
• PE LAN will design and implement a Quality
Improvement Activity (QIA)
– Topic chosen by SMEs: Patient Centered Care with
a focus on improving patient-provider
communication
– Will use a subset of ICH-CAHPS questions to
measure improvement
– Facilities will be selected to participate in QIA
working with ~4,000 patients and show a 5%
relative improvement
Aim 1-Patient and Family Engagement
• PE LAN design 2 Campaigns
– Topics:
• New Patient Orientation
• Disease Management
– Must impact 20% of Network population (~8,000
patients)
– Must show a 10% improvement in selected
measure
– Begin 2nd Quarter
Aim 1-Patient and Family Engagement
For more information on the PE LAN please contact
Anna Ramirez
aramirez@nw14.esrd.net
469-916-3800
Facilities are still needed to participate!
Application available online:
http://www.esrdnetwork.org/professionals/index.asp
Patient Experience of Care – Aim 1
• Formerly “Complaints and Grievances”
• Satisfaction survey
– All grievants invited to participate
– Network must maintain 80% satisfaction rate
• Facilities must inform patients about the
Network role in grievances
• Network collaborates with State Surveyors on
grievances
Aim 1-Patient Experience of Care
• Grievance Quality Improvement Activity (QIA)
– Use grievance data to identify common trend
– Select at least 5 facilities for intervention
– Selected facilities must show at least 1%
improvement in the measure
– Project may be expanded to 100 facilities at CMS’
request
Patient Experience of Care – Aim 1
• Facilities are expected to
– Utilize ICH-CAHPS – 2013 QIP Measure
ICH-CAHPS
– Address
issues
identified in ICH-CAHPS
In-Center
Hemodialysis
Consumer Assessment of
– Specifically
be aware
Healthcare Providers
and of disparities in care
Systems
• Network will
– Promote use of ICH-CAHPS
– Assist facilities with trend analysis of ICH-CAHPS
– 2014: Conduct a QIA using ICH-CAHPS
Patient-Appropriate Access to InCenter Dialysis – Aim 1
• Reduce IVD/IVT by 5% each quarter
IVD/IVT
• Avert 5% of potential IVD/IVT
Facility-generated discharge
or transfer resulting in
• Network to analyze datatermination
to evaluate
of services for
patient. Does not include
discharges for disparities
in race,
ethnicity,
transfers
due to emergency
or other closure.
new ESRD versus established
patient
• Network to report all actual and potential
IVD/IVT, failures to place and at risk
Vascular Access Management – Aim 1
• Catheter Reduction
– Move from a Fistula First to a Catheter Last
approach
– Quality Improvement Activity to decrease longterm catheter utilization begins this quarter
• Every facility that shows a long-term catheter rate
greater than 10% in CROWNWeb is selected
• Selected facilities must improve monthly and meet an
overall 2% reduction
Vascular Access Management – Aim 1
• Update CROWNWeb monthly with each ICH
patient’s vascular access type
• AV Fistulas
– New CMS goal: 68%
– New MRB goal: 57%
– Quality Improvement Activity to increase Network
AVF rate begins this quarter
• In conjunction with Catheter focus facilities
• Two tiered approach
119 facilities with >10% patients with catheter >=90 days
Distribution of Catheter >=90 days October 2012,
facilities >=50 patients (n=292 facilities)*
Number of Facilities
30
N=83 facilities with
>10% pts with
Catheter >=90 days
25
20
14
10 11
15
10
1 facility
50% of pts
656
5
2
4433
1122
21
11
11
1
>39-40
>37-38
>35-36
>33-34
>31-32
>29-30
>27-28
>25-26
>23-24
>21-22
>19-20
>17-18
>15-16
>13-14
>11-12
>9-10
>7-8
>5-6
>3-4
>1-2
0
0
Percent of Patients with Catheter >=90 days
45
40
35
30
25
20
15
10
5
0
N=36 facilities with
>10% pts with
Catheter >=90 days
1 facility
75% of pts
0
>1-2
>3-4
>5-6
>7-8
>9-10
>11-12
>13-14
>15-16
>17-18
>19-20
>21-22
>23-24
>25-26
>27-28
>29-30
>31-32
>33-34
>35-36
>37-38
>39-40
>41-42
>43-44
>45-46
>47-48
*CROWNWeb data, facilities with <11 patients
excluded (n=13 facilities), pediatric excluded
Number of Facilities
Distribution of Catheter>=90 days October 2012,
facilities with <50 patients (n=153 facilities)*
Percent of Patients with Catheter >=90 days
MRB 2/7/13
Patient Safety – Aim 1
• All facilities participating in NHSN
– Enroll
National Healthcare Safety Network
– Join Network 14 NHSN Group
– Enter monthly data
• Establish HAI LAN
– Open to all facilities in the Network
– Community Stakeholders
Patient Safety – Aim 1
• HAI Quality Improvement Activity to Reduce
Central-line-associated bloodstream infections
(CLABSI)
– Select 100 facilities working with ~2,000 patients
– Selected facilities must show 5% reduction in
CLABSI
– Begins 2nd Quarter
CMS ESRD Network Contract – Aim 2
Innovation Pilot Project - Reduce
Disparities in
Immunization
Reducing Hospitalization
Home Dialysis Placement
Quality of Life
Innovation Pilot Project – Aim 2
• Select topic with 85% of target population not
meeting the desired outcome
• Select population group (CMS-defined) with
the greatest disparity in outcomes
– African American/White
– Hispanic/Non-Hispanic
– Urban/rural
– Male/Female
– 65 years old/younger than 65
Innovation Pilot Project – Aim 2
• Select 50 facilities working with ~4,200
patients
• Selected facilities must increase immunization
in disparate group by 5 percentage points
• If non-disparate group improves more than
disparity group, widening the gap, project fails
CMS ESRD Network Contract – Aim 3
Aim 3
Reduce Costs of ESRD Care by Improving Care
Quality Incentive Program (QIP)
CROWNWeb
Quality Incentive Program – Aim 3
• Facility Responsibility
– Submit accurate quality data
– Complete QIP requirements timely
– Review Performance Score Report within 5 days
– Post Performance Score Certificate within 5 days
– Address QIP performance issues to deliver high
quality of care
Quality Incentive Program – Aim 3
• Network responsibility
– Assist patients in understanding QIP
– Help facilities improve QIP outcomes
– Remind facilities of due dates
– Provide feedback to CMS on any adverse impact
to patients and intervene to correct
– Discuss QIP measures and results with State
Surveyors
CROWNWeb – Aim 3
• Enter data into CROWNWeb accurately and
timely
• If you are a “batch” facility, make sure loaded
data is correct
• Make sure your QIMS enrollments are up to
date
CROWNWeb – Aim 3
• For technical issues, contact QualityNet Help
Desk at qnetsupport-esrd@sdps.org
• Contact Network 14 at
crownweb@nw14.esrd.net
• Visit http://projectcrownweb.org for the latest
CROWNWeb news and training modules
Summary
• Patient/Family Engagement in all
• Patient-Centered Care and Policies
• Reduction / elimination of Disparities in
Healthcare
• Performance-based measures
Summary
• 5 Quality Improvement Activities
– Patient/Family engagement
– Grievances
– Decreasing Catheter Use
– Healthcare Acquired/Associated Infections
– Reducing disparity in Immunizations
Summary
•
•
•
•
•
2 Educational Campaigns
Grievance resolution
Reducing IVD/IVT
CROWNWeb, NHSN, Dialysis Facility Reports
QIP Tracking and Education
Questions?
Send us an email
Subject line: Ask the Network
info@nw14.esrd.net
We will post a Q&A
response on our Website
within 2 weeks
www.esrdnetwork.org