CMS Questions and Answers
September 20, 2005
Question 1
Where can a patient get assistance in obtaining dialysis services?
Answer 1
There are five corporations that have traditionally provided dialysis services to over 70 percent of the dialysis patients in the affected areas. Each organization has emergency procedures in place to assist patients with obtaining dialysis services and can often assist with locating transportation services for dialysis, obtaining dialysis supplies, and with renal medications. It is advisable that patients contact the organization where their traditional facility was affiliated because they will be able to access information from their medical record. However, if a patient is unsure of the affiliation, or was receiving services from an independent facility, they can contact any organization and will receive the same level of service. Additionally, the End Stage Renal Disease (ESRD) Networks can assist patients in locating an available facility for dialysis and necessary items such as transportation for dialysis, dialysis supplies, and renal medications.
To determine if a dialysis facility is open or closed, access the eSource Web site. On the homepage, click on “ESRD Emergency Information.”
| Organization | Phone Number |
|---|---|
| Davita - Hurricane Hotline | 1.800.400.8331 Toll free |
| FMCNA - Hurricane Hotline | 1.800.626.1297 Toll free |
| RCG - Patient Transient Assistance | 1.888.724.4242 Toll free |
| Gambro - Patient Transient Assistance | 1.877.842.6276 Toll free |
| Gambro - Patient Transient Assistance | 1.866.815.2394 Toll free |
| DCI- Patient Transient Assistance | 1.800.969.4438 Toll free or 615.327.3061 |
| Network 6 (Georgia, North Carolina, South Carolina) | 1.800.524.7139 |
| Network 7 (Florida) | 1.800.826.3773 |
| Network 8 (Alabama, Mississippi, Tennessee) | 1.877.936.9260 |
| Network 13 (Arkansas, Louisiana, Oklahoma) | 1.800.472.8664 |
| Network 14 (Texas) | 1.877.886.4435 |
Question 2
What should we be advising the public regarding water limitations for dialysis and congestive heart failure patients?
Answer 2
There are public service announcements advising individuals to drink plenty of fluids. This has become problematic for individuals that require dialysis. Many of these patients have gone without dialysis for several days and the additional fluid makes their condition critical, and at times fatal.
The information in these announcements should include cautioning individuals that are on dialysis to limit their fluid intake if previously advised by their MD. We anticipate that the cardiac community would have the same request for congestive heart failure patients. Possible language: Drink plenty of fluids… UNLESS you are a dialysis or cardiac patient who has been advised by your MD to limit fluid intake.
Question 3
Are dialysis services available in the affected areas?
Answer 3
Yes, CMS, the ESRD Networks, the large dialysis organizations, patient representative groups, renal industry groups, and other partners in the renal community are working with state and federal officials to assure that individuals in need of dialysis get the services that they need, in the most effective manner. By working in partnership, dialysis services, renal related supplies, renal medications, transportation to dialysis services, emergency financial assistance for the dialysis patients, and other supporting services are available. The challenge is locating the individuals in need of dialysis and connecting them to the services that are available.
Question 4
Is there a strategy for providing dialysis to individuals in the hurricane-affected areas?
Answer 4
CMS, ESRD Networks, State Officials, FEMA, Public Works, Red Cross, and other Federal and state emergency response agencies have been meeting with beneficiary representative groups, renal industry organizations, local large dialysis organizations (Davita, FMCNA, RCG, Gambro, and DCI), independent dialysis facilities, and hospitals to discuss the most effective plan, under existing circumstances, for meeting the immediate needs of the patients in need of dialysis. While there are detailed procedures that have been implemented, in general, a transitional approach is being followed that focuses on getting the individual to a safe environment, as quickly as possible, with the delivery of quality dialysis services along the way.
Question 5
Are there any procedures that a facility providing dialysis services should follow to assist in the evacuation of dialysis patients?
Answer 5
There are areas where facilities, especially in the affected areas, can assist in the emergency and evacuation efforts. While the goal is to provide quality care (which is often best achieved when a patient obtains services consistently from the same provider/facility) under the changing situations, this is often not possible or desirable because of elements outside of the dialysis facility's control (e.g., availability of food, shelter, water, security, etc.). Therefore, it is imperative that health care providers take whatever steps possible to ensure quality care is still delivered during the period when a patient is transient.
- In all cases when a patient is being seen as a result of the disaster, the patient should be supplied with facility contact information, including corporate affiliation where appropriate. Emergency workers use this information (where feasible) to ensure that patients receive services from the same facility until they leave the area for a better environment. Additionally, the new treating facility will be able to use this information to obtain any necessary patient and clinical information.
- Additionally, at the end of each treatment, the patient should be supplied with a hard copy document that includes the clinical information a provider would need at the next session (e.g., daily run sheet).
- Also, even if actual medications are provided to a patient on-site, the patient should be provided with a written prescription to ensure that they can obtain additional medication if they are transported from the area.
Question 6
I am a health professional seeing dialysis patients that have evacuated due to hurricanes Katrina and/or Rita. Where can I obtain information about their previous medical care?
Answer 6
There are five corporations that have traditionally provided dialysis services to over 70 percent of the dialysis patients in the affected areas. If the individual is aware of the corporate affiliation of the facility where they previously received services, you should call their toll free hurricane emergency number (numbers provided in Q.1.). They will be able to provide you with the pertinent medical information that you need to provide care. Where it will expedite the delivery of quality care, corporations, on behalf of facilities, are permitted to directly share information with other dialysis facilities and/or corporate offices where treating facility is affiliated. If the patient is unsure of the corporate affiliation, any of the 18 ESRD Networks that are spread throughout the Country will be able to provide you with information on their previous dialysis facility status and location and corporate affiliation where you can obtain clinical information from their electronic medical record.
You can obtain a complete listing of contact information for the ESRD Networks at http://www.esrdnetworks.org.
Question 7
Is there anyone I should notify if I am providing dialysis services to an individual that has evacuated due to a hurricane?
Answer 7
The 18 ESRD Networks that span the Country are tracking where patients are receiving services. This information is being used to help facilitate exchange of critical patient and treatment information, to identify where additional dialysis access is needed, and to devise a plan for re-entry in to the affected areas. Therefore, it is critical that you provide the information necessary when seeing patients that have been displaced. If the patient is being seen at a facility affiliated with a large dialysis corporation, please follow that organization's plan for notification. The large dialysis organizations will be providing this information to the ESRD Networks in a centralized manner. If the patient is being seen at an independent facility, please notify the ESRD Network in the respective area. When you contact the ESRD Network, you will be asked to provide only the information that is needed to help treat and track the patient. The ESRD Networks will be sharing this information with other Federal agencies in order to assist in the location of individuals.