The Lone Star Bulletin - January 2008
From the desk of the Executive Director:
Happy New Year to all! This newsletter, our second electronic version, should reach you as 2008 begins. The electronic method will allow 4 newsletters rather than 2 per year. Please provide feedback using the embedded link to an evaluation on Survey Monkey to enable improvements and to let us know if the electronic version works as well for you as the printed version.
Publication of the revised CMS ESRD Conditions for Coverage (CFC) is expected in late January or early February 2008. The long awaited regulations will mark a major shift in the regulatory requirements for dialysis facilities. Although the actual final regulations are in the government approval process and therefore confidential, the regulations as published in the Notice of Proposed Rulemaking contained sweeping new requirements for Comprehensive Assessments and Care Planning, Quality Assessment and Performance Improvement and Medical Director responsibilities. CMS plans to make two presentations on the CFC in April at the NFK Clinical Meeting in Dallas and the ANNA national meeting in Philadelphia. Unfortunately, the Network 14 Annual Meeting scheduled for April 1, immediately preceding the NKF meeting has been cancelled. We hope to have a meeting in May or June this year.
Word from DSHS is that the Texas ESRD Licensure Rules revision process will begin again in early 08 with a Stakeholder Meeting in Austin. The Network will keep you posted when we receive more information on this important process.
Texas and Network 14 continues to lead the nation in quality of care in many areas as evidenced by the preliminary CPM data that was recently released.
It's almost time…
Be sure to keep your 12/31/2007 shift list and patient census handy because the ESRD Network will be mailing the annual 2744 forms to facilities the fourth week in January. Having this information readily available will enable your unit to submit the 2744 accurately and efficiently.
Did You Know?
According to the US Department of Health & Human Services: Health Resources and Services Administration (HRSA) nearly 90 million American adults cannot read above a fifth grade level. Unified Health Communication 101: Addressing Health Literacy, Cultural Competency, and Limited English Proficiency is a free on-line learning experience that will help you:
- Improve your patient communication skills
- Increase your awareness and knowledge of the three main factors that affect your communication with patients: health literacy, cultural competency and low English proficiency
- Implement patient-centered communication practices that demonstrate cultural competency and appropriately address patients with limited health literacy and low English proficiency.
This self-paced course is available for credit (CEU/CE, CHES, CME, CNE). There are five modules and takes approximately 5 hours to complete the entire course. For more information, including registration instructions, log onto the website at: http://www.hrsa.gov/healthliteracy/training.htm
New Texas ESRD Facilities
The End Stage Renal Disease Network of Texas is pleased to welcome the following new Medicare-approved dialysis facilities. You may access a complete listing with addresses, telephone and fax numbers, and provider numbers from our website at www.esrdnetwork.org.Under Provider Directory tab choose “Dialysis Facilities”, Transplant Centers, or All Facilities.
67-2573
FMC Horizon Dialysis
El Paso, TX
915-872-0270
For more information on opening a facility, please visit our website at www.esrdnetwork.org. Go to Provider Directory > Information for Providers > Opening a new dialysis unit. Make sure to allow 6 to 8 weeks for processing.
Tools and Resources for Assessing Health Related Quality of Life of ESRD Patients
Use of quality of life assessment tools can be an important step in improving patient health, decreasing hospitalization, increasing adherence, improving rehabilitation potential, and decreasing mortality rates. Many corporate dialysis organizations have a tool they recommend and make available to staff for implementing and scoring. The following are some additional resources and tools that can aide renal social workers in assessing the Quality of Life of patients.
Four Quality of Life Instruments: Domains Measured/Summary Data
Dartmouth Coop Functional Health Assessment Charts |
Duke Health Profile (DUKE) |
SF-36, SF-12, SF-8 |
Kidney Disease Quality of Life |
|
|---|---|---|---|---|
WHAT IS MEASURED |
GenericPhysical |
FunctionPhysical health DysfunctionAnxiety |
Generic(SF-36)Physical functioning |
Generic(SF-36 domains) ESRD/dialysisSymptoms/problems |
OBTAINABLE FROM |
Dartmouth Medical School (not available on website) |
Duke University Medical Center |
The Medical Outcomes Trust |
RAND Corporation |
COST |
Chart package (charts, manual, articles) available for $30 – one time admin fee |
Free for non-commercial purposes. |
Registration and licensing fees. |
Single copy free. Users permitted to make unlimited copies. |
# OF ITEMS |
7 |
17 |
SF-36= 36 |
KDQOL=134 |
MEANS OF ADMINISTRATION |
Self-reported data by patient or clinician (MD, RN, medical assistant) |
Self-reported data by patient or trained interviewer |
Self-reported data by patient or trained interviewer |
Self-reported data by patient or trained interviewer |
USER’S GUIDE?/SUPPORT MATERIALS? |
Yes/Translated into 20 languages |
Yes |
Yes/SF-36 translated into many languages |
Yes/KDQOL-SF translated into 5 languages |
ESTIMATED TIME FOR PATIENT TO COMPLETE SURVEY |
5 minutes |
5 minutes |
12-15 minutes (SF-36) |
KDQOL= 30 minutes |
For further information about these and other Quality of Life tools or for assistance in developing a program in your facility, contact John Q. Gowan, LMSW at jgowan@nw14.esrd.net.
FYI… Lookingfor Ways to Increase Evaluation for Potential Living Kidney Donation?
“Advances in immunosuppressive therapy and refinement in surgical techniques have allowed living donor transplantation to evolve from the first successful identical twin donor transplantation in 1954 to the current practice involving virtually all biologically related and unrelated medically and psychosocially suitable donors. During the past decade (1996 to 2006), the Organ Procurement and Transplantation Network/United Network of Organ Sharing (UNOS) database showed that although the number of deceased donors increased from 5,036 to 7,181, the number of living donors almost doubled from 3,681 to 6,434. The increased rates of living donation are believed to be caused in part by the superior patient and graft survival rates achieved with living compared with deceased donor transplantation, the advent of laparoscopic donor nephrectomy, and improved patient and public awareness. With the ever-increasing disparity between donor organ supply and demand, the invaluable contributions from living donors are much needed.
Because living kidney donation for transplantation has become common practice, we must aim to protect both the potential donor and recipient from preventable or foreseeable physical and psychosocial complications. The following article provides general guidelines for evaluating a potential living donor candidate. Topics that must be discussed with the potential donor, including ethical, psychosocial, and financial issues, are outlined. A medical evaluation focusing on minimizing immediate cardiovascular and pulmonary risks and long-term medical risks to the donors, as well as transmittable malignancy and infection risks to the recipients, also is presented.”
This comprehensive article can be found in the American Journal of Kidney Disease 2007; 50:1043-1051. You can also view a free version of the article at http://www.ajkd.org/article/PIIS0272638607012486/fulltext
Network 14 wants to hear from you…
We want and need your feedback. Network 14 prides itself on providing services and resources to the ESRD community that is accurate, useful and beneficial to the ongoing work that is done in Texas. In order to continue providing this valuable service to you, the professionals and staff, we need to know how to get you that information. We have launched our “New and Improved” website so you can locate information faster and our professional newsletter is now electronic so we can provide more resources, information and updates to you each year. Please take a few minutes to fill out an evaluation on “How We Are Doing? “. It’s anonymous and can be done online. Just click on the link below to begin.
Thank you for all you do to provide quality of care to ESRD patients in Texas!
Medicare Part D: What to look for in 2008
By William Rogers, MD, FACEP, Director of the Centers for Medicare & Medicaid Services (CMS) Physician’s Regulatory Issues Team
2008 will mark the third year that prescription drug coverage is available through the Medicare program. While the Part D program has been challenging for some providers, it’s been a success for both beneficiaries and taxpayers. In 2007, more than 90 percent of people with Medicare signed up for Part D or had creditable coverage, and a recent survey found that 85 percent of beneficiaries were happy with the program. The program is good news for taxpayers as well: the 10-year cost of Part D has turned out to be $200 billion less than original estimates, due primarily to competition among Medicare drug plans and the increased use of generics. The average national monthly premium in 2008 is expected to be $25 (40 percent lower than the initial estimate), and people with Medicare prescription drug coverage are saving an average of $1,200 per year.
One reason that Part D costs are lower is that Medicare drug plans are competing for beneficiaries in a very price-sensitive environment. Consumers can visit Medicare’s www.medicare.gov website and use the user-friendly “plan compare” web tools to figure out exactly which of the competing Medicare drug plans can supply them with their medications at the lowest price. Because the market is so price-sensitive, plans have had to aggressively control their costs. They’ve demanded lower prices from drug manufacturers, and created formularies that encourage consumers to use brands that are less expensive to obtain. As a practicing physician, I know just how much of a hassle these formularies have been, but using the free Epocrates software on my PDA (which you can find at www.epocrates.com/products/rx/) has allowed me to adapt my prescribing patterns to fit various plan formularies without too much trouble, thereby avoiding the need to file appeals.
Open enrollment for Medicare Part D occurs every year from November 15 -December 31. All Part D beneficiaries are eligible to join, switch or drop their Medicare drug coverage during this period. Once this open enrollment period ends, most Medicare patients are locked into their current plan until the end of the year. New Medicare beneficiaries who “age in” to the Medicare program will of course be able to join a Part D plan when they become eligible, and people with limited income (those receiving Medicaid or SSI, or who applied and qualified for the Low-Income Subsidy) can change plans any time during the year.
Some of your patients who have limited incomes may still qualify for the Low-Income Subsidy, which can help them pay for Medicare Part D. Patients with annual income of less than $15,355 (individual) or $20,535 (family) should call Social Security at 800-772-1213 or visit their website at www.socialsecurity.gov/prescriptionhelp/ to see if they qualify for this extra help, which covers a significant amount of the cost of the benefit.
Vaccine Coverage
Until 2006, Medicare Part B was only permitted to pay for four vaccines: pneumococcal vaccine, flu, Hepatitis B for patients at increased risk, and Tetanus when given as a part of the treatment of a traumatic wound. Part D came along in 2005, and most vaccines became Medicare-covered. However, there was no legal basis to pay for the administration of these “Part D” vaccines. On December 20, 2006 the President signed the Tax Relief and Health Care Act, and among its provisions was legal authority for Medicare to pay for the administration of the Part D vaccines. This new benefit will be implemented in stages. This year, physicians have been able to bill their Part B carrier for the administration fee, but next year they’ll no longer be able to do so. Beginning in 2008, the cost of administering vaccines covered by Part D will be the responsibility of the Medicare drug plans. Most physicians will probably elect to bill their patients for the vaccine and the administration, and the patient will have to submit a claim to their Part D plan for reimbursement. Network pharmacies operating in states that allow pharmacists to administer vaccines will be able to bill the Part D plan directly if they administer a vaccine to a covered beneficiary. Both the vaccine and the administration fee for the Part B vaccines mentioned above will continue to be covered under Part B and billed to Medicare. More information on vaccine administration and Part D can be found at www.cms.hhs.gov/MLNMattersArticles/downloads/SE0727.pdf.
For patients who change plans
This table lists the steps we have taken to ensure that patients who change plans continue to get their medications during the transition period. New plans must provide patients with at least a 30-day supply of any medication covered by their previous plan. The new plan must also initiate notification processes to give patients time to either get a new prescription for a comparable drug covered by the new plan, or to file an exception request. Download a copy of the standardized exception form.
Table. CMS transition process requirements and expectations in 2008
Enrollees: transition process |
CMS requirements, expectations |
|---|---|
Non-long-term care enrollees who are:
(also applies to re-assignees and any individual moving to a new plan) |
Plans must provide a temporary 30-day fill (unless enrollee presents with a prescription written for <30 days) when presenting at a pharmacy to request a refill of a non-formulary drug that patient was taking before enrollment (including Part D drugs that are on a plan’s formulary but that require pre-authorization or step therapy under a plan’s utilization management rules) within the first 90 days of coverage, under the new plan |
New enrollees who are residents of long-term care facilities |
Plans must provide a temporary 31-day fill (unless the prescription is written for <31 days) of non-formulary Part D drugs—including Part D drugs that are on a plan's formulary but require pre-authorization or step therapy under a plan's utilization management rules. Also, plans must honor multiple fills of non-formulary Part D drugs (including Part D drugs that are on a plan's formulary but require pre-authorization or step therapy under a plan's utilization management rules) during the first 90 days of their coverage, under the new plan |
Enrollees who remain in same plan as in 2007 but experience negative formulary changes in 2008 (eg taking a drug that was on formulary in 2007 but is not on formulary in 2008, or had an exception granted in 2007 that will not be honored in 2008). |
After enrollees receive their Annual Notice of Change on October 31st of a given year, CMS expects plan sponsors to select 1 of the following 2 options for effectuating an appropriate, meaningful transition for enrollees who experience negative formulary changes:
|
Enrollees who request an exception, but the plan fails to issue a timely decision on the request by the end of the transition period |
CMS expects plans to make arrangements to continue providing requested drugs via a case-by-case extension of the transition period to the extent that the individual's exception request or appeal has not been processed by the end of the minimum transition period |
Enrollee who remains in same plan as in 2007 and is using a drug as a result of an exception that was granted in 2007 |
Plans have the option of “honoring” exceptions granted in 2007 beyond the end of the plan year (ie, a plan may choose to honor an exception for as long as the beneficiary remains in the plan) If a plan is not going to honor an exception beyond the end of the plan year, it must have notified the enrollee in writing at least 60 days before the end of the 2007 plan year and either (1) offer to process a prospective exception request for the 2008 plan year, or (2) provide the enrollee with a temporary supply of the requested prescription drug (if not medically contraindicated) at the beginning of 2008, and notify the enrollee that he/she must either switch to a therapeutically appropriate drug on the plan’s formulary or get an exception to continue taking the requested drug |
Enrollee who remains in same |
Before the beginning of the new plan year, enrollees may attempt to satisfy the pre-authorization requirement by requesting a coverage determination or by requesting a formulary exception if he/she cannot satisfy the pre-authorization requirement |
Current enrollees experiencing a level-of-care change |
Enrollees who are outside their transition period may experience circumstances that involve level-of-care changes in which a beneficiary is changing from one treatment setting to another. CMS encourages, but does not require, plans to incorporate processes in their transition plans that allow for transition supplies to be provided to current enrollees with level-of-care changes. Thus, beneficiaries and providers must avail themselves of plan exceptions and appeals processes |
Current enrollees entering long-term care settings from other care settings |
These enrollees will be provided emergency supplies of nonformulary drugs (including Part D drugs that are on a plan’s formulary but require prior authorization or step therapy under a plan’s utilization management rules). This transition supply is not limited only to initial enrollment |
Current enrollees in a long-term care setting requiring an emergency supply of a nonformulary drug |
To the extent that an enrollee in a long-term care setting is outside his/her 90-day transition period, the plan must still provide an emergency supply of nonformulary Part D drugs (including Part D drugs that are on a plan's formulary but require prior authorization or step therapy under a plan's utilization management rules) while an exception is being processed. These emergency supplies must be for at least 31 days of medication, unless the prescription is written by a prescriber for <31 days |
CMS= Centers for Medicare & Medicaid Services
Why Is A Vascular Access Improvement Plan So Important?
At the beginning of the Fistula First (FF) initiative in 2003, 25.7% of prevalent Texas patients were using an A-V Fistula (AVF) as their dialysis access; as of September 2007, 47.3% of prevalent Texas patients were using an AVF. Although growth in the utilization of AVF continues to occur, the ESRD Medical Review Board (MRB) recognizes that many Texas facilities continue to encounter multiple “system barriers” that hinder their ability to decrease long-term catheter utilization and increase AVF utilization. The MRB has asked our QI team to identify Texas facilities reporting low AVF rates and/or high long-term catheter rates and to collaborate with them to develop facility-specific Vascular Access Improvement Plans (VAIP).
Every year the data from the Fistula First facility specific report for the July – September quarter is reviewed by the Network Quality Improvement team. There are 4 categories of data, which are selected for contact, and require specific actions by the facility.
1) More than 20% of facility’s prevalent patients used a catheter for 90 days or longer during the last year.
Actions Required:
- Review Facility Specific VA reports in Quality Improvement Meeting.
- Utilize attached template to create and implement a VAIP for your facility.
2) More than 20% of facility’s prevalent patients used a catheter for 90 days or longer during the last 2 years.
Actions Required:
- Review Facility Specific VA reports in Quality Improvement Meeting.
- Utilize attached template to create and implement a VAIP for your facility.
- VAIP submitted to the ESRD Network for review and recommendations.
3) Less than 30% of facility’s prevalent patients used an AVF during the last year.
Actions Required:
- Review Facility Specific VA reports in Quality Improvement Meeting.
- Utilize attached template to create and implement a VAIP for your facility.
4) Less than 30% of facility’s prevalent patients used an AVF during the last 2 years.
Actions Required:
- Review Facility Specific VA reports in Quality Improvement Meeting
- Utilize attached template to create and implement a VAIP for your facility.
- VAIP submitted to the ESRD Network for review and recommendations.
If you identify during the internal monthly Continuous Quality Improvement (CQI) meetings that your facility falls into one of these categories at anytime throughout the year, please take the necessary actions to begin a pro-active Vascular Access Improvement Plan (VAIP). We encourage you to share your Vascular Access Outcomes with your patients and incorporate their participation in the development of the facility VAIP. There are various tools available to assist you with this effort on the website (www.esrdnetwork.org) under the Fistula First section.
Working to improve vascular access outcomes in the face of complex “system barriers” can be discouraging and frustrating. We encourage you to collaborate with the Network #14 QI team to develop new strategies that address your facility specific barriers. You can contact the Network QI team by calling (469) 916-3803 for Bobbie or (469) 916-3806 for Angie.
Congratulations To All Quality of Care Benchmark & Recognized Facilities
CONGRATULATIONS! This is a list of the facilities in the state of Texas who have achieved the distinction of being in the top 10% of all eligible facilities for various Quality of Care indicators. Benchmark facilities have not only achieved this distinction in the last year but for the last 2 years! Recognized facilities have achieved this status and are in the running to achieve Benchmark status for next year! A sincere thanks goes out to all of these outstanding individuals and facilities that have worked so diligently to achieve this most prestigious status. Please join us in acknowledging these dedicated individuals, and congratulating them for a job well done!
These are the categories:
-
Hemodialysis Adequacy Management (% of patients with URR > 65%)
- Benchmark – 10 Facilities
- Recognized – 27 Facilities
-
Hemodialysis Anemia Management (% of patients with HGB > 11.0)
- Benchmark – 11 Facilities
- Recognized – 23 Facilities
-
Hemodialysis Albumin Management (% of patients with ALB > 3.8)
- Benchmark – 11 Facilities
- Recognized – 20 Facilities
-
Peritoneal Dialysis Adequacy Management (% of patients with Kt/V > 1.7)
- Benchmark – 4 Facilities
- Recognized – 15 Facilities
-
Peritoneal Dialysis Anemia Management (% of patients with HGB > 11)
- Benchmark – 2 Facilities
- Recognized – 10 Facilities
-
Peritoneal Dialysis Albumin Management (% of patients with ALB > 3.8)
- Benchmark - None
- Recognized – 4 Facilities
*Please note that some facilities identified as having missing data are being reviewed and may become eligible for Benchmark or Recognized status upon verification of their data.
For those facilities that would like to join this elite group you may want to contact these facilities and discuss some of their strategies, which have been successful in reaching these goals.
Run Charts
Each year the ESRD Network of Texas, Inc. collects Quality of Care data for the previous October through December from all Texas facilities. This data collection project is done in January or February each year. Once individual patient data is collected, it is aggregated into facility-specific data. Each facility receives data charts containing their aggregate data, as well as Texas comparative data. These charts give facilities an opportunity to compare their outcomes to Texas data, as well as U.S. data.
In order to facilitate use of the data, the ESRD Network of Texas produces modality specific Run Charts which are available on our website at www.esrdnetwork.org > Professionals > Quality Improvement. These Run Charts, which include Texas comparative data, can be used to track and trend facility specific data for monthly Continuous Quality Improvement (CQI) meetings. The use of pictorial representation, such as the run charts, can be helpful in identifying areas for improvement, as well as areas where the facility excels. We encourage you to incorporate these graphs into your CQI.
If you need assistance with this or any other Quality Improvement project, please do not hesitate to contact the QI team at the Network – Angie Wieler at 469-916-3806 or Bobbie Knotek at 469-916-3803.
Recent QI Special Alerts
Carbon Monoxide Alert
On November 8, 2007, NW #14 sent a broadcast fax to Texas facilities, which included a cover memo and a 2-page Fact Sheet from Occupational Safety and Health Administration (OSHA). The cover memo and the Fact Sheet contain important information for all dialysis facilities. If you have not reviewed these documents in one of your facility’s Continuous Quality Improvement (CQI) meeting, we encourage you to discuss this information in your next CQI meeting. If you didn’t receive the fax copy or were unable to read it, you can print a copy of the document from our website at www.esrdnetwork.org > Our Network > News.
MRB Recommendations on Use of Non-Standard Baths
On November 26, 2007, Texas facilities received a broadcast fax, which included a cover memo and a 3-page document developed by the Medical Review Board (MRB). This document discusses clinical practices and guidelines for facilities that use non-standard bath compositions on a routine basis in their facilities. These recommendations were developed to assist facilities in developing Governing Body approved protocols, policies and procedures for use of non-standard baths. The MRB strongly recommends that each facility’s Medical Director and Medical Staff collaborate with the facility management in developing medically sound practice guidelines for use of non-standard bath compositions to ensure that patient safety is not compromised. A copy of this document can be found on the NW #14 website at www.esrdnetwork.org > Our Network > News.
Vinegar Use Alert
On December 3, 2007, a memo containing information about Vinegar Use in Hemodialysis was sent to Texas facilities. The memo contains general housekeeping guidelines for use of this product in a hemodialysis setting. As with any chemical, it is imperative that machine manufacturers’ recommendations on use of this product with their equipment be followed. Although vinegar is harmless when ingested, it requires special handling when introducing it into a hemodialysis machine used for dialysis treatments. Always ensure that safe handling and good housekeeping practices are maintained to prevent harm to patients. To print a copy of this document, go to the NW #14 website at www.esrdnetwork.org > Our Network> News.
A Texas-Sized Thank You From Network #14’s QI Team!
The ESRD Network of Texas, Inc. and Texas dialysis and transplant facilities have a long history of partnering to improve clinical outcomes for Texas ESRD patients. Something that we, the NW QI team, rely heavily upon is the support and collaboration that we receive from our Texas facilities. Improvement initiatives are only as successful as the level of commitment demonstrated by all partners. The QI Team, Angie Wieler, Gay Grauke and myself, Bobbie Knotek, want to send a Texas-Sized Thank You to you and your facility staff for the support that you give us throughout the year. We also wanted to give you an update on the Quality improvement initiatives that Texas facilities have participated in during the last year, which include:
The Quality of Care (QOC) Project, which collects data on 100% of all ESRD patients dialyzing in Texas facilities during the fourth quarter of each year. Outcome data is collected and reported back to each facility in the form of comparative data reports and charts. Measures collected in the QOC Project include:
- Anemia Management, including severe anemia, TSAT and Ferritin
- Hemodialysis adequacy
- Peritoneal dialysis adequacy
- Albumin
- Osteodystrophy Management, including Calcium and Phosphorous
Facilities with one or more outcomes in the top 10% for 1 year receive
Recognized status, while facilities with one or more outcomes in the
top 10% for 2 years receive Benchmark status. Facilities reporting
clinical indicator data that don’t meet Medical Review Board
(MRB)
cut-points for minimally acceptable care are required to develop and
implement an improvement plan that addresses the outlier outcome(s).
The Fistula First Project, now in its’ 5th year, addresses vascular access outcomes in dialysis patients. A major component of this project is the collection of prevalent and incident vascular access utilization data from outpatient dialysis facilities. The Centers for Medicare & Medicaid Services goal for the Fistula First (FF) project is for 66% of eligible, prevalent hemodialysis (HD) patients to be using an arterio-venous fistula (AVF) as their primary dialysis access by 2009. Vascular access data on incident and prevalent facility patients is collected monthly from every hemodialysis facility in Texas. The data is aggregated with vascular access data from the other ESRD Networks and is published monthly in the Fistula First Dashboard. The 2008 CMS goal for our Network is 48.9% prevalent AVF by the March 2008 Fistula First Dashboard, which will be published in May 2008.
In an effort to assist facilities that continue to encounter seemingly insurmountable barriers to optimal vascular access placement for their patients, NW #14 QI staff utilizes FF data to identify facilities with less than 30% of their prevalent patients using an AVF as their primary dialysis access. These facilities are asked to develop and implement a Vascular Access Improvement Plan (VAIP). Facilities that have a prevalent AVF rate of less than 30% for 2 years are required to submit their VAIP to the ESRD Network for review and recommendations. For more information on the VAIP process, you can refer to the Vascular Access Improvement Project article in this newsletter. Facilities reporting an average quarterly prevalent AVF rate of 50% or greater are awarded Fistula First Benchmark status and are recognized in FF mail-outs and on the NW #14 website. The first time a facility achieves FF Benchmark status; they receive a certificate for their facility. In addition, the surgeon(s) to whom the FF Benchmark facilities attribute their high prevalent AVF rate to be recognized as Champion Surgeons. These surgeons receive a certificate that acknowledges their contribution to the Fistula First Project and have their names listed on a Benchmark Facility list that is distributed to the Texas nephrology and surgical communities.
Clinical Performance Measures (CPM) Project
This data collection project originated in the late 1990’s when CMS recognized the need to collect outcome data that would provide regional profiles for dialysis clinical indicators. Although the name and the scope of the project have changed since its inception, the goal of the CPM Project remains the same. Data is collected on a 5% sample of patients in each ESRD Network. This data is collected and reported upon annually. Not every facility receives a CPM form, although most of you have probably completed at least one of the yellow or blue CPM forms since the projects inception.
Although the CPM Project does not produce facility specific data, it does give each Network a way to identify clinical outcomes within the Network region that offer an opportunity for improvement. For the last 2 years, the MRB has selected catheter reduction as NW #14’s CPM Quality Improvement Project. The focus in this QIP is to keep the Texas rate for catheters greater than/or equal to 90 days less than the U.S. rate for these catheters. As part of the CPM Project, the QI team identified facilities that have a greater than/equal to 90 day catheter rate of 20% or higher. These facilities were required to develop and implement a Vascular Access Improvement Plan (VAIP) that targets high catheter rates.
For more information on how clinical outcomes in Network #14 compares to those in the other ESRD Networks, refer to the article in this newsletter article written by Glenda Harbert.
Network Quality Improvement Projects
In addition to the previous data collection projects, all Networks are required by CMS to develop and implement an annual quality improvement project that addresses a Network-specific need or deficit. Previous NW #14 projects that you may be familiar with focused on anemia management, stenosis monitoring, catheter reduction and hemodialysis adequacy.
The NW #14 2006-2007 QIP focused on Care of the Hospitalized Peritoneal Dialysis (PD) Patient. PD nurses across the state completed surveys describing how their PD patients receive their peritoneal dialysis during hospitalizations. Based on their responses, the NW #14 Medical Review Board developed a set of recommendations that address the dialysis issues hospitalized PD patients often encounter. This project is close to completion and Texas facilities will be receiving the MRB’s final recommendations this spring.
The 2007-2008 QIP for our Network is Improving Access to Home
Therapy. This QIP, which is still in the initial stages, addresses
the extremely low percent of Texas patients who perform home dialysis.
The first step in the QIP was to identify Texas facilities who were
in the top 10% of all facilities for the percent of their facility
patients who were receiving home dialysis, either home hemodialysis
or peritoneal dialysis. These facilities have been contacted and
asked to identify facility practices they feel contribute to their
success in “recruiting” home dialysis patients. Responses
from these facilities are being integrated into Best Demonstrated
Practices for Improving Access to Home Therapy. The next step will
be the mail-out of a toolkit to all Texas facilities that includes
facility specific home therapy referral data, comparative Texas data,
Best Demonstrated Practices, a patient education DVD, and a home
dialysis candidate screening tool. Be on the lookout for this toolkit,
which will be mailed to facilities within the next month.
Forms Submission Is Not An Option… It Is Part Of Your Network Agreement
The various forms and data requests that are sent to the facilities by NW #14 fulfill our contractual obligations with the Centers for Medicare & Medicaid Services (CMS). These data items, required by CMS, have timelines and set deadlines in which the Network must gather the data, enter the data into templates and submit the data to CMS.
Although the Network is very aware of the time constraints on the Clinical Managers and Administrators in the facilities and how that impacts completion of Network forms, these forms are crucial to NW #14’s fulfillment of CMS requirements.
One of the agreements, which facilities sign as part of the process of opening a clinic, includes the statement that the facility will participate and assist with the data collection processes in a timely fashion that allows the Network to meet their contractual requirements. Because there have been situations where facilities have not upheld this agreement, the Network will be implementing a process to ensure timely data submission. As a part of this process, if a request for data or improvement plans does not receive a timely response from a facility, the following process will occur:
- The facility will be given a short “grace period” in which to submit the data.
- If the requested data/information is not submitted during the grace period, the facility will be referred to the Texas Department of State Health Services (DSHS) for failure to abide by Network #14’s goals and objectives.
- A facility referral to DSHS will almost always precipitate a DSHS facility survey.
We have been very reluctant to put such a stringent process in place, however, with over 400 facilities in Texas, it has become extremely time-consuming for Network staff to have to continually remind facilities multiple times by phone, email and fax that their data is due. We want you to know that we truly appreciate the majority of our Texas facilities that submit their data, forms, improvement plans, etc. on a timely basis and we thank you for your assistance in helping us meet our CMS contract requirements.
Thanks for the support!
We appreciate your comments or suggestion to bring you information and tools you need. Please email gbrown@nw14.esrd.net to make suggestions, comments or corrections. Or if you wish to be removed from or added to this distribution list, please let us know.
This newsletter is published by the ESRD Network of Texas, Inc. #14 under contract #HHS-500-2006-NW014C with The Centers for Medicare & Medicaid Services (CMS)