Entering A New Era Together

March 7, 2013

NEW Expectations, Activities and OPPORTUNITIES

NEW Expectations, Activities and OPPORTUNITIES

Today's presentersToday's presenters

Glenda Harbert, RN, CNN, CPHQExecutive Director

Anna Ramirez, MPH, CPH Community Outreach Coordinator

Kelly Shipley, RHIA Quality Improvement Director

Treneva Butler, LCSWPatient Services Director

Nathan Muzos, BSInformation Management Director

Today’s Objectives for Participants

• Identify CMS’ vision for ESRD oversight• Describe the projects in the Network contract• Explain the role of the dialysis and transplant

facility in the new projects• Offer input and feedback on the Network

projects (via feedback at the end)

US Department of Health and Human Services (HHS)

• Created National Quality Strategy (NQS) to promote quality health care focused on the needs of patients, families and communities

• Identified 3 Aims for Healthcare– Better Care– Healthy People and Communities– Affordable Care

US Department of Health and Human Services (HHS)

The Affordable Care Act sets America on a path toward a higher quality health care system so we stop doing things that don’t work for patients and start doing

more of the things that do work.

HHS SecretaryKathleen Sebelius

Centers for Medicare & Medicaid Services (CMS)

• CMS, 1 of 11 HHS Divisions, administers the ESRD Medicare Program

• CMS’ Aims for the ESRD Program1. Better Care for the Individual through

Beneficiary and Family Centered Care 2. Better Health for the ESRD Population3. Reduce ESRD Costs Improving Care

USRDS 2012 Annual Report

Centers for Medicare & Medicaid Services (CMS)

• CMS uses two external groups to provide ESRD oversight– State Survey Agencies– ESRD Networks

• CMS contracts with 18 ESRD Networks to oversee ESRD care nationally

• Network Contract/Statement of Work describes projects required to accomplish the 3 aims and the national quality goals

(i) Standard: Relationship with the ESRD network. The governing body receives and acts upon recommendations from the ESRD network. The dialysis facility must cooperate with the ESRD network designated for its geographic area, in fulfilling the terms of the Network’s current statement of work. Each facility must participate in ESRD network activities and pursue network goals. §494.180

Centers for Medicare & Medicaid Services (CMS)

CMS Chief Operating Officer and Acting AdministratorMarilyn Tavenner

The Networks are uniquely positioned to ensure full participation of the ESRD

community in achieving the AIMS of the NQS. The Networks

shall assist providers in adjusting to the heightened focus on patient and family centered care, aiming to help them

optimize customer service.

ESRD Network of Texas, Inc.

• Nonprofit organization, volunteer Boards• ESRD NW of TX, Inc. holds the contract with

CMS for ESRD Network #14, the state of Texas• Office in Dallas• The largest Network in the US based on

numbers of dialysis and transplant patients • 3rd largest in number of providers• 13 Staff members

2012 Network Coordinating Council Input Scan Evaluation of

achievingOur Mission

To support quality dialysis and kidney transplant healthcare through the

provision of patient services, education, quality

improvement, and information management.

To support quality dialysis and kidney transplant healthcare through the

provision of patient services, education, quality

improvement, and information management.

ESRD Network 14 – New Communications Policy

• Most Network 14 to Dialysis Facility correspondence will be sent via email to all registered QIMS users of the facility

• Essential to keep email address updated in QIMS

• Disable accounts for personnel when they leave your facility

2013 Network #14

Growth & Trends

• CMS Certified Facilities

• Facility Ownership

• Growth in Patient Census

• Patients Transplanted

2013 Network #14

Growth & Trends

• CMS Certified Facilities

• Facility Ownership

• Growth in Patient Census

• Patients Transplanted

NETWORK GROWTHNumber of Medicare Certified Providers

44 facilities awaiting Medicare Certification at end of Feb. 2013

44 facilities awaiting Medicare Certification at end of Feb. 2013

National Chain Ownership TX Dialysis facilities

Feb. 2013

Number of Patients 12/31/12

40, 082

9,103

6,234

ESRD Network 14

• Currently providing care and oversight for >50,000 people receiving Renal Replacement Therapies– 40,082 people on dialysis – 54.1% Male– 28.9% African American– 43.2% Hispanic– 70.1% between 50 and 79 years old

Themes of the New ESRD Plan/SOW

• Patient and Family Engagement• Reducing Disparities in Healthcare• Connecting communities, sharing best

practices• Performance-Based Measures

AIM 1: Better Care for the Individual through Beneficiary and Family Centered Care

AIM 1: Better Care for the Individual through Beneficiary and Family Centered Care

Domain Sub-DomainVascular Access Management

Reduce Catheter Rates for Prevalent PatientsSupport Facility Vascular Access ReportingSpread Best PracticesProvide Technical Support in the Area of Vascular AccessRecommend Sanctions

Patient Safety: Healthcare-Acquired Infections (HAIs)

Support National Healthcare Safety Network (NHSN)Establish HAI LANReduce Rates of Dialysis Facility Events

AIM 1: Better Care for the Individual through Beneficiary and Family Centered Care

AIM 1: Better Care for the Individual through Beneficiary and Family Centered Care

AIM 2: Better Health for the ESRD Population

AIM 2: Better Health for the ESRD Population

Population Health Innovation Pilot Project

Reduce Identified Disparity

Increase Hepatitis B (HBV), staff & Patient Influenza, and Pneumococcal Vaccination Rates

Domain Sub-Domain

AIM 3: Reduce Costs of ESRD Care by Improving Care

AIM 3: Reduce Costs of ESRD Care by Improving Care

Support for ESRD Quality Incentive Program (QIP) & Performance Improvement on QIP Measures,Support for Facility Data Submission to CW, NHSN, and/or Other CMS- Designated Data Collection System(s)

Assist Facilities in Understanding and Complying with QIP Processes and RequirementsAssist Beneficiaries and Caregivers in Understanding the QIPAssist Facilities in Improving their Performance on QIP Measures

Domain Sub-Domain

CMS directed organizational changes• Network Council

– Currently 1 representative from all Medicare Certified Facilities

– Divide stat into 5 RAC regions with one representative from each

• Board of Directors– Non renal healthcare members– Non Healthcare members– 2 patients

• Bylaws revision in progress with Electronic bylaws change and election of new Network Council in next 2 months

AIM 1: Better Care for the Individual through Beneficiary and Family

Centered Care

Two Tier Approach to Patient and Family Engagement

Tier 1: Engagement at the dialysis facility level to foster patient and family involvement

Tier 2: Development and implementation of a beneficiary and family centered care focused Learning and Action

Network to promote patient and family involvement at the Network level.

Patient and Family Involvement at the Facility Level

•Webinar on Patient Centered Care (PCC) and Patient Engagement (PE) March 22, 2013 from 12:00 – 1:15pm.

•Free CEUs for nurses, dietitians, social workers & technicians•Registration information available: http://www.esrdnetwork.org/network/calendar.asp

•PCC and PE Mail Out

•Facility onsite visits, the Network will assess whether•The QAPI program includes patient and family participation•Patient and family meetings exist (patient council, support groups, vocational rehabilitation groups, new patient adjustment groups)•Patients and families are involved in the governing body of the facility•Patient’s involvement in plan of care meetings

Patient and Family Engagement – Aim 1

• “In CMS’ view, most Network activities will be enhanced by the Patient’s voice”

• Establish a Patient Learning and Action Network (LAN)– Patient Subject Matter Experts– Family members– Dialysis Facilities– State Surveyors– Other stakeholders

Patient SMEs

•Committed and informed patients•Representative of the demographic characteristics of the Network area

LAN

•Uses change methodologies, tools, and/or time-bounded initiatives.•Engages leaders around an action-based agenda. •Creates opportunities for in-depth learning and problem solving.•Creates an opportunity for communities, with assistance and guidance from the ESRD Network, to harness the knowledge, skills, and abilities of community partners to reach a critical mass of the appropriate stakeholders in the community concerned with a common aim(s).

Aim 1-Patient and Family Engagement

• PE LAN will design and implement a Quality Improvement Activity (QIA)– Topic chosen by SMEs: Patient Centered Care with

a focus on improving patient-provider communication

– Will use a subset of ICH-CAHPS questions to measure improvement

– Facilities will be selected to participate in QIA working with ~4,000 patients and show a 5% relative improvement

Aim 1-Patient and Family Engagement

• PE LAN design 2 Campaigns– Topics:

• New Patient Orientation• Disease Management

– Must impact 20% of Network population (~8,000 patients)

– Must show a 10% improvement in selected measure

– Begin 2nd Quarter

Aim 1-Patient and Family Engagement

For more information on the PE LAN please contact Anna Ramirez

aramirez@nw14.esrd.net469-916-3800

Facilities are still needed to participate!Application available online:

http://www.esrdnetwork.org/professionals/index.asp

Patient Experience of Care – Aim 1• Formerly “Complaints and Grievances”• Satisfaction survey

– All grievants invited to participate– Network must maintain 80% satisfaction rate

• Facilities must inform patients about the Network role in grievances

• Network collaborates with State Surveyors on grievances

Aim 1-Patient Experience of Care

• Grievance Quality Improvement Activity (QIA)– Use grievance data to identify common trend– Select at least 5 facilities for intervention– Selected facilities must show at least 1%

improvement in the measure– Project may be expanded to 100 facilities at CMS’

request

Patient Experience of Care – Aim 1

• Facilities are expected to– Utilize ICH-CAHPS – 2013 QIP Measure– Address issues identified in ICH-CAHPS– Specifically be aware of disparities in care

• Network will– Promote use of ICH-CAHPS– Assist facilities with trend analysis of ICH-CAHPS– 2014: Conduct a QIA using ICH-CAHPS

ICH-CAHPSIn-Center Hemodialysis

Consumer Assessment of Healthcare Providers and

Systems

Patient-Appropriate Access to In-Center Dialysis – Aim 1

• Reduce IVD/IVT by 5% each quarter• Avert 5% of potential IVD/IVT• Network to analyze data to evaluate

discharges for disparities in race, ethnicity, new ESRD versus established patient

• Network to report all actual and potential IVD/IVT, failures to place and at risk

IVD/IVTFacility-generated discharge

or transfer resulting in termination of services for patient. Does not include

transfers due to emergency or other closure.

Vascular Access Management – Aim 1

• Catheter Reduction– Move from a Fistula First to a Catheter Last

approach– Quality Improvement Activity to decrease long-

term catheter utilization begins this quarter• Every facility that shows a long-term catheter rate

greater than 10% in CROWNWeb is selected • Selected facilities must improve monthly and meet an

overall 2% reduction

Vascular Access Management – Aim 1

• Update CROWNWeb monthly with each ICH patient’s vascular access type

• AV Fistulas– New CMS goal: 68%– New MRB goal: 57%– Quality Improvement Activity to increase Network

AVF rate begins this quarter • In conjunction with Catheter focus facilities• Two tiered approach

119 facilities with >10% patients with catheter >=90 days

*CROWNWeb data, facilities with <11 patients excluded (n=13 facilities), pediatric excluded

MRB 2/7/13

Patient Safety – Aim 1

• All facilities participating in NHSN– Enroll– Join Network 14 NHSN Group– Enter monthly data

• Establish HAI LAN– Open to all facilities in the Network– Community Stakeholders

National Healthcare Safety Network

HAI: Healthcare Acquired/ Associated Infections

Patient Safety – Aim 1

• HAI Quality Improvement Activity to Reduce Central-line-associated bloodstream infections (CLABSI)– Select 100 facilities working with ~2,000 patients– Selected facilities must show 5% reduction in

CLABSI– Begins 2nd Quarter

CMS ESRD Network Contract – Aim 2Innovation Pilot Project - Reduce

Disparities inImmunization

Reducing HospitalizationHome Dialysis Placement

Quality of Life

Innovation Pilot Project – Aim 2

• Select topic with 85% of target population not meeting the desired outcome

• Select population group (CMS-defined) with the greatest disparity in outcomes– African American/White– Hispanic/Non-Hispanic– Urban/rural– Male/Female– 65 years old/younger than 65

Innovation Pilot Project – Aim 2

• Select 50 facilities working with ~4,200 patients

• Selected facilities must increase immunization in disparate group by 5 percentage points

• If non-disparate group improves more than disparity group, widening the gap, project fails

CMS ESRD Network Contract – Aim 3

Aim 3Reduce Costs of ESRD Care by Improving Care

Quality Incentive Program (QIP)CROWNWeb

Aim 3Reduce Costs of ESRD Care by Improving Care

Quality Incentive Program (QIP)CROWNWeb

Quality Incentive Program – Aim 3

• Facility Responsibility– Submit accurate quality data– Complete QIP requirements timely– Review Performance Score Report within 5 days– Post Performance Score Certificate within 5 days– Address QIP performance issues to deliver high

quality of care

Quality Incentive Program – Aim 3

• Network responsibility– Assist patients in understanding QIP– Help facilities improve QIP outcomes– Remind facilities of due dates– Provide feedback to CMS on any adverse impact to

patients and intervene to correct – Discuss QIP measures and results with State

Surveyors

CROWNWeb – Aim 3

• Enter data into CROWNWeb accurately and timely

• If you are a “batch” facility, make sure loaded data is correct

• Make sure your QIMS enrollments are up to date

• For technical issues, contact QualityNet Help Desk at qnetsupport-esrd@sdps.org

• Contact Network 14 at crownweb@nw14.esrd.net

• Visit http://projectcrownweb.org for the latest CROWNWeb news and training modules

CROWNWeb – Aim 3

Summary

• Patient/Family Engagement in all• Patient-Centered Care and Policies• Reduction / elimination of Disparities in

Healthcare• Performance-based measures

Summary

• 5 Quality Improvement Activities– Patient/Family engagement– Grievances– Decreasing Catheter Use– Healthcare Acquired/Associated Infections– Reducing disparity in Immunizations

Summary

• 2 Educational Campaigns• Grievance resolution• Reducing IVD/IVT• CROWNWeb, NHSN, Dialysis Facility Reports• QIP Tracking and Education

Questions?

We will post a Q&A response on our Website within 2 weeks

www.esrdnetwork.org

Send us an emailSubject line: Ask the Network

info@nw14.esrd.net