Issue 2 2 nd Quarter 2015

In this Issue AIM 1 AIM 2 AIM 3 Quick Links Network 13 Website CROWNWeb Online Help Dialysis Facility Compare NHSN QIP Payment Year 2017 Final Rule Materials are Available here. Network 13 All- Hazards Preparedness Resources Recurring Topics ICH-CAHPS To keep updated on ICH-CAHPS, click here. PATIENT EDUCATION Patients have rights as well as responsibilities while receiving treatment at your unit. Make sure that they are Issue 2 2 nd Quarter 2015 From the Executive Director Time is truly flying these days as we move into Spring. Spring will be bringing the Network 13 improvement project activities into the ESRD community and we are excited to be offering more and more patient educational resources for your use to improve patient care outcomes. We hope that you are willing and able to join us in these improvement activities and always welcome your input and feedback. Next, I would like to provide a big THANK YOU to those clinicians that participated in the recent Network 13 provider needs assessment. As you know, the Network also conducts a patient needs assessment, which allows for comparison and evaluation of the different perspectives of our target audiences. This helps the Network to improve technical assistance and resources. One example is the results for Question 3 as seen here: Question 3 Provider Assessment-Do you educate patients about filing a grievance? In-Center: Home: Yes 98% (216) 98% (50) No 2% (5) 2% (1) Question 3 Patient Assessment-Do you know how to file a grievance? In-Center: Home: Yes 61% (1396) 79% (228) No 39% (876) 21% (61) We look at this information to then determine the best improvement approach to assist providers and patients with knowledge about grievances. This information is also utilized in the development of quality improvement/patient engagement campaign materials and resources. So again, thank you for helping us to better understand how to help you. Never hesitate to call or email with your suggestions, recommendations, and/or if you d just like to talk or brainstorm about an idea or issue. Linda Duval, BSN, RN Executive Director O: 405-948-2244 F: 405-942-6884 lduval@nw13.esrd.net Page 1 of 10

educated on what these "Rights and Responsibilities include. Available in English and Spanish. SPOTLIGHT ON MODALITIES Are your patients looking for treatment options that they can tailor to work around their schedule of school, work, and family activities? Click here to learn more about nocturnal dialysis. AIM 1 Better Care for the Individual through Beneficiary and Family Centered Care 2015 Patient Engagement Learning and Action Network (LAN) Empowering Patients to Share in Health Decision Making Through Participation in His/Her Individual Plan of Care The objective for the LAN is to increase patient empowerment through participation in the plan of care. Patient participation will be defined as patient and interdisciplinary team signatures on the plan of care. There will be 31 facilities, representing 10% of the eligible Network population (n=1,920) within the Network 13 service area that will be participating in this activity. The goal is to increase patient participation in their plan of care by 5% over baseline. 2015 Patient LAN Campaigns Campaign #1: Reducing Blood Stream Infections (BSIs) Networks are required to carry over one project from 2014. Since this project was so successful and is an important aspect of care for patients, this project will be repeated with a new group of facilities and patients. Fifty-nine facilities with a census of 3,682 patients have been selected. Orientation for this project is scheduled for March 10 and 11, 2015. We will be adding more patient engagement pieces in the new campaign, so stay tuned! Campaign #2: Preventing and Reducing the Use of Long-Term Catheters (LTCs) The national and Network 13 goal is to have less than 10% of Network 13 patients using LTCs. The Network has 141 hemodialysis facilities with greater than 10% of patients with LTCs, which has increased by 41 facilities over 2014. The risk of infection, hospitalization, and death for patients is extremely high with this access type. A patient engagement focus for this project should definitely have an impact. This project will include 41 facilities with a census of 3,697 patients. New Resources from Fistula First / Catheter Last The National Coordinating Center (NCC) has announced the newest addition to the vascular access materials for the Lifeline for a Lifetime toolkit. The newest tools include resources for the One Minute Catheter Check and a Spanish language version of the Access Planning Manual. The complete toolkit for patients and providers can now be found in one central location and includes: All-inclusive Resource Download Center for convenient access and downloading of educational materials Videos that can now be downloaded and saved for continued use Downloadable PDFs and interactive files for patients and professionals Patient resources available in English and Spanish April is National Humor Month Have you ever heard the phrase laughter is good medicine? Well, it s true! Of course we all know that laughter reduces stress, but it can also result in physical changes to our bodies, according to the Mayo Clinic. It can improve your immune system by releasing neuropeptides to help fight stress, increase blood circulation and oxygenation to your organs, and act as a natural pain killer. So, go ahead, laugh all you want! Page 2 of 10

National Minority Health Month! During April, the Centers for Disease Control and Prevention (CDC) will mark National Minority Health Month by raising awareness about the health disparities that continue to affect minority populations in conjunction with the Health and Human Services action plan to reduce racial and ethnic health disparities. This year's theme, Prevention is Power: Taking Action for Health Equity, emphasizes the critical role of prevention in reducing health disparities. For more information, visit www.cdc.gov/minorityhealth/mhmonth.html National Donate Life Observances April is National Donate Life Month (NDLM) to support organ and tissue donation with April 17 designated as National Blue and Green Day. There are far more people needing organs than there are donors. Let s raise awareness about organ donation for our patients. For more information about NDLM and National Blue and Green Day visit www.donatelife.net. May is National Physical Fitness and Sports Month Most people hate the word EXERCISE. It usually means at least an hour of sweating, huffing, and puffing in a gym, which turns off a lot of individuals. I think a much better term is physical activity. So how does physical activity and exercise differ? Physical activity is movement, like taking a walk, playing with the grandkids, or going for a bike ride something you enjoy doing, yet gets your blood pumping. In older adults it can help prevent falls, and lowers the risk for heart disease and Type 2 diabetes. For more information, visit www.healthfinder.gov/nho/maytoolkit.aspx. June is National Safety Month Injuries are a leading cause of disability for people of all ages and they are the leading cause of death for Americans age 1 to 44. Slips, trips, and falls are just one of the areas of focus for National Safety Month. Did you know that one in three older adults falls each year? Many falls lead to broken bones and other health problems. Take time to talk to your patients about looking at ways to prevent accidents from happening in their homes. It is also a good time for staff to stop and survey the dialysis and transplant units to make sure everyone is safe every day. For more information, visit www.healthfinder.gov/nho/junetoolkit2.aspx. Joint Patient Services and Quality Improvement QIA: Reducing BSIs in Patients on Hemodialysis As part of the Network Option Year (OY) 2 contract, the Network was required to carry over a QIA from OY1. Since this activity was a joint project with patients and providers, and it was very successful, this activity was chosen to be repeated with a new set of facilities and patients. Fifty-nine facilities have already been notified that they will be participating in this activity that will involve approximately 3,700 patients. Orientation is scheduled for March. Page 3 of 10

BREAKING NEWS from the Dialysis NHSN Helpdesk! SAMS Registration Process for Existing NHSN Users: 1. Check your inbox for an email from sams-no-reply@cdc.gov with Invitation to Register in the subject line. Click the link at the bottom of the email to log in to SAMS and complete the online SAMS registration form. 2. Within five business days of successful online registration, you will receive a SAMS Identity Verification Request email. From the email, print and complete the Identity Verification Form. 3. Take the Identity Verification Form to a notary public for endorsement. 4. Mail or fax the complete and endorsed Identity Verification Form and copies of your supporting documents to the CDC. To Fax (Toll-Free): 1-877-681-2899 To Mail: Centers for Disease Control and Prevention Attn: Proofing Authority 1600 Clifton Road, MS K-94 Atlanta, GA 30333 5. Receive confirmation from CDC that forms were received ( Proofing Documentation Delivered email and letter via U.S. Postal Service). 6. After CDC processes the documents, receive SAMS Account Activation and SAMS Activity Authorization emails. 7. Within 10 business days, receive your SAMS grid card (delivered by U.S. Postal Service to your home address). 8. Begin logging in to NHSN through SAMS, using your SAMS grid card, username, and password. REMEMBER: It can take up to 30 days to complete SAMS registration and obtain a SAMS grid card in the mail. Don t wait! Vascular Access Procedures It is important that patients understand that their vascular access, no matter what kind, will require occasional tune-ups to keep it working in tip-top shape. Because the access flows are abnormally higher than the regular blood flow within a native vein, trauma often results. Using the analogy of keeping a car tuned-up can help a patient better understand the need to see their surgeon or interventionalist. Staff Page 4 of 10

need to make sure they do a complete assessment of the patient s access at each dialysis treatment. Changes in the skin within the cannulation zone, temperature, drainage, absence of a thrill or bruit, excessively high or low arterial pressures, and high venous pressures are all symptoms of access issues that need the evaluation of a doctor. The Network will be spending time reinforcing this information with patients during our vascular access QIA. Patients don t know what they don t know, and rely on their doctor, nurse, and technician to help keep them informed of any access issues. 2014 Reducing Bloodstream Infections Quality Improvement Activity Award Network 13 would like to thank all the participants who diligently provided data for this QIA. This activity was submitted as a poster presentation to the National Kidney Foundation s 2015 Spring Clinical Meeting. Out of a total of 338 posters, ours won one of the two Healthcare Professional Top Poster Awards on March 26, 2015! Lynda Ball, QID is shown next to the poster and award ribbon. Congratulations! AIM 2 Better Health for the ESRD Population 2014 AIM 2 Project - Increase Hepatitis B and Pneumococcal Vaccination Rates in the Rural Setting Award Presentation Lynda Ball, QID and Cheryl George, QIC receiving the Best Hemodialysis Nursing Abstract Award at the 35 th Annual Dialysis Conference. Presented by Leonor Ponferrada, Chair, Nursing and Health Related Program for the 2014 AIM 2 Vaccination Project. 2015 AIM 2 Project Increase Hepatitis B and Pneumococcal Vaccination Rates The Network successfully completed the OY1 AIM 2 vaccination project with a small group of rural facilities. Upon analysis of the vaccination data within Network 13 from Quarters 3 and 4, the rural vs. the urban setting once again has the largest area for improvement. The Network has decided to apply the framework of spread to other rural dialysis facilities to improve access to care with regard to hepatitis B and pneumococcal vaccination rates. A new group of facilities has been identified, and our goal will be to see at least a 10% improvement in each of the vaccination rates by the end of the third quarter. Page 5 of 10

AIM 3 Reduce Costs of ESRD by Improving Care Quality Improvement - Am I Doing It Right? Quality Improvement (QI) is described by the CMS Conditions for Coverage as Quality Assessment and Performance Improvement (QAPI). The QI process must maintain and demonstrate evidence of continuous monitoring. Your QI meetings should be based on aggregate data which is reviewed by the interdisciplinary team (medical director, nurse, dietitian, and social worker), and should incorporate all facility services (e.g., incenter hemodialysis, home therapies). Meetings should focus on quality indicators related to improving health outcomes and the prevention and reduction of medical errors. Many clinicians are more comfortable focusing on what is going on with each individual patient rather than looking at aggregate facility outcomes. Taking care of patients is your main priority, but as a QI team, you must look at the overall big picture of the facility s performance by evaluating your processes and outcomes. Going over each individual patient lab is not a QI meeting, but rather a patient care meeting. Monthly QI Meeting 1) Aggregate data should be collected and provided to the team for the monthly QI meeting. Aggregate data is the combined outcomes of all of the patients in the facility, usually broken out by modality. Patient outcomes should be reviewed as a group. For example, what percentage of patients is achieving the Kt/V target of 1.2? 2) Review data to see if quality goals are being met. Consider utilizing graphs, tables, and trend-lines to present the data for review. 3) Trend data to determine if there is improvement or if there is a decline in outcomes. Review at least six data points. If you are only looking at one month s data, you are not reviewing trends. Page 6 of 10

4) Identify which quality indicators need action. If there are multiple areas, prioritize which will be the immediate facility focus for improvement and create a quality improvement plan. 5) Document any activities from the prior month. Were there successes? If not, do plans/interventions need to be adjusted? 6) Include evidence of the interdisciplinary team involvement in the meeting. What were the contributions by the various team disciplines? Creating a Quality Improvement Plan/Action Plan: Utilize a Plan-Do-Study-Act (PDSA) model. 1) PLAN: Complete a root cause analysis (RCA). Many facilities struggle with this concept. Begin by listing all possible problems. You may want to use a Fishbone or Cause and Effect template to organize the issues. Use measurement to quantify what issues are causing the most problems. Listing reasons or excuses is not root cause analysis. Determine what actions/processes will be implemented. What can be done that will improve the quality for ALL patients? 2) DO: Implement actions/new processes. 3) STUDY: Review your results. Using a run chart can assist in determining if change has occurred and if changes were sustained. What worked or didn t work. Look at process, not just outcomes. 4) ACT: Doing the same things repeatedly will not result in change. Go back to the root cause - has anything changed? If interventions are not having positive effects try a different approach. QI resources can be found on Network 13 s Facility Resource Materials web page at www.network13.org/frm-2/2013%20frm%20content/section_04.htm Emergency (All-Hazards) Preparedness Several activities are underway to review and update emergency preparedness resources for 2015. In the meantime, as we transition (hopefully soon) from winter to spring, it is important to remember that plans and drills are important components to successfully handling any major emergency. One of the critical planning issues for dialysis patients is TRANSPORTATION. In good times, transportation can be problematic, so it becomes even more problematic when transportation services are not functioning properly due to snow, ice, or hurricanes. It is important that back-up transportation arrangements are made ahead of time and to know who is available to assist prior to a weather-related event. If back-up transportation is not possible, especially in winter, patients should consider staying closer to their dialysis facility with family, friends, or at a local motel/hotel. REMEMBER - Emergency responders such as ambulance and fire departments will not provide transportation assistance to scheduled dialysis treatments and should only be contacted when emergency services at the hospital are required. Emergency (all-hazards) preparedness materials, including patient needs assessment and tip sheets are available at: www.network13.org/disaster_resources.php Page 7 of 10

KCER Update on Peritoneal Dialysis Solutions Shortage UPDATE - MARCH 27, 2015 by Joan Thomas, KCER Director Since mid-august 2014, KCER has held meetings with manufacturers, federal agencies, dialysis and kidney organizations, and healthcare associations to discuss current and potential impacts and issues of the PD Solutions Shortage. This is a recap of the last PD Solution meeting held on March 20, 2015. Baxter had communicated that they expected supply recovery planned for the end of the first quarter in March 2015 for PD Solution. In August of 2014, Baxter PD Solution was allocated to clinics based on historical usage during the timeframe of January to June 2014. There has been progress in allocations moving from 25% in August 2014 to 70% in March 2015. Current inventory levels have been restored via Line 6 expansion based on historical levels of service for patients. Line 6 is operating as expected but looking to develop new manufacturing to handle unconstrained growth. Baxter is committed to PD. Baxter stated that they need to use careful management with the unrestrained growth in PD: 1. In the short-term, to monitor before getting new patients; 2. Long-term commitment to responsible growth; 3. Manage additional capacity and not be outpaced by demand; and 4. Strong commitment to service levels New allocations were announced for the balance of 2015, from March until December, at 70%, also based on January June 2014 average run rates with agreement owners. The allocations will allow for agreement owners to qualify for 2 PD patients per month or allocation based on January June 2014; whichever is greater. The importation from Ireland of PD Solution will end in April. They will re-evaluate allocations at the end of the year. What will not change is that (1) Pediatrics will continue to be supplied at 100% and (2) CAPD is not under restriction. This is expected to help smaller clinics receive allocation. Baxter would like to ensure that existing customers see service improvements before opening up to new patients. Baxter has learned lessons from the shortage and is introducing new improvement in patient services: 1. Regular monthly deliveries resume with Baxter trucking services, including additional Baxter drivers 2. Destination and Domestic Travel Programs will be restored April 1, 2015 3. Patients able to track delivery (to start end of April) 4. New portals for patients to order supplies online The FDA has been working closely with Baxter since the onset of this shortage in August 2014. They will continue to consider this situation a critical shortage and, if supply cannot be met, they will assist with importation. An extension of importation, however, is the decision of Baxter. They are supportive of Baxter and the demand issues. Additional information for Baxter PD Solutions can be acquired by calling their Home Therapies line at 800.284.4060 or on the web at www.homebybaxter.com. Page 8 of 10

Dialysis Facility Compare (DFC) Star Ratings are the newest part of DFC website. The star ratings are part of Medicare s efforts to make data on dialysis centers easier to understand and use. The star ratings show whether your dialysis center provides quality dialysis care that is, care known to get the best results for most dialysis patients. The rating ranges from 1 to 5 stars. A facility with a 5-star rating has quality of care that is considered 'much above average' compared to other dialysis facilities. A 1- or 2-star rating does not mean that you will receive poor care from a facility, it only indicates that measured outcomes were below average compared to those for other facilities. The posted star ratings will use the same data previewed by facilities during the July 2014 preview period, and this data will be updated on an annual basis beginning in October 2015. Other information on the DFC website includes: Dialysis facility descriptions and services, Detailed quality scores that provide information about the facility s hospitalizations, deaths, and the use of best treatment practices For more information, visit www.medicare.gov/dialysisfacilitycompare/#about/whatis-dfc CROWNWeb CROWNWeb Activities There are activities that must be performed monthly through the single user interface by facility staff at every dialysis facility. Completion of these activities is extremely important, as failure to do so could adversely affect patient benefits, as well as skewing the data on reporting required by CMS. Monthly, the Network will send facilities the list of delinquent activities. The list below does not reflect every CROWNWeb activity, but it is intended to be a reminder of monthly reoccurring tasks: Verification/entry of vascular access (VA) and clinical data due within 60 days after the end of each month (i.e., January data is due by the end of March). You may use the NA option if there is no lab available. NOTE: Remember to make sure that all data is in submitted status, as saved data will be counted as missing. Verification of the Patient Activity and Related Treatment (PART) Report is due by the 10th of each month - no exception. Batch Users: this is a good time to verify and match your patient s information (last name, first name, SSN, HIC number, date of birth, and gender) with your corporate database for a smooth transition for batch submissions of your VA and clinical data. Enter the required CMS 2728 and 2746 forms, as appropriate. o The CMS 2728 is due within 45 days of the date that the patient starts permanent dialysis at your facility. o The CMS 2746 is due within 14 days of the date of death. Update patient records from the Action List weekly. The items on this list reflect instances where the patient information in CROWNWeb does not match what is in the Social Security (Medicare) database. As you verify the Action List, make sure to update CROWNWeb as needed, and then accept/reject the Action. Page 9 of 10

CROWNWeb Training Are you having problem with CROWNWeb? Use the Project CROWNWeb website training on how to use the software. The website contains many tools and videos for training purposes. UPCOMING EVENTS and WEBINARS HAI LAN - Revisiting Infection Control Practices Date: Thursday, April 2, 2015 Time: 12:00 noon 1:00 p.m. Central Time HAI LAN Access Disinfection 101 Date: Thursday, June 11, 2015 Time: 12:00 noon 1:00 p.m. Central Time HAI LAN Controlling Buttonhole Infections Date: Thursday, August 6, 2015 Time: 12:00 noon 1:00 p.m. Central Time HAI LAN Fighting the Battle of Antimicrobial Resistance Date: Thursday, November 12, 2015 Time: 12:00 noon 1:00 p.m. Central Time Fall 2015 Workshop Series Date: September 24, 2015 Location: Tulsa, OK Time: 7:00 a.m. 4:00 p.m. Date: October 15, 2015 Location: Baton Rouge, LA Time: 7:00 a.m. 4:00 p.m. Date: October 27, 2015 Location: Little Rock, AR Time: 7:00 a.m. 4:00 p.m. This material was prepared by ESRD Network 13, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication Number: OK-ESRD-Aim1-03112015-01 Page 10 of 10