Network of New England

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Network of New England An Educational Day
Time Out For Technicians

• April 24, 2008

Douglas Shemin, MD Network Chairman
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(No Transcript)
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ESRD Network Organization

• ESRD Medicare Program Public Law 92-603 in 1972.
• Medicare coverage for ESRD began July 1973.
• ESRD Network Coordinating Councils (32 areas)
  established in 1978, consolidated to 18 networks
  in 1988.
• Network Organizations are independent
  contractors. Performance evaluated by CMS
  annually. 2/18 networks now administered by QIOs
• Contracts renewed every 3 years based on
  performance.
• Network of New England, Inc. (not-for-profit
  corporation) has held the ESRD Network contract
  for 30 years.
• New contract effective July 1, 2006 for three
  years.

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ESRD Network Organization

• Each network has paid staff, volunteer Board of
  Directors (BOD), volunteer Medical Review Board
  (MRB). The MRB reviews, suggests QI projects,
  reviews grievances and complaints), and patient
  advisory committee.
• BOD and MRB made up of nephrologists, nurses,
  dieticians, social workers, administrators,
  transplant professionals, patient
  representatives and technicians.
• Network of New England welcomes interested renal
  professionals to our BOD and MRB.

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What do the Networks do?

• Collect data (demographics, comorbidity,
  mortality information) on gt 400,000 patients in gt
  4000 facilities
• Assess Data Identify QI needs on a local level,
  institute and administer QI projects, offer
  assistance to underperforming facilities
• Respond to grievances, complaints, concerns by
  patients, families, and facilities.
• Special projects

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New England ProviderDistribution
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Number of ESRD Providers 2001 2006
 
 
ESRD Resources in New England 12/31/2001
 
 
ESRD Resources in New England 12/31/2006
 
 
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Modality By State 2001 2006
 
 
2001 Dialysis Prevalence by Modality Provider
of Service
 
 
2006 Dialysis Prevalence by Modality Provider
of Service
 
 
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Dialysis Patient Characteristics in New
England Dialysis Population 12/31/2006

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From Network 1 Annual Report 2006 in New
England, 27 working age dialysis patients work,
3 go to school
patients 18-54 Employed school
CT 3,389 962 277 23
MA 5,091 1,334 351 52
RI 880 208 45 5
VT 291 57 5 1
NH 731 194 53 4
ME 958 228 64 4
Total 11,340 2,983 795 89
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Providers with Treatments after 5PM
2001 2001 2001 2006 2006 2006
Dialysis Providers Providers w/ shift after 5PM Providers w/ shift after 5PM Dialysis Providers Providers w/ shift after 5PM Providers w/ shift after 5PM
CT 32 7 22 31 9 29
MA 67 26 39 74 26 35
ME 13 6 46 18 5 28
NH 10 6 60 10 5 50
RI 14 2 14 18 2 11
VT 6 4 80 7 6 86
Total 142 51 36 158 53 34
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Dialysis Providers by Ownership12/31/2006
For profit chain Hospital Independent, nonprofit Total
CT 26 5 31
MA 51 23 74
ME 10 8 18
NH 9 1 10
RI 15 3 18
VT 0 7 7
Total 111 47 158
Percent 70 30 100
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Goals adjusted by the BOD/MRB 6/07.
Source CMS/CPM 2006/2007 report, which has
2005/2006 data. Serum Albumin is not considered
a CPM. Note Annual random 5 patient
sample
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4 targets KT/V gt 1.2, Hgb gt 11, AVF, albumin gt
4

• Rocco, Annals Internal Medicine, 2006
• 1 year death rate
• 4/4 targets 7
• 3/4 targets 14
• 2/4 targets 21
• 1/4 targets 25
• 0/4 targets 29

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Why Fistula First?

• Better solute clearance with AV Fistulae
• Much lower risk of infection Sixfold greater
  rate of bacteremia with catheters (Hosp Inf
  Disease 2003)
• Lower risk of death with AV Fistulae (from
  CHOICE Study, JASN 2007)47 higher adjusted
  mortality rate in catheter patients compared to
  AVF patients

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Prevalent Vascular Access Network 1 and
StateJan. 2007 to Jan. 2008
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Quality Improvement Initiatives

• Fistula First increase to 66 by 2009
• Clinical Performance Measures for focused
  intervention
• Anemia Management
• Network Special QI Projects
• Catheter reduction
• Nutrition management
• Patient Safety
• Facility Specific Quality Assessment and
  Performance Improvement Projects
• Use data profiles to identify providers needing
  assistance
• Provide QI technical assistance to dialysis
  providers

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5 Diamond Patient Safety ProgramESRD Network of
New England(Network 1)Mid-Atlantic Renal
Coalition(Network 5)
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Patient Safety Culture

• Pervasive Commitment to Patient Safety
• Open Communication
• Blame-free Environment
• Safety Design
• Employee Physician Involvement Accountability

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Objectives

• To promote patient safety values
• To create an awareness of patient safety issues
• To help dialysis units learn more about specific
  areas of patient safety
• To build a patient safety culture in every
  dialysis unit

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Educational Modules

• Patient Safety Principles (required)

• Hand Washing
• Flu Vaccination
• Slips, Trips and Falls
• Medication Reconciliation

• Emergency Preparedness
• Sharps Safety
• Decreasing Patient Provider Conflict

• Under Development
• Staff Adherence to Procedures
• Dialyzer Set-up Errors

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Modules

• Each topic is a complete educational module
• Tools and resources are located on the Network of
  New England website
• Required and optional activities
• PowerPoints for staff in-service presentations
• Posters for display
• Games and activities to engage patients

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Recognition

• All participants completing at least one
  component or more will be recognized
• 1 4 Diamonds
• Acknowledged in Network Newsletter
• Listed on Network Website

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Recognition - 5 Diamond

• Acknowledged in Network Newsletter
• Listed on Website
• Special recognition at Annual Network Council
  Meeting
• 2 free passes to Annual Meeting
• 75.00 gift certificate for entertainment
  material for patients
• Plaque to display in unit

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Details

• Time frame
• Starts April 2008 in Network 1
• Launch project at Technician Meeting
• April 24, 2008
• Mass Mailing to all Providers Medical Directors
• Requires registration to do the program and
  submission of documentation when each module is
  completed by dialysis provider

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Promote

• Please go back to your facility and encourage
  your management to participate in this
  educational safety effort.

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ESRD Community Information Clearinghouse/Resour
ce

• Promote patient, public, and professional
  education
• Maintain a resource library of educational
  materials
• Conduct workshops on quality of care concepts
• Distribute a newsletter to dialysis and
  transplant facilities
• Maintain Network website, with QI links
• Establish partnership and collaborative
  activities
• Major disaster coordination
• Assist patients, family or providers
• Provide consultation or investigation

Complaints/Grievances
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Network Leadership 3 Face to Face Meetings per
Year

• Board of Directors 25 to max of 40 members.
  Term of service is 2 years but can be renewed to
  a max of 4 years.
• Medical Review Board 15 to max of 20 members.
  Term of service is 2 years but can be renewed to
  a max of 4 years.
• Election to be held in November 2007. Terms
  begin January 2008.
• 1/3 of BOD and MRB rotate off at each election
  cycle.

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CMS Conditions of Coverage for ESRD Facilities
Final Rule Published 4/15/08

• Highlights of Provisions in the Final Rule
  Include
• Updated CDC guidelines for hemodialysis
  facilities
• Updated AAMI water quality guidelines
• Defibrillators in every dialysis unit
• Incorporates sections of the 2000 Life Safety
  Code for fire safety
• Option for patients to have an advance directive

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Highlights of Provisions in the Final Rule
Continued

• Facilities provide written notice 30 days before
  a patient is involuntary discharged
• Facilities perform clinical assessment within 30
  days, or 13 hemodialysis treatments, of patient
  starting treatment
• Home dialysis water purity requirements based on
  updated AAMI standards
• Facility-level quality assurance and performance
  improvement program

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Highlights of Provisions in the Final Rule
Continued

• Minimum qualifications and training requirements
  for patient care technicians (PCTs)
• Responsibility of Medical Director for Quality
  Assessment and Performance Improvement (QAPI) and
  involuntary transfers or discharges
• Electronic data collection and reporting
• The CMS link to the final rule
• www.cms.hhs.gov/CFCsAndCoPs/downloads/ESRDdisplayf
  inalrule.pdf

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Effective Dates
New Conditions for Coverage 6 months 10/14/2008
Life Safety Code and Separate room for HBsAg patients 300 days 2/9/2009
Certification of technicians hired after 10/4/2008 18 months from hire
Certification of existing technicians 24 months 4/15/2010
Governance Electronic Data Submission As of
2/1/2009, every facility must electronically
submit data on all patients, including data on
clinical performance measures, to CMS.
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Thank you for all the good work you do for your
patients