Network Council Meeting Westin Hotel Indianapolis, IN March 10, 2009 6:00PM The Renal Network facilitates the achievement of optimal wellness for renal disease patients.
PRESIDENT S REPORT George Aronoff, MD
Network 9/10 By the Numbers Network 9 Network 10 470 Dialysis Facilities 13 Transplant Centers 26,228 Patients 218 Dialysis Facilities 8 Transplant Centers 15,607 Patients
70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Network 9/10 Vital Stats Light Shaded Bars - Network 9 Dark Shaded Bars - Network 10 0-17 18-44 45-64 65-74 75-Up Black White Other Male Female Diabetes Hypertension GN Unknown Other 0-6 months 6-12 months 1-2 years 2-3 years 3-4 years 4-5 years 5 - up years Age (years) Race Gender Primary Cause of Renal Failure Time On Dialysis
600 Dialysis Providers by Network by Ownership 500 400 ies Number of Faciliti 300 NON-LDO LDO 200 100 0 16 3 1 17 10 2 4 15 12 13 18 5 7 8 11 14 9 6 Networks
Year In Review Conditions for Coverage - October 14, 2008 CROWN Web Preparation MIPPA Legislation Passed Disaster Planning? Earthquakes Tornados Floods Ice Storms
NOMINATING COMMITTEE REPORT Craig Stafford, MD
Nominations Board of Trustees Open Positions 1 Nephrologist 1 Social Worker 1 Dietitian 1 Administrator 1 Technician
Nominations Medical Review Board Open Positions 4 Nephrologists 1 Transplant Nephrologist 1 Nurse 1 Social Worker 2 Technicians
Election Process MARCH 10, 2009: Nomination process closes following the Network Council meeting. JULY 2009: The Nominating Committee will review all nominations to decide the slate. AUGUST 2009: The slate will be sent to the Board of Trustees for approval. OCTOBER 2009: Ballots will be sent to all voting members, to include: Facility Representatives to the Network Council Board of Trustees Medical Review Board Patient Leadership Committee NOVEMBER 2009: Successful candidates will be notified of their election.
MEDICAL REVIEW BOARD REPORT Peter DeOreo, MD
QUALITY IMPROVEMENT WORK PLAN (QIWP) Quality Improvement Projects: Prevalent Fistula Rates Catheter Reduction Adequacy of Dialysis Anemia Management
Fistula First Contract Goals March 2009 Network CMS 2009 Goal December 2008 Variance 9 48.8% 47.3% -1.5 10 50.3% 49.1% -1.2
Vascular Access Prevalent Fistula Rates December 2007 December 2007 December 2008 December 2008 Prevalent Fistula Rates December 2007 December 2007 December 2008 December 2008 Ashtabula Lake Lucas Steuben Cook Du Page Lake Kane McHenry Winnebago Carroll De Kalb Jo Daviess Lee Stephenson Ogle Whiteside Boone P W U V Morga n Unio n Columbiana Mahoning Trumbull Portage Summit Cuyahoga Geauga Lorain Medina Defiance Erie Fulton Henry Huron Lucas Ottawa Sandusky Seneca Williams Wood Allen Auglaize Hancock Hardin Logan Mercer Paulding Putnam Van Wert Ashland Carroll Crawford Holmes Richland Stark Tuscarawas Wayne Belmont Coshocton Guernsey Harrison Hocking Monroe Morgan Muskingum Noble Perry Washington Jefferson Champaign Clark Darke Greene Miami Montgomery Preble Shelby Butler Clinton Warren Delaware Fairfield Franklin Knox Licking Madison Marion Morrow Pickaway Union Wyandot Fayette Adams Allen Cass De Kalb Elkhart Fulton Huntington Jasper Kosciusko La Grange Lake La Porte Marshall Miami Newton Noble Porter Pulaski St Joseph Starke Steuben Wabash Wells Whitley Benton Blackford Boone Carroll Clinton Delaware Fountain F kli Grant Hamilton Hancock Hendricks Henry Howard Jay Johnson Madison Marion Montgomery Morgan Randolph Rush Shelby Tippecanoe Tipton Warren Wayne White Union Fayette Clay Parke Putnam Vermillion Vi Whiteside Henry Mercer Rock Island Grundy Kankakee Kendall Will Bureau Fulton Henderson Knox La Salle McDonough Marshall Peoria Putnam Stark Tazewell Warren Woodford Champaign Coles De Witt Douglas Edgar Ford Iroquois Livingston McLean Macon Moultrie Piatt Vermilion Adams Brown Cass Christian Hancock Logan Mason Menard Morgan Pike Sangamon Schuyler Scott X S Y R Q N M G H F L K J I D E n Vanderbur gh Anderso n Campbe ll Frankli n Garrar d Trimbl e Athens Gallia Jackson Lawrence Meigs Vinton Adams Brown Butler Clermont Clinton Hamilton Highland Warren Pike Ross Scioto Franklin Bartholomew Brown Clark Clay Crawford Daviess Dearborn Decatur Dubois Floyd Gibson Greene Harrison Jackson Jefferson Jennings Knox Lawrence Martin Monroe Ohio Orange Owen Perry Pike Posey Ripley Scott Spencer Sullivan Switzerland Vigo Warrick Washington Vanderburgh Clark Cumberland Shelby Calhoun Greene Jersey Macoupin Montgomery Clinton Madison Monroe St. Clair Alexan Bond Clay Crawford Edwards Effingham Fayette Franklin Gallatin Hamilton Hardin Jackson Jasper Jefferson Johnson Lawrence Marion Massac Perry Pope Pulaski Randolph Richland Saline Union Wabash Washington Wayne White Williamson Bath Boone Bourbon Boyd Boyle Bracken Breathitt Campbell Carroll Carter Casey Clark Clay Elliott Estill Fayette Fleming Floyd Gallatin Grant Greenup Harrison Henry Jackson Jessamine Johnson Kenton Knott Lawrence Lee Lewis Lincoln Madison Magoffin Marion Martin Mason Menifee Mercer Montgomery Morgan Nicholas Owen Owsley Pendleton Perry Pike Powell Robertson Rockcastle Rowan Scott Shelby Spencer Washington Wolfe Woodford Franklin Gerrard Anderson Breckinridge Bullitt Butler Crittenden Daviess Edmonson Grayson Green Hancock Hardin Hart Henderson Hopkins Jefferson Larue Livingsto n McLean Meade Muhlenberg Nelson Ohio Oldham Taylor Trimble Union Webster T Z O A B C der Adair Bell Clay Clinton Cumberland Harlan Knox Laurel Leslie Letcher McCreary Pulaski Russell Wayne Whitley Allen Ballard Barren Butler Caldwell Calloway Carlisle Christian Edmonson Fulton Graves Hickman n Logan Lyon McCracken Marshall Metcalfe Monroe Muhlenberg Simpson Todd Trigg Warren
Vascular Access Prevalent Catheter Rates December 2007 December 2007 December 2008 December 2008 Prevalent Catheter Rates December 2007 December 2007 December 2008 December 2008 Ashtabula Lake Fulton Lucas Ott Williams Elkhart La Grange St Joseph Steuben Cook Du Page Lake Kane McHenry Winnebago Carroll De Kalb Jo Daviess Lee Stephenson Ogle Whiteside P W U V Morga n Unio n Columbiana Mahoning Trumbull Portage Summit Cuyahoga Geauga Lorain Medina Defiance Erie Henry Huron Ottawa Sandusky Seneca Williams Wood Allen Auglaize Hancock Hardin Logan Mercer Paulding Putnam Van Wert Ashland Carroll Crawford Holmes Richland Stark Tuscarawas Wayne Athens Belmont Coshocton Guernsey Harrison Hocking Monroe Morgan Muskingum Noble Perry Vinton Washington Champaign Clark Darke Greene Miami Montgomery Preble Shelby Butler Clinton Warren Delaware Fairfield Franklin Knox Licking Madison Marion Morrow Pickaway Ross Union Wyandot Fayette Adams Allen Cass De Kalb Elkhart Fulton Huntington Jasper Kosciusko La Grange Lake La Porte Marshall Miami Newton Noble Porter Pulaski St Joseph Starke Wabash Wells Whitley Benton Blackford Boone Carroll Clinton Delaware Fountain Franklin Grant Hamilton Hancock Hendricks Henry Howard Jay Johnson Madison Marion Montgomery Morgan Randolph Rush Fayette Shelby Tippecanoe Tipton Warren Wayne White Union Bartholomew Clay Decatur Owen Parke Putnam Vigo Henry Mercer Rock Island Grundy Kankakee Kendall Will Bureau Fulton Knox La Salle McDonough Marshall Peoria Putnam Stark Tazewell Warren Woodford Champaign Clark Coles C b l d De Witt Douglas Edgar Ford Iroquois Livingston McLean Macon Moultrie Piatt Shelby Adams Brown Cass Christian Greene Hancock Logan Mason Menard Montgomery Morgan Pike Sangamon Schuyler Scott X S Y R Q N M G H F C L K J I D E Vanderbur gh Anderso n Campbe ll Frankli n Garrar d Trimbl e Gallia Jackson Lawrence Meigs Adams Brown Clermont Hamilton Highland Pike Scioto Bartholomew Brown Clark Crawford Daviess Dearbor n Decatur Dubois Floyd Gibson Greene Harrison Jackson Jefferson Jennings Knox Lawrence Martin Monroe Ohio Orange Perry Pike Posey Ripley Scott Spencer Sullivan Switzerland Warrick Washington Vanderburgh Cumberland Jersey Macoupin Montgomery Clinton Madison Monroe St. Clair Bond Clay Crawford Effingham Fayette Franklin Gallatin Hamilton Hardin Jackson Jasper Jefferson Johnson Lawrence Marion Massac Perry Pope Pulaski Randolph Richland Saline Union Washington Wayne White Williamson Adair Bath Boone Bourbon Boyd Boyle Bracken Breathitt Campbell Carroll Carter Casey Clark Clay Elliott Estill Fayette Fleming Floyd Gallatin Grant Greenup Harrison Henry Jackson Jessamine Johnson Kenton Knott Knox Laurel Lawrence Lee Leslie Letcher Lewis Lincoln Madison Magoffin Marion Martin Mason Menifee Mercer Montgomery Morgan Nicholas Owen Owsley Pendleton Perry Pike Powell Pulaski Robertson Rockcastle Rowan Russell Scott Shelby Spencer Washington Wayne Wolfe Woodford Franklin Gerrard Anderson Ballard Barren Breckinridge Bullitt Butler Caldwell Christian Crittenden Daviess Edmonson Grayson Green Hancock Hardin Hart Henderson Hopkins Jefferson Larue Livingsto n Logan Lyon McCracken McLean Meade Metcalfe Muhlenberg Nelson Ohio Oldham Taylor Union Warren Webster T Z O A B C Bell Clinton Cumberland Harlan Knox McCreary Wayne Whitley Allen Calloway Carlisle Fulton Graves Hickman Logan Marshall Monroe Simpson Todd Trigg
60.0% 50.0% % Prevalent Patients Using a Fistula by State & Network Network Goal 58% 40.0% 30.0% 20.0% DEC2004 DEC2005 DEC2006 DEC2007 DEC2008 10.0% 0.0% IN KY OH NW9 IL DEC2004 33.7% 36.8% 34.6% 34.7% 36.6% DEC2005 35.3% 41.6% 38.2% 38.0% 39.3% DEC2006 37.5% 46.8% 42.6% 41.9% 42.7% DEC2007 40.5% 50.7% 44.2% 44.3% 46.1% DEC2008 43.6% 53.8% 47.2% 47.3% 48.9%
% Prevalent Patients Using a Catheter by State & Network 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% DEC2004 DEC2005 DEC2006 DEC2007 DEC2008 5.0% 0.0% IN KY OH NW9 IL DEC2004 32.1% 30.8% 34.7% 33.3% 30.5% DEC2005 34.5% 29.1% 35.0% 33.9% 31.9% DEC2006 35.7% 27.3% 32.2% 32.4% 31.9% DEC2007 34.3% 26.6% 32.1% 31.7% 31.7% DEC2008 33.7% 24.7% 29.9% 30.1% 30.7%
Network 9 December 2008 1800 1600 1400 1200 Tota al # Prevalent Patie ents 1000 800 600 400 200 0 0 15 17 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 78 81 100 Facility Prevalent Fistula Rate
Network 10 December 2008 1400 1200 1000 Tota al # Prevalent Patie ents 800 600 400 200 0 15 20 24 26 30 32 34 36 38 40 42 44 46 48 50 52 54 56 59 61 63 65 67 69 71 76 100 Facility Prevalent Fistula Rate
Network 9 December 2008 30 25 20 # Facilities 15 10 5 0 0 15 17 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 78 81 100 Prevalent Fistula Rate
Network 10 December 2008 18 16 14 12 # Facilities 10 8 6 4 2 0 15 20 24 26 30 32 34 36 38 40 42 44 46 48 50 52 54 56 59 61 63 65 67 69 71 76 100 Prevalent Fistula Rate
Vascular Access Program Management QIP Program management training including continuous quality improvement (CQI) techniques Assemble a vascular access interdisciplinary team Conduct regular team QAPI meetings Collect data monthly and report outcomes to the Network Identify barriers to fistula placement and usage Develop/change structured processes Utilize the reports provided in the collection tool for specific surgeon and Nephrologist reporting Nine Network 9 facilities participating Nine Network 10 facilities participating
Vascular Access Coordinator QIP Assign vascular access coordinator at participating facilities Root cause analysis to identify facility barriers to fistula placement and usage Develop intervention strategies Complete a project plan to improve prevalent fistula rates Submit the project plan to the Network Share project plans and ideas with other participants Report progress quarterly through updated project plans 167 facilities participating in Networks 9 and 10
Physician Regional Learning Sessions Learning session goal - to increase physician leadership, commitment and involvement in fistula prevalence quality improvement and to encourage facility adoption of policies and procedures for improved vascular access management. Learning session programs include the following topics: facility data including trends and regional comparisons physician py specific data routine CQI techniques best practices in fistula placement and usage process change tools and resources surgical and interventional techniques for AVF placement and use networking with mentor facilities patient & staff culture 15 facilities in Network 9 7 facilities in Network 10
Fistula Surveillance QIP Targets facilities needing assistance in monitoring and maintenance of placed fistulas. The facilities were be asked to: Complete a questionnaire designed to identify the facility barriers to fistula maturation in patients with placed fistulas Provide an action plan to improve fistula maturation Provide data monthly using a data collection tool that t identifies patient t level fistula rates by physician and surgeon Utilize the specific physician and surgeon data in the CQI activities as a comparison reporting tool To attend two learning sessions to discuss barriers to appropriate fistula placement and best practice models 19 facilities in Network 9 5 facilities in Network 10
Vascular Access Reporting QIP Enhanced Fistula First report - sent to all facility medical directors, administrators, vascular access coordinators/nurse managers quarterly. Report now includes: the number of patients needed to reach the Network goal the percentage of prevalent AV fistulas within their facilities. The report will assist facility QAPI Interdisciplinary teams in managing g the prevalent patient fistula rate by having a concrete number of patients to change vascular access. Facility staff will be asked to: Use this report as a part of their vascular access QI program to chart their progress in reaching Network and CMS targets Use the number of fistulas needed as a guide to manage identification of patients that need vascular access intervention Complete and submit to the Network, an environmental scan to determine how the reports were used by the vascular access team
Vascular Access QIPs Nt Network k9 Project March 31, 2009 December 2008 Variance Goal Fistula Rate Network 9 VA Program Management 48.8% 47.3% -1.5 percentage points Interventions 28 New Fistulae 52 +24 VA Coordinator 295 New Fistulae 211-84 Regional Learning Sessions 35 New Fistulae 40 +5 Fistula Surveillance 38 New Fistulae 41-3 Total New Fistulae Needed to reach 4% 932
Vascular Access QIPs Network 10 Project March 31, 2009 Goal Fistula Rate Network December 2008 Variance 50.3% 49.1% -1.2 percentage points Interventions VA Program 26 New Fistulae 56 +30 Management VA Coordinator 138 New Fistulae 210 +72 Regional Learning Sessions 19 New Fistulae 26 +7 Fistula Surveillance 13 New Fistulae 10-3 Total New Fistulae Needed to reach 4% 546
Catheter Reduction QIP Interventions address facility policies/procedures for reducing the prevalence of permanent catheters including: 1. No policies or procedures in place for evaluating catheter patients for an AVF Tools and resources on policy and procedure development provided Learning sessions. - Topics include best practice models, and data describing patient and facility infection, hospitalization and mortality rates related to increased chronic catheter usage. 2. No formal tracking of catheter patients to ensure that a plan is developed for catheter removal vascular access quality improvement data collection tool provided to collect and analyze data monthly. Quarterly feedback reports comparing outcomes to other QIP participants
Catheter Reduction QIP 3. No structured CQI vascular access management program Facility VAC and Medical Directors will receive instruction on using the vascular access quality improvement template including the vascular access needs assessment. designed to provide a structure for a vascular access management program. Facility VAC and Medical Directors will submit a facility barriers questionnaire and an action plan Facility VAC and Medical Directors will attend scheduled learning sessions. Topics will include best practice models and QAPI development to assist in catheter 9 facilities in Network 9 9 facilities in Network 10
Catheter Reduction QIP Nt Network Goal December 2008 Variance Results 9 5 Targeted 8 targeted +3 Facilities decrease chronic catheter population by 20 percent facilities have decreased chronic catheter population by 20 percent 10 5 Targeted Facilities decrease 8 targeted facilities have +3 chroniccatheter t population by 20 percent decreased d chronic catheter population by 20 percent
Fistula First Update Other Activities Buttonhole Technique Webex Physician Incident Reports based on 2728 data Vascular Access QAPI Template Change Concept Education Mailing Medical Director Mailing
Hemodialysis Adequacy Goal 95% or More Patients Achieve a URR of 65% And a Kt/V of 1.2 12
National CPM Data Collection % Patients with Kt/V 1.2 4 th Quarter 2007 100 90 80 70 60 50 40 30 20 10 0 17 5 2 10 11 13 15 US 3 6 7 12 18 1 4 8 9 14 16
Percentage of HD Patients with Reported Kt/V >= 1.2 by State and Network 9/10 for Selected Collection Periods % pat tients 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 4Q96 4Q98 4Q00 4Q02 4Q03 4Q05 4Q06 4Q07 4Q08 IL 66% 78% 82% 88% 91% 92% 93% 93% 93% IN 76% 86% 89% 92% 93% 95% 94% 94% 94% KY 64% 78% 86% 91% 89% 93% 94% 94% 94% OH 71% 84% 87% 90% 91% 92% 93% 94% 94% Net 9/10 70% 82% 86% 90% 91% 93% 93% 94% 94%
Adequacy QIP Target facilities include dialysis facilities with <74.7% of patients with URR 65% To address barriers, the medical director, head nurse and other facility staff will: Complete a Facility Barriers to Adequate Dialysis Questionnaire and submit to the Network. Network QI staff work with the facilities to develop action plans to address facility specific barriers. Receive model policies and algorithms to address adequacy protocols from Network QI staff Submit data and complete the Needs Assessment Report monthly via the Hemodialysis Adequacy Template data collection tool
Adequacy QIP Goal 4 th Quarter 2008 Results Variance 60% of Targeted facilities meet the Network average of 88% 77.8% of targeted facilities have met goal + 17.8
Anemia Management Goal Goal has been replaced by A Statement on the Use of ESA in CKD Patients Requiring Dialysis Developed by the Medical Review Board www.therenalnetwork.org
100 National CPM Data Collection % Pts with mean Hgb 11g/dl 4 th Quarter 2007 90 80 70 60 50 40 30 20 10 0 2 4 8 9 13 5 6 10 11 12 16 US 3 7 15 17 18 1
Percentage of HD Patients with HGB>= 11 gm/dl by State and Network 9/10 for Selected Collection Periods % pa atients 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 4Q98 4Q00 4Q02 4Q04 4Q05 4Q06 4Q07 4Q08 IL 55% 73% 79% 83% 81% 82% 80% 76% IN 61% 75% 81% 84% 81% 82% 80% 74% KY 57% 73% 79% 82% 81% 83% 80% 74% OH 59% 70% 77% 83% 83% 83% 80% 75% Net 9/10 58% 72% 79% 83% 82% 83% 80% 75%
Percentage of PD Patients with HGB >= 11 gm/dl by State and Network 9/10 for Selected Collection Periods ients % pat 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% S-D 99 S-D 01 S-D 02 O-D 04 O-D 05 O-D 06 O-D 07 O-D 08 IL 65% 71% 76% 77% 75% 77% 73% 72% IN 70% 78% 79% 78% 78% 77% 77% 70% KY 68% 76% 77% 84% 78% 83% 76% 73% OH 68% 71% 74% 79% 77% 78% 76% 74% Net 9/10 68% 73% 76% 79% 77% 78% 75% 72%
Anemia Management QIP The MRB identified three barriers to increasing the hemoglobin target range (percent of patients in 10-1212 gm/dl): Lack of awareness and understanding of the new FDA hemoglobin target range of 10-1212 gm/dl Failure to adapt ESA dosing algorithms to new hemoglobin target t range Lack of awareness that based on the underlying distribution of the hemoglobin concentration in the population (all patients in the Network), one can reasonably expect to see specific percentages outside the target range and that this is dependent on facility size.
Anemia Management QIP To address barriers, all dialysis facilities in the Network 9/10 area will be educated on the new clinical performance measures and be provided with dosing algorithms to help achieve target hemoglobin. Dialysis facilities will receive five resources: FDA Statement on ESAs along with revised Network 9/10 goal for Anemia Management Facility specific anemia data report based on 2007 Elab data with regional comparatives The Hemoglobin Target Calculator and instructions for use MRB Recommendations to Medical Directors on achieving i hemoglobin targets Notification that sample algorithms targeting a mean Hgb of 11gm/dl are posted on the Network website
Anemia Management QIP Recommendations to all medical directors, physicians and nurse managers include- Head nurses track their monthly mean hemoglobin to ensure that this average is moving to the target (11gm/dl) recommended by the calculator. Failure of the mean hemoglobin to fall below 11.5 gm/dl should prompt a review of the facility's anemia management protocol. Medical Directors should compare the observed percentage of patients in each of the three monitoring ranges to the expected percentage identified by the calculator and make changes to the facility s anemia management protocol as necessary.
Percentage of All Patients with Hgb 10-12gm/dl 60% 50% 40% 30% 20% 10% 4Q07 4Q08 0% IL IN KY OH Network 4Q07 49% 48% 50% 53% 51% 4Q08 58% 57% 59% 60% 59%
Other CPM Outcomes
Nutrition Goal All patients will have serum albumin measured and evaluated each month. A stabilized serum albumin equal to or greater than the lower limit of the normal range (approximately 3.5g/dl for bromcresol green)
National CPM Data Collection % Pts with mean serum albumin 3.5/3.2 g/dl 4 th Quarter 2007 100 90 80 70 60 50 40 30 20 10 0 4 9 11 7 1 2 13 17 5 8 10 12 16 US 15 14 3 6 18
Percentage of HD Patients with Average Albumin >= 3.5 gm/dl by State and Network for Selected Collection Periods % pa atients 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 4Q96 4Q98 4Q00 4Q02 4Q04 4Q05 4Q06 4Q07 4Q08 IL 76% 82% 82% 83% 85% 81% 81% 81% 81% IN 82% 83% 78% 82% 80% 78% 78% 79% 78% KY 81% 80% 77% 80% 80% 75% 75% 79% 78% OH 79% 79% 77% 80% 83% 78% 79% 80% 79% Net t9/10 79% 81% 79% 81% 83% 79% 79% 80% 79%
Percentage of PD Patients with Average Albumin >= 3.5 gm/dl by State and Network 9/10 for Selected Collection Periods % patie ents 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% S-D00 S-D01 S-D02 O-D04 O-D05 O-D06 O-D07 O-D08 IL 63% 67% 65% 69% 55% 62% 65% 65% IN 64% 66% 73% 61% 57% 60% 58% 59% KY 59% 59% 60% 70% 56% 50% 60% 61% OH 56% 54% 62% 67% 57% 57% 62% 61% Net 9/10 60% 61% 65% 67% 56% 58% 62% 62%
Mineral Metabolism Goals All patients measured for calcium & phosphorus every month 75% of patients will have a Ca/PO 4 product of < 55 mg 2 /dl 2 All patients will be measured for intact PTH quarterly
National CPM Data Collection % Patients with Adjusted Calcium 8.4 10.2 4 th Quarter 2007 100 90 80 70 60 50 40 30 20 10 0 3 5 18 10 2 8 15 6 12 13 18 US 7 11 14 16 4 9 1
National CPM Data Collection % Patients with Mean Phosphorus 3.5 5.5-4 th Quarter 2007 100 90 80 70 60 50 40 30 20 10 0 6 7 16 5 8 13 17 9 11 US 3 15 10 12 1 18 2 4 14
Proposed Future Quality Improvement Topics Phosphorus Management Medication Reconciliation Vaccination Diabetes Involuntary Discharge
Hospital Alliance Disparities in Care Project Purpose increase awareness and address consequences of disparities in healthcare Involuntary discharge Barriers to admission Patient dumping Adherence issues Case mix adjustment Social and economic needs and resources to address them Staff recruitment and retention Rehabilitation
Facility Intervention Profiling Annual Review Elab Data Dialysis Facility Reports Lab Lb values SMR SHR Vascular access Data submission compliance Grievances & complaints
Facility Intervention Profiling Goal Targeted facilities will be expected to improve by next year s intervention profiling analysis (as measured by the assignment of < 10 Points) Interventions > > 10 - < 40 points Facility internal review > > 40 - < 50 points MRB required facility review & action plan > > 50 points -VIP Status - MRB required facility review, action plan & site visit if no improvement with 6 months of report date
Intervention Profiling Points Distribution 2005-2007 50% 45% 40% 35% 30% 25% 20% 2005 15% 2006 10% 2007 5% 0% 0 >0-10 >10-25 >25-40 >40-50 50
Weather Related Events Affecting Network 9/10 Area Date Disaster States Affected # Facilities Affected March 2008 Flooding IL 2 April 2008 Earthquake IL, IN, OH 0 June 2008 Flooding Tornado IN, IL 1 September 2008 Hurricane Ike KY, IN, OH 32 January 2009 Snow, Ice KY, IN, OH 19
Emergency Preparedness Conditions For Coverage Implement processes and procedures to manage medical and non-medical emergencies Emergencies include Fire Equipment or power failures Care-related related emergencies Water Wt supply interruption it ti Natural disasters
Disaster/Emergency Plan Must address failure of basic systems Power Source water Air conditioning/heating Water treatment system Supply delivery Responsible staff must have knowledge of the plan Conduct drills annually Coordinate with local emergency management agency annually
Staff Emergency Preparedness Training Annually Staff must demonstrate knowledge of emergency procedures What to do Where to go Whom to contact How to disconnect patients from dialysis
Patient Emergency Preparedness Training Instruction on facility emergency plan How to contact facility alternate emergency phone number What to do if they cannot get to dialysis Seek treatment elsewhere (immediately) in the event that their dialysis i facility in closed
EXECUTIVE DIRECTOR S REPORT Susan Stark Executive Director
Executive Director s Report CMS Update Network contract extension December 2010 No changes to Network work plan
Conditions for Coverage Update QAPI Templates Completed Adequacy Infection Control Anemia Vascular Access QAPI Templates Being Developed Nutritional Status Mineral Metabolism Medical Injuries and Errors Reuse Patient Satisfaction & Grievances Webex & Information Sessions QAPI Webex September 16 & 18 Information Sessions October 30 Chicago November 18 Cleveland November 20 - Indianapolis Medical Director s Education & Technical Assistance Meetings October 21 & March 11 Web Site www.therenalnetwork.org
Medical Director s Site Medical Director s Site www.therenalnetwork.org
Medical Director s Site Medical Director s Site www.therenalnetwork.org
CROWNWeb Concerns sent to CMS SIMS Decommissioned on January 16 th No transition period Inadequate testing Registration i t ti system is too intricate i t Significant data burden to providers (non-ldo) No validation plan Patient tracking in a disaster will be compromised Fistula First data is changing
CROWNWeb - Launch 2/2/09 Phase 1 Pilot Phase 2 4 4 small Networks 8 8 dialysis facilities Expand pilot to all Networks Volunteer dialysis facilities Phase 3 Implementation nationally
CROWN Web What you need to know to prepare Register Understand entry deadlines 2728 2746 Clinical Performance Measures Hemodialysis January through March Peritoneal Dialysis January through May CPMs due within 30 days of the close of the month
Forms Compliance 2728 Patient Registration & Entitlement Due within 45 days of the first date of dialysis Physician signature required Patient signature required 2746 Death Notification Due within 30 days of the date of death No signature required Patient Activity Reports Due by the 10 th working day of the month
CPM Data Collection - 2009 No national collection of clinical performance measures in 2009 ELAB data will be collected from non-ldo dialysis facilities next January
Lab Data Collection Project Fourth Quarter Lab Data Collection 100% Hemodialysis Patient Population Reported Kt/V Calculated URR Hemoglobin Albumin Vascular Access Rates Mineral Metabolism PD Patients
Patient Services Department Assistance to Patients and Staff Mdi Mediation i Technical Assistance Involuntary Discharges Education and Training Programs Pti Patient twhi Whisperer Professionalism Emergency Preparedness / Adherence in Crisis i Dialysis Patient-Provider Provider Conflict Web Ex Training
Patient Services Department 2008 Patient Education Meeting In cooperation with RSN Resources Renal Outreach Poster Updated Patient Rights and Responsibilities Grievance Poster Quality of Care Concerns Handout Access Site Packet and Poster Upcoming Adherence Packet
Patient Services Department Patient Leadership Committee Advisory role Patient and facility cultures Update of Network resources Reduction of complaints Educational materials Fistula First education materials Renal Outreach articles
Top Patient Complaint Comparison 2004-2008 YEAR NUMBER OF COMPLAINTS PATIENT TRANSFER/ DISCHARGE STAFF RELATED TREATMENT RELATED/ QUALITY OF CARE 2004 134 21 30 41 2005 117 21 36 24 2006 128 20 30 40 2007 123 8 60 26 2008 114 6 31 35
Year Top Grievance Comparison 2004-2008 Number of Grievances Staff Related Patient Transfer/Discharge Treatment/ Quality of Care 2004 7 1 2 1 2005 3 1 1 0 2006 2 1 0 0 2007 3 2 0 0 2008 2 1 0 1
Top Facility Concern Comparison 2004-2008 YEAR NUMBER OF FACILITY DISRUPTIVE PATIENT TRANSFER/ NON- COMPLIANT CONCERNS DISCHARGE 2004 148 24 53 22 2005 208 18 61 39 2006 235 27 76 39 2007 254 33 84 41 2008 307 33 70 37
Involuntary Discharges 2005-2008 80 70 rges Number of In nvoluntary Discha 60 50 40 30 20 10 0 2005 2006 2007 2008 Total Involuntary Discharges 44 53 72 68
Admission Contacts 2005-2008 60 50 40 30 20 10 0 2005 2006 2007 2008 Total Admissions 45 56 53 57 Number of Contacts about Admission Issues
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