Entering A New Era Together

NEW Expectations, Activities and OPPORTUNITIES

March 7, 2013

Today's presenters

 Glenda Harbert, RN, CNN, CPHQ

Executive Director



Anna Ramirez, MPH, CPH Community Outreach Coordinator

 Kelly Shipley, RHIA

Quality Improvement Director



Treneva Butler, LCSW Patient Services Director

 Nathan Muzos, BS

Information 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 Secretary Kathleen Sebelius

Centers for Medicare & Medicaid Services (CMS)

• • CMS, 1 of 11 HHS Divisions, administers the ESRD Medicare Program CMS’ Aims for the ESRD Program 1. Better Care for the Individual through Beneficiary and Family Centered Care 2. Better Health for the ESRD Population 3. 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 – CMS contracts with 18 ESRD Networks to oversee ESRD care nationally dialysis facility must cooperate with the ESRD Network Contract/Statement of Work describes projects required to accomplish the 3 aims and the national quality goals ESRD network activities and pursue network goals.

§494.180

Centers for Medicare & Medicaid Services (CMS)

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. CMS Chief Operating Officer and Acting Administrator Marilyn Tavenner

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 3 rd largest in number of providers 13 Staff members

2012 Network Coordinating Council I

nput Scan

Evaluation of achieving Our Mission

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

NETWORK GROWTH

Number of Medicare Certified Providers 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 Vascular Access Management Patient Safety: Healthcare-Acquired Infections (HAIs) Sub-Domain Reduce Catheter Rates for Prevalent Patients Support Facility Vascular Access Reporting Spread Best Practices Provide Technical Support in the Area of Vascular Access Recommend Sanctions Support National Healthcare Safety Network (NHSN) Establish HAI LAN Reduce Rates of Dialysis Facility Events

AIM 2: Better Health for the ESRD Population

Domain Sub-Domain Reduce Identified Disparity Population Health Innovation Pilot Project Increase Hepatitis B (HBV), staff & Patient Influenza, and Pneumococcal Vaccination Rates

AIM 3: Reduce Costs of ESRD Care by Improving Care

Domain 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) Sub-Domain Assist Facilities in Understanding and Complying with QIP Processes and Requirements Assist Beneficiaries and Caregivers in Understanding the QIP Assist Facilities in Improving their Performance on QIP Measures

• • •

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

LAN

1

• • Uses change methodologies, tools, and/or Engages leaders around an action-based enhanced by the Patient’s voice”

Committed and

Network (LAN)

Representative of the

– • • Creates opportunities for in-depth learning Establish a Patient Learning and Action Creates an opportunity for communities, with assistance and guidance from the Patient Subject Matter Experts skills, and abilities of community partners Family members to reach a critical mass of the appropriate stakeholders in the community concerned – Dialysis Facilities with a common aim(s). – State Surveyors – Other stakeholders

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 2 nd Quarter

Aim 1-Patient and Family Engagement

For more information on the PE LAN please contact Anna Ramirez [email protected]

469-916-3800 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 – – ICH-CAHPS 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

Patient-Appropriate Access to In Center Dialysis – Aim 1

• • • Reduce IVD/IVT by 5% each quarter Avert 5% of potential IVD/IVT IVD/IVT or transfer resulting in termination of services for discharges for disparities in race, ethnicity, • Network to report all actual and potential IVD/IVT, failures to place and at risk

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 30 25 20 15 10 5 0

Distribution of Catheter >=90 days October 2012, facilities >=50 patients (n=292 facilities)*

N=83 facilities with >10% pts with Catheter >=90 days 10 14 11 6 5 6 2 4 4 3 3 1 1 2 2 2 1 1 1 1 1 1 facility 50% of pts 1

Percent of Patients with Catheter >=90 days

*CROWNWeb data, facilities with <11 patients excluded (n=13 facilities), pediatric excluded 20 15 10 5 0 45 40 35 30 25

Distribution of Catheter>=90 days October 2012, facilities with <50 patients (n=153 facilities)*

N=36 facilities with >10% pts with Catheter >=90 days 1 facility 75% of pts

Percent of Patients with Catheter >=90 days

MRB 2/7/13

Patient Safety – Aim 1

• • All facilities participating in NHSN – Enroll National Healthcare Safety Network – Join Network 14 NHSN Group – Enter monthly data Establish HAI LAN – Open to all facilities in the Network – Community Stakeholders

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 2 nd Quarter

CMS ESRD Network Contract – Aim 2

Innovation Pilot Project - Reduce Disparities in  Immunization Reducing Hospitalization Home 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 3



Reduce 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

CROWNWeb – Aim 3

• For technical issues, contact QualityNet Help Desk at [email protected]

• Contact Network 14 at [email protected]

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

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?

Send us an email Subject line: Ask the Network [email protected]

We will post a Q&A response on our Website within 2 weeks www.esrdnetwork.org