The Lone Star Bulletin - January 2009
From the desk of the Executive Director:
The Network staff, Boards and Committees are enthusiastic about our Annual Network Coordinating Council Meeting and the Nephrology Today and Tomorrow Conference that is fast is approaching in February 2009. Be sure to register early because attendance will be limited. Consider bringing your family to this delightful setting. Go to www.greatwolf.com/grapevine/waterpark for a preview.
As always we strive to bring timely, topical information to the meeting to support you in providing quality care. The meeting will be packed with information for all disciplines and include a plenary session by Glenda Payne on Lessons Learned on the New Regulations as well as breakouts sessions on the Comprehensive Assessment. Other highlights are of the all day plenary session on Friday February 20 are Dr. Susan Bray on Successful Self Care and Home Programs, Dr. Vo Nguyen and Lynda Ball, RN on Increasing Fistulas while Decreasing Catheters and Robert Mallon speaking on Dealing with Difficult People, an interactive session with mystery performers.
The transition from the old system of sending CMS forms to the Network to the new electronic Crown Web system is already in progress with the registration for Security Administrators in full swing in December. Training Sessions will be conducted in both Dallas and Houston in January, and attendance is highly recommended. Watch for information to sign up for these sessions. Tips for Success for Crown Web use will be presented at the Annual Meeting with presentations by both Network and Dialysis Facility staff that have used the system.
Finally, the Department of State Health Services is in the process of revising the Texas ESRD Licensure Rules and has conducted 3 stakeholder meetings for input thus far. The publication date is uncertain although it is expected to be in the late spring 2009.
I know we are all glad to see the end of 2008 Hurricane season, and we need to recognize the many dedicated professionals that went above and beyond the call to care for our Texas patients. We had Gustav, Edouard, Dolly and finally the big one Ike. For the first time and then the second time, the TEEC command center was activated and staffed by representatives of the community serving our patients working over 720 hours in 7 days. Over 1,700 calls were received during the Ike response. While most have returned to normal, Galveston Island and surrounding communities are far from recovered. As this newsletter goes to press, Island Dialysis Center remains closed; however, the UTMB home program that had relocated to the Mainland is expected to reopen at the previous location in December. Lessons learned will be presented at the Annual Meeting. Be sure to be there!
Nancy Carlson, MPA recently left the Network after 20 years of loyal and devoted service. I know you all join us in thanking her and wishing her the very best in her new endeavors. If you didn’t get a chance to talk to her before she left, you’ll get an opportunity to do so at the Annual Meeting.
Thank you for all you do providing quality care in Texas. I look forward to seeing you in February.
Centers for Medicare & Medicaid Services - 7500 Security Boulevard - Baltimore, MD 21244
Conditions for Coverage Require Use of CROWNWeb by 2/1/09
On April 15, 2008, the Centers for Medicare & Medicaid Services published updated Conditions for Coverage for End-Stage Renal Disease Facilities in the Federal Register. These regulations modernize Medicare’s ESRD health and safety Conditions for Coverage and update CMS standards for the delivery of safe, high quality care to dialysis patients. The revised regulations are patient-centered, reflect improvements in clinical standards of care, require the use of more advanced technology, and outline a framework to incorporate performance measures viewed by the scientific and medical communities to be related to the quality of care provided to dialysis patients.
Electronic Data Submission Requirement
The final rule requires the submission and maintenance of electronic patient and provider records for all dialysis facilities in the United States (§494.180(h)). This requirement takes effect on February 1, 2009. To support this mandate, CMS announces CROWNWeb, a web-based software application that all dialysis facilities will be required to use beginning February 1, 2009. Use of CROWNWeb for data submission by February 1, 2009 is mandatory to support CMS’s goals of quality improvement and performance assessment, as well as to ensure prompt claims processing and reimbursement.
CRWNWeb Overview
CMS designed CROWNWeb to collect patient records, clinical performance measures (CPMs), and facility data. It includes a listing of all ESRD facilities within each Network, as well as employees and patients within each facility. Dialysis patients are assigned to the facility primarily responsible for their treatment and may be transferred from one facility to another as required. Your facility will create CMS-2728 and CMS-2746 forms using this system, and you can print copies of these forms for Social Security before submitting the data electronically. In addition, CROWNWeb can generate reports to assist you in maintaining required records and ensuring that Social Security receives required information.
Facility Staff
CROWNWeb contains a facility staff module that tracks your personnel and their roles within your dialysis facility. CMS and the Networks grant a CROWNWeb Facility Administrator (an individual responsible for maintaining CROWNWeb data at your facility) permission to add and edit facility staff to the list, and the CROWNWeb Facility Administrator may modify the permissions of facility staff to access certain data within CROWNWeb based on a need-to-see basis. These permissions also regulate which staff members may create, read, update, or delete other personnel records, including those for physicians and other members of the facility staff.
Patients
Patients are assigned to the dialysis facility primarily responsible for their treatment. Facilities can easily transfer patients to other facilities for transient care or in the event of an emergency. Staff members will be able to search for patients within their facilities who meet specific criteria. Once they locate the patient, they can view and edit the information for the selected patient and see a list of any forms that they may need to submit for that patient.
2728 and 2746 Forms
Facility personnel will create and submit 2728 and 2746 forms for patients using an on-screen data entry system. This includes generating an original, as well as submitting an updated or re-entitlement 2728 form. To save time, CROWNWeb pre-populates the patient information on the form using any data that already exists in the database. If all information needed to complete and submit the form is not available, you can save the form temporarily until you obtain the additional data, then continue to work on the form through completion. Once staff enters all required information, you can submit the 2728 to CMS and the Networks electronically, as well as print out the paper version for the physician signature (in blue ink), as required by Social Security.
CROWNWeb also pre-populates the 2746 form using any data that already exists in the database, and you can also save these for completion at a later time. When you submit either form, the system automatically performs an audit of the 2728 or 2746 to ensure that you have filled in all required information and notifies you if there is missing data.
Reports
CROWNWeb permits authorized facility staff to generate reports and copies of blank forms for their facility. The following reports and forms are available:
- Patient Forms
- Blank 2728
- 2728 Instructions
- Blank 2746
- 2746 Instructions
- Facility Reports
- Facility and Personnel report – Permitted personnel can view a listing of all facilities and personnel within their scope. Facilities and personnel outside their scope will remain hidden, although CROWNWeb displays general facility information (name, hours of operation, etc.) for all facilities.
- Patient Records
- Patient Roster Report – a listing of all current patients for a facility, or those within a specified date range.
- Audit Reports
- Audit Forms Report – a listing of personnel, patients, facilities, 2728 and/or 2746 forms and treatment changes for facilities.
- Audit Additions Report – a list of all new/added records for personnel, patients, facilities, 2728 forms, or 2746 forms entered into CROWNWeb by your facility.
- Audit Deletions Report – a list of all personnel, patients, facilities, 2728 forms, or 2746 forms deleted from CROWNWeb by your facility.
Security and Cost
CROWNWeb uses an encryption technology that assures privacy, confidentiality, and security for electronic communications consistent with applicable HIPAA and Privacy Act statutes and related regulations. CROWNWeb also meets applicable security criteria included in the CMS Information Security Acceptable Risk Safeguards (ARS) policy (http://www.cms.gov/InformationSecurity/Downloads/ARS.pdf), which contains a broad set of CMS security controls based upon National Institute of Standards and Technology (NIST) requirements.
CMS will provide dialysis facilities with access to CROWNWeb free of charge once the facility completes a verification and authorization process. This verification process will require proper ID and a notarized application. Your facility can begin the verification process starting in December 2008.
System Requirements
To access CROWNWeb, a facility must have a computer connected to the Internet that meets the minimum specifications outlined in the table below. Most computers built within the last four years will meet these minimum requirements. High-speed Internet connectivity (DSL, cable, or faster) is recommended.
|
Minimum | Suggested |
|---|---|---|
| Internet Browser | Internet Explorer 6.0 |
Internet Explorer 6.0 or Later |
| Operating System | Windows 98 SE2 |
Windows 2000 or XP |
| Processor Speed | Pentium (or equivalent) 66 megahertz (MHz) |
Pentium 4 (or equivalent) 1.8 gigahertz (GHz) or faster |
| Available RAM | 64 megabytes (MB) |
128 megabytes (MB) |
| Document Viewer | Adobe Acrobat Reader 6 |
Adobe Acrobat Reader 8.0+ |
| Internet Connection | 56 KBps dial-up |
High speed (DSL, cable, or faster) |
Your facility’s computer system must meet the minimum system requirements by February 1, 2009.
Training
CMS will provide training on CROWNWeb to facilities in two venues:
- Face-to-face training at a variety of locations across the United States
- Online training available via a central website 24 hours a day, 7 days a week at: http://www.projectcrownweb.org
CMS will provide online training at no cost to the facility. The core CROWNWeb training program will consist of a series of online courses totaling approximately two hours. This core instruction will cover the main functions of CROWNWeb, and additional modules will be available. While face-to-face training may require your facility incurring travel costs, there is no fee to attend the actual training. CMS recommends attending face-to-face training, and has made this type of training available for those that prefer this method of instruction.
Milestone Dates
Dates to remember for the CROWNWeb application are:
- October-December 2008 – Begin the CROWNWeb registration process for your facility.
- December 2008–March 2009 – Attend training on the use of CROWNWeb.
- February 1, 2009 – Begin submitting data electronically via CROWNWeb.
Need More Information?
If you have any questions regarding CROWNWeb, please contact the CROWNWeb team directly via e-mail at ESRDHD1@esrd.net by phone at 1-888-ESRDHD1 or visit http://www.projectcrownweb.org
Minimum System Requirement Checklist
The following checklist will assist your facility in verifying that your computer system meets the minimum CROWNWeb requirements. If you would like a more detailed explanation of the system requirements, please contact the CROWNWeb team at ESRDHD1@esrd.net.
Requirements Checklist
The minimum CROWNWeb requirements are listed below:
| Item | Minimum Requirement | |
|---|---|---|
| ___ | Internet access speed | 56KBps dial-up minimum (DSL, Cable or faster recommended) |
| ___ | Browser version | Internet Explorer 6.0 minimum (IE 7.0 or higher recommended) |
| ___ | Operating System | Windows 98 SE2 minimum (Windows 2000 or XP recommended) |
| ___ | Processor Speed | 66 MHz Pentium (or equivalent) processor minimum (1.8 GHz or greater Pentium 4 or equivalent processor recommended) |
| ___ | Random Access Memory (RAM) | 64 MB for Win98 SE2 (128 MB or more recommended) |
New Texas ESRD Facilities:
The End Stage Renal Disease Network of Texas is pleased to welcome the following new Medicare dialysis facilities. You may access a complete listing with addresses, telephone and fax numbers, and provider numbers from our website at www.esrdnetwork.org. Go to Provider Directory > Dialysis Facility > On right hand side of webpage > “Dialysis and Transplant facilities”.
67-2588
Dialysis Services of West Texas
Denver City, TX
806-592-2090
67-2593
Lubbock Kidney Center
Lubbock, TX
806-771-9933
67-2590
Hope Kidney Clinic
Laredo, TX
956-242-4810
67-2592
First Colony Dialysis
Sugar Land, TX
281-494-1465
67-2591
Cedar Park Dialysis Center
Cedar Park, TX
512-528-8478
For more information on opening a facility, please visit our website
at www.esrdnetwork.org. Go
to Provider Directory ÞInformation for Providers Þ Opening
Instructions for a New Facility Þ New Facility Welcome Packet
and Forms. Compete and fax to 972-503-3219. Make sure
to allow 6 to 8 weeks for processing.
Quality of Care Updates and Data:
Each spring the ESRD Network of Texas, Inc. collects Quality of Care data on 100% of Texas patients from the fourth quarter of the previous year (October, November and December).
- Patient specific data is aggregated and analyzed by facility and displayed in facility-specific data tables and charts. Each facility receives a copy of their facility-specific charts.
- To allow facilities to compare their data to that of other Texas facilities, Quality of Care data is aggregated and analyzed to produce Network comparative data.
- To facilitate use of comparative data, the ESRD Network of Texas, Inc. produces modality specific Run Charts, which are available on our website at www.esrdnetwork.org > Professionals > Quality Improvement.
- The Run Charts, which display facility-specific and comparative data, can be used to track and trend data for monthly Continuous Quality Improvement (CQI) meetings. Run Charts are an excellent visual aid for identifying areas for improvement as well as areas of excellence.
- To prepare for CQI meetings, we encourage use of either the Network Run Charts or a tracking/trending methodology endorsed by your facility/corporation.
- Please be sure to share this data and other clinical outcomes data provided by the Network with your patients! Sharing your facility data with your patients helps to open communication channels and encourages patient involvement in your facility’s quality improvement initiatives. If you would like to share an example of how your facility displays comparative clinical outcome data with your patients (i.e. teaching sheets, charts, forms, etc.), we will gladly share your ideas with other facilities at our annual meeting in February 2009! If you would like your ideas acknowledged at the annual meeting please email them to Angie Wieler at awieler@nw14.esrd.net.
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 (469) 916-3806 or Bobbie Knotek (469) 916-3803.
REMINDER…
Please remember that the Network will no longer accept 2728 or 2746 forms after 12/31/2008. Please submit all forms for recent admissions as well as Missing Forms by this date. Also, be advised that in the event that the Network receives 2728 or 2746 after 12/31/2008, they will be returned to your unit for entry into CROWN Web in February 2009. Each facility will still be required to submit a December PAR. Please have this report submitted to the Network no later than 1/05/2009.
Don’t Violate Federal HIPAA Laws by Emailing Patient-Specific Information:
Q – Why can’t I email documents with patient-specific information?
A – Patient-specific information cannot be sent by email because email is not secure. This includes information in the body of the email or in documents attached to the email. Patient information is private and should go only to the person or organization authorized to have access to it. Sending private, patient-specific information by email provides the opportunity for unauthorized persons or organizations to intercept it during transmission. Centers for Medicare & Medicaid (CMS) strictly forbid transmission of patient-specific information by email because it is a Serious HIPAA Violation.
Q – What is patient-specific information?
A – Patient-specific information is any information that can be used to identify a person or to steal a person’s identity. This includes the patient’s name, Social Security number, date of birth or any other unique identifier.
Q – What should I do if I’m running late getting information to the Network, and the fax isn’t working?
A – Call the Network and tell them that you are having difficulty faxing the information and advise them that you are putting the document in the mail that day. To avoid this problem, try to have reports or other information to the Network a day or two before the due date. Then if you run into difficulty, you will still have time to meet the deadline.
Q – Who at my facility needs to know that you should never email patient-specific information?
A – EVERYONE! Educate your entire staff about not emailing patient-specific information. Print and make copies of the notice below and tape it to every computer in your facility as a constant reminder not to email patient-specific information in violation of the HIPAA laws!
Using the Decreasing Dialysis Patient-Provider (DPC) Toolkit to meet
new requirements in the Federal Regulations:
The revised Conditions for Coverage for ESRD facilities institutes new requirements in two areas where tools in the DPC Toolkit can be helpful. §494.70 articulates the “patients right to respect, dignity, and recognition of his or her individuality and personal needs and ability to cope with ESRD”. The interpretive guideline states that “in all verbal and non-verbal communication, patients must treated with respect, dignity and sensitivity” and that “interactions should demonstrate observance of patients’ rights and consideration of a patient’s physical condition, emotional state, and cultural background.” Numerous requirements regarding Involuntary Discharge fall under patients’ rights, medical director and governance.
The goals of the Decreasing Dialysis Patient/Provider Conflict Initiative (DPC) include decreasing conflicts that often lead to Involuntary Discharge through staff training and Quality Improvement activities related to conflict in the dialysis facility. Very often conflict arises when a patient’s personal needs, cultural differences and/or (in)ability to cope with ESRD collide with the busyness of the dialysis unit and unsatisfactory interactions with patient care staff lacking interpersonal training and skills. Utilizing the DPC Initiative can demonstrate a facility’s commitment to treating patients in a manner consistent with the requirements for Patients’ Rights.
Use of the DPC Conflict Tracking Tool for QI also can provide real data for use in Quality Assessment and Performance Improvement (QAPI) and again demonstrate the governing body’s commitment to identifying and improving outcomes related to conflict that may lead to Involuntary Discharge. This tool was developed to assist in tracking the number, causes, and severity of patient/provider conflicts and to identify trends unique to your facility so that the facility can implement strategies to decrease the frequency and severity of conflicts that occur. The tool contains the following components:
- Conflict Log – an easy way to document pertinent information about each conflict that occurs. Use of this log may also demonstrate ongoing issues with an individual patient or staff member and provide documentation of repeated efforts to meet the needs of a patient or to call out unacceptable behavior of a staff member for personnel actions and training.
- Graphs/Tables – to help identify trends and measure progress
- Number of Dialysis Patient/Provider Conflicts by Month
- Types of Dialysis Patient/Provider Conflicts by Month
- Causes of Dialysis/Patient Provider Conflict by Month
- Documentation Form – to allow you to examine in more detail each conflict that occurs and how it was handled for a QAPI approach that can be shared with the Governing Body for their oversight.
Access these tools in your facility’s DPC Toolkit or go to our website www.esrdnetwork.org under the professional section. If you have additional questions, please feel free to contact our Patient Services Department directly at (469)-916-3808.
Home Sweet Home:
Increasing Access to Home Dialysis Therapies
Quality Improvement Project Results
Although the 2004-2007 CMS 2744 Annual Report data indicated that only 35% (141/399) of Texas facilities had home dialysis patients, an additional 34% (135/399) of Texas dialysis facilities were able to validate patient referrals to a home dialysis facility for PD or Home HD during this time period, and were removed as focus facilities.
As part of their Improvement Plan (IP), the remaining 31% (123/399) of the facilities were validated as focus facilities and were asked to:
- Show the Home Sweet Home DVD to their patients and submit rosters signed by the patients verifying the patients viewed the DVD
- Review and revise their facility’s modality education processes and submit a copy to the Network QI department and
- Develop a home dialysis referral agreement with a home dialysis training facility and submit this documentation to the QI department.
Status of the remaining 123 focus facilities to date:
- 53% (65/123) of the identified focus facilities had previously referred patients to home therapy, but did not have any patients interested in home dialysis during the reporting period. These facilities were removed as focus facilities.
- 22% (28/123) of the focus facilities have not referred patients to home therapies, but have complied with Improvement Plan requirements.
- 19% (23/123) of the focus facilities are in the process of submitting the requested IP documentation.
The Network QI staff and our Medical Review Board and Executive Committee member recognize that this comprehensive project, which involved all Texas facilities, required increased utilization of facility staff resources and we thank you for the time and energy your facility has dedicated to incorporating the QIP initiatives into your facility’s processes and policies. We feel that the actions undertaken by NW #14 facilities in response to this QIP have and will continue to facilitate more timely and objective home dialysis education. Additional achievements identified as a result of this QIP include:
- Provision of standardized, objective home dialysis patient education for all NW #14 patients.
- Development of Home Dialysis Referral Agreements for therapies not provided by a facility. Home Dialysis Referral Agreements will be a mandatory requirement of the forthcoming 2009 Network #14 Goals and Objectives.
- Outreach to Home Dialysis Training facilities for support in the provision of home dialysis information education sessions.
- Establishment (or review/revision) of home modality education and referral processes.
- Dissemination and utilization of the standardized MEI Home Dialysis Evaluation Criteria guidelines (included in the toolkit sent to all facilities).
- Anecdotal reports of increased number of patients requesting home dialysis evaluation at corporately owned regional home dialysis training center following implementation of the QIP.
Last, but not least - as a result of this project, the Network became appraised of misperceptions about home dialysis that could adversely impact a dialysis facility’s ability to provide objective information about home dialysis therapies to their patients. We encourage you to review the misperceptions listed below and clarify the facts with your QI team, staff members and facility patients. If you have any questions or concerns about the information presented below, please contact Bobbie Knotek at 469-916-3803 or bknotek@nw14.esrd.net.
Misperception #1: The term “Home Dialysis” refers ONLY to home hemodialysis.
Truth: Home dialysis includes both peritoneal dialysis and home hemodialysis.
Misperception #2: Medicare doesn’t pay for home hemodialysis; therefore, only patients with private insurance can choose to do home hemodialysis.
Truth: Medicare does pay for both peritoneal dialysis and home hemodialysis. In fact, new patients that start on home dialysis receive Medicare entitlement immediately and do not have a 90-day waiting period for Medicare entitlement.
Misperception #3: Because there isn’t a Home Dialysis Training Facility close to our facility, it’s “not fair” to educate patients about home dialysis options.
Truth: Under the new CMS Conditions for Coverage, dialysis facilities are charged with educating their patients about all ESRD treatment modalities, including home dialysis options.
Misperception #4: Staff prefer not to refer patients to Peritoneal Dialysis (PD) because they don’t do as well as our in-center HD patients and always end up “sickly” or with a bad peritonitis.
Truth: Home dialysis training facilities with experienced PD physicians and nurses have strong quality management programs that ensure PD patients achieve optimal adequacy, anemia management and mineral metabolism outcomes and a low percentage of peritonitis occurrences. Before referring patients to a home dialysis training facility, ask them to share their clinical outcomes with you to ensure that they can provide optimal PD training and follow-up for your patients.
Misperception #5: Home dialysis patients need a tremendous amount of extra storage space for their home dialysis supplies.
Truth: While it’s true that home dialysis supplies require additional storage, the supplies come in boxes that can be stacked efficiently into a reasonable space. Home dialysis training nurses are the best people to evaluate whether or not a person has adequate, safe storage for home dialysis supplies.
Misperception #6: Patients with heart disease are not good candidates for either home hemodialysis or peritoneal dialysis.
Truth: Patients with heart disease often do better on peritoneal dialysis because of the more gentle method of ultrafiltration. Anecdotally, I have worked with several patients with severe heart disease who survived for many years on home hemodialysis.
Misperception #7: Home dialysis patients can’t own indoor pets, like cats or dogs.
Truth: As long as the dialysis area is kept clean and the pets are not in the room during tubing connections, pets do not need to be a “deal breaker” for home dialysis. However, every home dialysis training facility has the right to develop their own facility-specific policy regarding indoor pets and home dialysis.
Rock the Boat…Navigating into the Future
Nephrology Today & Tomorrow 2009 is almost here!
February 20-22, 2009
Great Wolf Lodge and Resort
Annual Educational Collaborative for ESRD professionals. Registration available online at www.esrdnetwork.org click on Annual Meeting then click on the meeting icon. Don’t forget the PCT study review course on Sunday! For more information or assistance with registration contact 972-503-3215 and dial x316 for Geli Brown or x315 for Debbie O’Daniel.
Patient Care Technician National Certification
|
Nephrology Nursing Certification Commission (NNCC) | Board of Nephrology Examiners for Nurses and Technicians (BONENT) | National Nephrology Certification Organization (NNCO) Professional Testing Corporation | |
|---|---|---|---|---|
| Credentials | Certified Clinical Hemodialysis Technician (CCHT) | Certified Hemodialysis Technician (CHT) | Certified Clinical Nephrology Technician (CCNT) | |
| Address | P.O. Box 56 East Holly Avenue Pitman, NJ 08071 |
1901 Pennsylvania Ave NW, Suite 607 Washington, DC 20006 |
1350 Broadway, 17th Floor New York, NY 10018 |
|
| Phone Number | 888-884-6622 | 202-462-1252 | 212-356-0660 | |
| Web site | www.nncc-exam.org | www.BONENT.org | www.ptcny.com | |
| Experience Required | 6 Months (Suggested) |
1 Year | 1 Year | |
| Pre-requisites |
|
|
High School Diploma or Equivalent |
|
| Test Administration Options | Available as Paper and Pencil Exam (PPE) | Paper and Pencil Exam (PPE) | Computer Based Test (CBT) (10/2008) | Available as Paper and Pencil Exam (PPE) |
| Exam Fee | $150.00 | $200.00 | $225.00 | $195.00 |
| Late Fee | $50.00 | N/A | N/A | N/A |
| Re-take | $150.00 | $160.00 |
$185.00 |
$195.00 |
| $200.00 *if more than 1 year |
$225.00 *if more than 1 year |
|||
| Special Exam Center Fee
|
N/A | N/A | $125.00 | |
|
Nephrology Nursing Certification Commission (NNCC) | Board of Nephrology Examiners for Nurses and Technicians (BONENT) | National Nephrology Certification Organization (NNCO) Professional Testing Corporation | |
| Recertification Fee | $75.00 | Annual Certification Fee $55.00 (OR $200.00 in advance for 4 years) | $195.00 | |
| Late Fee | $50.00 | First X 3 years = $10.00/year Fourth year = $20.00 |
N/A | |
| Inactive Status | $50.00 | Unknown | N/A | |
| Late Fee | $50.00 | Unknown | N/A | |
| On-Line Practice Exams | $30.00 | $50.00 | N/A | |
| Certification effectiveness | 2 years | 4 years | 4 years | |
| Recertification Qualifications |
|
|
|
|
| Recertification Continuing Education Requirements |
|
Forty (40) Contact Hours of hemodialysis related continuing education |
Currently must re-take exam |
|
| Application submission timeline | Must be postmarked ten (10) weeks prior to exam
date *as of January 1, 2009 |
Must be received 45 days before exam date | Must be postmarked 6 weeks prior to exam date | |
Comparative Data Report for HD & PD
2008 Quality of Care Indicator Results (4th quarter 2007 data)
Texas Comparative Data – Hemodialysis Indicators (Adult)
| Adequacy: | Average URR = 74.0% Average Kt/V = 1.7 Percent of HD Patients with URR = 92.1% Percent of HD Patients with URR > 70% = 78.4% Percent of HD Patients with Kt/V > 1.2 = 95.8% |
|---|---|
| Anemia Management: | Average HGB = 11.9 gm/dl Percent of HD Patients with HGB > = 82.6% Percent of HD Patients with HGB < 10 gm/dl = 4.9% Percent of HD Patients with HGB < 10 gm/dl = 4.6% |
| Iron Management: | Average Transferrin Saturation (TSAT) = 29.4 % Average Ferritin = 603.7 ng Percent of HD Patients with TSAT > 20% = 83.8% Percent of HD Patients with Ferritin > 100ng and < 1000ng = 84.9% Percent of HD Patients with Ferritin > 100ng and < 500ng = 38.1% Percent of HD Patients with Ferritin > 1000 ng = 11.0% |
| Albumin: | Average Albumin = 3.8gm/dl Percent of HD Patients with Albumin > 3.5/3.2 gm/dl = 82.5% Percent of HD Patients with Albumin > 4.0/3.7 gm/dl = 34.8% |
| Osteodystrophy Management: | Average Phosphorus = 5.5 mg/dl Percent of HD Patients with Phosphorus < 5.5 gm/dl = 56.8% Average Calcium = 9.1 mg/dl (not corrected for serum albumin) Percent of HD Patients with Calcium < 10.2 gm/dl = 96.9% Percent of HD Patients with Calcium < 9.5 gm/dl = 76.9% |
Texas Comparative Data – Peritoneal Dialysis Indicators (Adult)
| Adequacy: | Average Kt/V = 2.3 Percent of PD Patients with Kt/V > 1.7 = 89.9% |
|---|---|
| Anemia Management: | Average HGB = 11.9 gm/dl Percent of PD Patients with HGB > 11 gm/dl = 78.3% Percent of PD Patients with HGB < 10 gm/dl = 8.0% Percent of PD Patients with HGB < 10 gm/dl = 7.2 % |
| Iron Management: | Average Transferrin Saturation (TSAT) = 31.5% Average Ferritin = 471.6 ng Percent of PD Patients with TSAT > 20% = 87.7% Percent of PD Patients with Ferritin > 100ng and < 1000ng = 80.6% Percent of PD Patients with Ferritin > 100ng and < 500ng = 51.8% Percent of PD Patients with Ferritin > 1000 ng = 8.6% |
| Albumin: | Average Albumin = 3.6 gm/dl Percent of PD Patients with Albumin > 3.5/3.2gm/dl = 62.6% Percent of PD Patients with Albumin > 4.0/3.7gm/dl = 20.6% |
| Osteodystrophy Management: | Average Phosphorus = 5.3 mg/dl Percent of HD Patients with Phosphorus < 5.5 gm/dl = 61.6% Average Calcium = 9.1 mg/dl (not corrected for serum albumin) Percent of HD Patients with Calcium < 10.2 gm/dl = 95.6% Percent of HD Patients with Calcium < 9.5 gm/dl = 74.2% |
Updated 2008 Texas Run Charts Available NOW!
2008 Texas Quality of Care Indicators Data
Making the Most of Vocational Rehabilitation:
In January, each facility will receive their annual vocational rehabilitation activity report and information packet. This information compares your facility with the state averages of patients receiving vocational rehabilitation services. The ESRD Network of Texas recognizes multiple barriers that have been prohibitive for patients to access vocational rehabilitation in the past.
Our goal is to improve this system so patients and providers can work more efficiently in assisting patients in maintaining or gaining employment eligibility. To this end, the Network and Texas Department of Assistive and Rehabilitative Services (DARS) are collaborating through a pilot project to increase the number of Texas ESRD patients benefitting from the many services DARS offers. A report of this activity will be provided to SW’s at the Annual Meeting in February 20, 2009.
The ESRD Network of Texas is charged with educating and encouraging patients to achieve the maximum level of rehabilitation and to participate in activities that will improve their quality of life. In the mail out, we will include:
- Easy to use tools and resources designed to help you help your patients better understand what resources are available to reach this goal.
- Posters to make available to all patients that will answer some of their questions on this subject.
All patients should be encouraged to pursue meaningful activities such as maintaining employment, retraining for future employment, going back to school, or volunteering. Please feel free to contact John Q. Gowan, the Patient Services Coordinator at 469- 916-3808 if you have any questions.
Advance Directives, Advance Care Planning and the revised Conditions for Coverage:
The revised Conditions for Coverage include a standard addressing the patient’s right with regard to advance directives (AD) (ref: §494.70(a)(6)). Following are some of the highlights:
- Patients should be informed about and participate in all aspects of their care and be informed of their right to refuse or discontinue treatment.
- Patients should be informed about advance directives and their right to execute them.
- If a patient has an advance directive, a copy must be placed in their chart.
- Patients should be informed about the extent to which the facility is willing to honor their advance directives.
Many states, including Texas, have enacted laws requiring healthcare providers to honor patients’ advance directives and “do not resuscitate” (DNR) orders. Facilities are required to know and comply with such state laws. In Texas, a medical professional can be charged with criminal medical battery if CPR is administered to a person who has a duly executed AD that has a DNR directive. If state law does not address this facet of healthcare, and the facility’s policy does not allow the honoring of a patient’s advance directive, there must be a protocol in place for facilitating the patient’s transfer to a facility that will honor the advance directive, if the patient so chooses.
Network 14 will be sending a packet to all facilities in early January 2009 that provides information, resources and tools on Advance Care Planning. A copy of the brochure Advance Care Planning: For the Dialysis Patient and Their Family, developed by the Mid-Atlantic Renal Coalition (Network #5), will be included along with ordering information. The brochure is available from the Network 5 for the cost of postage. You may download the order form at http://www.kidneyeol.org/brochure_order_form.doc, or contact Network 5 directly at 804.794.3757 for more information.
For tools to assist in educating patients about Advance Care Planning visit the national Kidney End-of-Life Coalition website, http://www.kidneyeol.org, which provides resources and tools for both professionals and patients/families related to this topic such as:
- Sample advance directive policies for facilities can be found on the Advance Care Planning page (http://www.kidneyeol.org/advanced.htm).
- Sample DNR policies can be found on the End-of-Life Decisions in Dialysis Unit page (http://www.kidneyeol.org/dialysis.htm).
- Links to state-specific advance directive documents can be found at http://www.caringinfo.org/stateaddownload, or by clicking on the Caring Connections link on the Advance Care Planning page (http://www.kidneyeol.org/advanced.htm).
Another tool for Advance Care Planning is a free ceu module Techniques to Facilitate Discussion for Advanced Care Planning (ACP) on the ANNA Website at http://www.prolibraries.com/anna/?select=publication&publicationID=317.
To review the "Medicare and Medicaid Programs; Conditions
for Coverage for End-Stage Renal Disease Facilities; Final Rule."
FederalRegister 73:73 (15 April 2008) p. 20478. ONLINE. Go
to http://www.cms.gov/CFCsAndCoPs/downloads/ESRDfinalrule0415.pdf.
Adapted from the Mid Atlantic Renal Coalition by Network 14.
GENERAL GUIDELINES FOR THE INVOLUNTARY DISCHARGE PROCESS:
Background:
We frequently receive calls regarding the process of involuntarily discharging a disruptive or abusive patient under the new Conditions for Coverage. Let us first emphasize that involuntary discharge should be an option of last resort. Discharging a patient for “non-compliance” is not an acceptable reason for discharge as these patients are at high risk for morbidity and mortality. Facilities should train staff in conflict management techniques and utilize the Decreasing Patient Provider Conflict (DPC) toolkit. We also recommend NW-14’s Intensive Intervention with the Non-Compliant Patient booklet that can be found on our web site. In the event that all options have been exhausted, the Network has several recommendations for the involuntary discharge process. Since this is a common concern, we felt it would be helpful to provide all facilities with these general guidelines and an Involuntary Discharge Checklist detailing the required steps. A copy of the checklist is included below.
- Notify the Network prior to an involuntary discharge: This provides an opportunity for the Patient Services Department to review the issues and interventions with facility staff and see if there are other options that can be explored.
- Train facility staff: The Network recommends that all staff receive training in conflict management techniques and that this training be documented. The Network highly recommends the Decreasing Patient Provider Conflict toolkit.
- Documentation: It is essential that the staff document and address any problematic behavior, no matter how insignificant it may seem. This should include documentation of all meetings, interventions, and behavioral contracts.
- IVD should be the option of last resort: If the behavioral issues and interventions made to attempt to solve them have been properly documented and all efforts to resolve the problem have failed, then an involuntary discharge can begin. The specifics of this process are discussed in more detail in the checklist. The discharge should be coded as an Involuntary Discharge type.
- Have a policy and procedure in place for involuntary discharges: It is the Medical Director’s responsibility to make sure “that no patient is discharged or transferred from the facility unless- (1) The patient or payer no longer reimburses the facility for the ordered services; (2) The facility ceases to operate; (3) The transfer is necessary for the patient’s welfare because the facility can no longer meet the patient’s documented medical needs; or (4) The facility reassessed the patient and determined that the patient’s behavior is disruptive and abusive to the extent that the delivery of care to the patient or the ability of the facility to operate effectively is seriously impaired…” ('494.180 (f) Standard: Involuntary discharge and transfer policies and procedures; Conditions for Coverage for End Stage Renal Disease Facilities).
We hope this letter and checklist help to clarify the involuntary discharge process. If you have any further questions, please contact the Network at (972)503-3215, and we will be happy to address your concerns.
INVOLUNTARY DISCHARGE CHECKLIST FOR DIALYSIS FACILITIES Draft version 01-09
If you have made the decision to involuntarily discharge a patient due to disruptive and abusive behavior make sure that you have covered the following, in accordance with the Conditions for Coverage §494.180 (f):
- Notify the Network of the potential Involuntary Discharge.
- Perform a comprehensive reassessment and revision of the plan of care for each patient considered for potential IVD as these patients would be considered unstable.
- Document the ongoing problem in patient’s medical record.
- Document the impact of the patient’s behavior on other patients/staff.
- Document all steps to resolve the problem (including behavioral contracts and patient/staff meetings) and adherence to the facility policy regarding disruptive/abusive behavior.
- Document patient’s response to each step taken and the reassessment of the situation.
- Obtain a written physician’s order signed by both the medical director and the patient’s attending physician agreeing with the patient discharge.
- Send to the Network all contracts, letters of notification of discharge or other written communication with the patient regarding the problem.
- Attempt to place the patient at other facilities, and document your efforts.
- Notify the State Survey Agency of the involuntary discharge (see phone number below)
- In cases of immediate severe threats to the health and safety of others, the facility may use an abbreviated involuntary discharge procedure.
- Report the patient as an IVD in the new CrownWeb system. Patients that are transferred out due to lack of payment should also be reported.
If you have any further questions regarding this process, please contact The ESRD Network #14 at 972-503-3215
Texas Department of State Health Services
ESRD Facility Licensure Certification Division
1100 W. 49th St
Austin, Texas 78756
(888) 973-0022