ESRD Network #14 (or ESRD Network-Facilitated) Data Collection Projects

Form Name	When is Data Collected?	Origin of Form	Type of Data Collected	Where are data results published?	Do all facilities complete form(s)?	Type of comparative data
CMS Entitlement and Patient Tracking Forms
*HCF-2728* *Medical Evidence Report* Processed by ESRD NW #14 Data Department	Ongoing Completed on new incident patients.	CMS Facility completes form and sends it to Network, where it is entered electronically and sent to CMS.	Entitlement to Medicare including cause of ESRD, patient demographics, date of first treatment and pre-ESRD labwork â â	Currently unavailable to facilities. Network can access SIMS database	Yes – on every incident patient, regardless of Medicare status. Transplant centers are not required to complete 2728 on patients who are on dialysis.	No comparative data
*Network Patient Activity Report (NPAR)* Processed by ESRD NW #14 Data Department	Monthly Due by the 8^th day of the following month or the Friday prior if the 8^th falls on the weekend.	ESRD Network Form assists in the completion of the 2744 at the end of the year and terminates Medicare coverage.	Monthly record of every chronic patient event – initiations, discontinuations, transfers, deaths. (Each Network collects this data in a different manner).	Currently unavailable to facilities. Network can access SIMS database.	Yes	Dismissed patient data is being compiled from this form
Event Validation Processed by ESRD NW #14 Data Department	Ongoing Completed with the NPAR’s	Facilities	Events	Event Listing/2744	Yes	Remis
*HCFA-2744* *Annual Facility Survey* Processed by ESRD NW #14 Data Department	Annually January through March.	CMS NW sends form to facility. Facility completes & sends to NW where it is edited/entered CMS database.	Status of all chronic dialysis patients that received treatment at the facility during the previous year.	Currently unavailable to facilities. Network can access SIMS database.	Yes – every chronic patient on HD, PD or with a kidney transplant must be accounted for on this report.	No comparative data
*HCFA-2746* *ESRD Death Notice* Processed by ESRD NW #14 Data Department	Ongoing Completed as patients expire.	CMS Facility completes form and sends it to the Network when a patient dies. Form removes deceased patients from the Medicare system.	Date of and reason(s) for patient’s death.	Currently unavailable to facilities. Network can access SIMS database.	Yes – for every patient who expires. Note: Transplant centers can contact NW #14 if the patient is lost to follow-up.	No comparative data
Quality Department Data Collection Projects and Forms
*Fistula First Data Collection* Processed by ESRD NW #14 QM Department	Monthly Due by 10^th day of the following month or prior Friday if the 10^th is a weekend.	ESRD Network LDO’s – Corporate Data Submission Non-LDO’s - Form must be downloaded from the ESRD Network website.	Monthly type of vascular access for each patient in the facility census for the end of the month.	Vascular access reports are sent to all facilities annually. Facilities with less than 30% AVF rates receive their reports quarterly.	Yes LDO’s – Corporate headquarters submit the data electronically. Non-LDO’s – Must complete the form and send to the Network.	Facility specific data as well as Network comparative data.
*Quality of Care Indicators Data Collection* Processed by ESRD NW #14 QM Department	Annually January through February	ESRD Network LDO’s – Corporate Data Submission. Non-LDO’s – Must complete forms sent by NW.	Patient specific outcome data is collected for all HD & PD patients which includes URR/Kt/V, Hgb, and iron management, etc.	Quality of Care Indicators Report developed from returned data and sent to facility with facility-specific graphs.	Yes LDO’s – Corporate headquarters submit the data electronically. Non-LDO’s – Must complete the form and send to the Network.	Facility specific data as well as Network comparative data.
*Clinical Performance Measures Project* Processed by ESRD NW #14 QM Department	Annually May - July Chart validation July through September.	CMS - Centers for Medicare & Medicaid Services The Network sends forms, edits completed forms and validates 5% of the forms.	Patient specific outcome data for HD & PD. Data collected includes anemia management, adequacy of dialysis, iron management, EPO use and vascular access. Form is revised annually.	Clinical Performance Measure Project Annual Report sent to every dialysis facility by CMS.	No – Because Medicare selects a random sample of patients for whom data needs to be abstracted and entered on the forms not every facility will receive CPM form(s).	Network comparative data for HD and US comparative data for PD. No facility specific data is obtained from this data collection project.
§ *Dialysis Facility Report (DFR)* § *State Surveyor Report* § *Dialysis Facility Compare*	Annually June through August Report is sent by the ESRD NW #14 QM Department	CMS The Network sends reports to facilities and keeps a copy of the report in the facility’s file.	SMR, SHR, patient demographics Information is obtained from the facility’s billing data. This is a data report mailing – it is not a data collection activity.	Facility specific reports are sent to the facility, with directions on how to comment on the data that will be published in the State Surveyor Report and on Dialysis Facility Compare.	Yes	Facility specific tables generated by (UM-KECC) Kidney Epidemiology and Cost Center at the University of Michigan and CMS
*Quality Improvement Projects (QIP)* Processed by ESRD NW #14 QM Department	Timeline Varies with Project Baseline and post-intervention data collected.	Mandated by CMS Projects are developed, implemented and assessed at the ESRD Network level with oversight of the MRB.	Type of data collection is specific to the project. (Each ESRD Network selects and implements one of the CMS recommended projects).	A Network Report is compiled and mailed to every facility during the project and at the conclusion of the project.	Yes.	Facility specific and generic graphs are usually a part of the QIP. Patient education & staff education are also components of QIPs.

Form Name

When is Data Collected?

Origin of Form

Type of Data Collected

Where are data

results published?

Do all facilities complete form(s)?

Type of comparative data

CMS Entitlement and Patient Tracking Forms

HCF-2728

Medical Evidence Report

Processed by ESRD NW #14

Data Department

Ongoing

Completed on new incident patients.

CMS

Facility completes form and sends it to Network, where it is entered electronically and sent to CMS.

Entitlement to Medicare including cause of ESRD, patient demographics, date of first treatment and pre-ESRD labwork

Currently unavailable to facilities. Network can access SIMS database

Yes – on every incident patient, regardless of Medicare status.

Transplant centers are not required to complete 2728 on patients who are on dialysis.

No comparative data

Network Patient Activity Report (NPAR)

Processed by ESRD NW #14

Data Department

Monthly

Due by the 8^th day of the following month or the Friday prior if the 8^th falls on the weekend.

ESRD Network

Form assists in the completion of the 2744 at the end of the year and terminates Medicare coverage.

Monthly record of every chronic patient event – initiations, discontinuations, transfers, deaths.

(Each Network collects this data in a different manner).

Currently unavailable to facilities. Network can access SIMS database.

Yes

Dismissed patient data is being compiled from this form

Event Validation

Processed by ESRD NW #14

Data Department

Ongoing

Completed with the NPAR’s

Facilities

Events

Event Listing/2744

Yes

Remis

HCFA-2744

Annual Facility Survey

Processed by ESRD NW #14

Data Department

Annually

January through March.

CMS

NW sends form to facility. Facility completes & sends to NW where it is edited/entered CMS database.

Status of all chronic dialysis patients that received treatment at the facility during the previous year.

Currently unavailable to facilities. Network can access SIMS database.

Yes – every chronic patient on HD, PD or with a kidney transplant must be accounted for on this report.

No comparative data

HCFA-2746

ESRD Death Notice

Processed by ESRD NW #14

Data Department

Ongoing

Completed as patients expire.

CMS

Facility completes form and sends it to the Network when a patient dies. Form removes deceased patients from the Medicare system.

Date of and reason(s) for patient’s death.

Currently unavailable to facilities. Network can access SIMS database.

Yes – for every patient who expires.

Note: Transplant centers can contact NW #14 if the patient is lost to follow-up.

No comparative data

Quality Department Data Collection Projects and Forms

Fistula First Data Collection

Processed by

ESRD NW #14

QM Department

Monthly

Due by 10^th day of the following month or prior Friday if the 10^th is a weekend.

ESRD Network

LDO’s – Corporate Data Submission

Non-LDO’s - Form must be downloaded from the ESRD Network website.

Monthly type of vascular access for each patient in the facility census for the end of the month.

Vascular access reports are sent to all facilities annually. Facilities with less than 30% AVF rates receive their reports quarterly.

Yes

LDO’s – Corporate headquarters submit the data electronically.

Non-LDO’s – Must complete the form and send to the Network.

Facility specific data as well as Network comparative data.

Quality of Care Indicators Data Collection

Processed by

ESRD NW #14

QM Department

Annually

January

through

February

ESRD Network

LDO’s – Corporate Data Submission.

Non-LDO’s – Must complete forms sent by NW.

Patient specific outcome data is collected for all HD & PD patients which includes URR/Kt/V, Hgb, and iron management, etc.

Quality of Care Indicators Report developed from returned data and sent to facility with facility-specific graphs.

Yes

LDO’s – Corporate headquarters submit the data electronically.

Non-LDO’s – Must complete the form and send to the Network.

Facility specific data as well as Network comparative data.

Clinical Performance Measures Project

Processed by

ESRD NW #14

QM Department

Annually

May - July

Chart validation July through September.

CMS - Centers for Medicare & Medicaid Services

The Network sends forms, edits completed forms and validates 5% of the forms.

Patient specific outcome data for HD & PD. Data collected includes anemia management, adequacy of dialysis, iron management, EPO use and vascular access.

Form is revised annually.

Clinical Performance Measure Project Annual Report sent to every dialysis facility by CMS.

No – Because Medicare selects a random sample of patients for whom data needs to be abstracted and entered on the forms not every facility will receive CPM form(s).

Network comparative data for HD and US comparative data for PD. No facility specific data is obtained from this data collection project.

§ Dialysis Facility Report (DFR)

§ State Surveyor Report

§ Dialysis Facility Compare

Annually

June through August

Report is sent by the ESRD NW #14 QM Department

CMS

The Network sends reports to facilities and keeps a copy of the report in the facility’s file.

SMR, SHR, patient demographics

Information is obtained from the facility’s billing data.

This is a data report mailing – it is not a data collection activity.

Facility specific reports are sent to the facility, with directions on how to comment on the data that will be published in the State Surveyor Report and on Dialysis Facility Compare.

Yes

Facility specific tables generated by (UM-KECC) Kidney Epidemiology and Cost Center at the University of Michigan and CMS

Quality Improvement Projects (QIP)

Processed by

ESRD NW #14

QM Department

Timeline Varies with Project

Baseline and post-intervention data collected.

Mandated by CMS

Projects are developed, implemented and assessed at the ESRD Network level with oversight of the MRB.

Type of data collection is specific to the project.

(Each ESRD Network selects and implements one of the CMS recommended projects).

A Network Report is compiled and mailed to every facility during the project and at the conclusion of the project.

Yes.

Facility specific and generic graphs are usually a part of the QIP. Patient education & staff education are also components of QIPs.