2020 CMS Priorities, Goals, and Quality Improvement Activities IPRO ESRD Network of New England (Network 1) Network Council Meeting December 11, 2019 1
Meeting Reminders • This WebEx will be recorded and slides made available on the Network Website • All phone lines have been muted to avoid background noise • Be present and engaged in the presentations • Be prepared for active participation in the WebEx chat board p. 2
Meeting Reminders • Be prepared for active participation in polling questions p. 3
Agenda Topics • Overview of IPRO ESRD Program: Network 1 • National ESRD Initiatives • Emergency Preparedness and Management • Patient Experience of Care • Patient Engagement • Quality Improvement Activities (QIA) • Information Management • Closing Comments p. 4
Overview of IPRO ESRD Program: Network 1 Danielle Daley, MBA Executive Director 5
ESRD Networks 6
IPRO ESRD Network Program Network Service Areas Network 2 NY Network 1 Patients: 30,846 NW1 CT, MA, ME, NH, RI, VT Facilities: 325 Patients: 15,334 Transplant: 13 Facilities: 201 Transplant: 15 NW2 Network 9 IPRO OH, KY, IN Network 9 ESRD Program Patients: 34,570 IN, KY, OH Facilities: 650 Transplant: 14 132,394 Network 6 ESRD Patients Network 6 GA, NC, SC NC, SC, GA 1,948 Patients: 51,644 Facilities: 772 Dialysis Facilities Transplant: 9 51 Transplant Centers 7
Mission Statement The Mission of the IPRO End Stage Renal Disease (ESRD) Network Program is to promote health care for all ESRD patients that is safe, effective, efficient, patient-centered, timely, and equitable. p. 8
Network Demographics By State ESRD Patient # of Dialysis # of Transplant State Census Facilities Facilities Connecticut 4,442 52 2 Maine 1,171 20 1 Massachusetts 7,074 84 9 New Hampshire 1,113 20 1 Rhode Island 1,168 17 1 Vermont 366 8 1 TOTAL 15,334 201 15 Data Source: CROWNWeb 12/2019 9 9
Facility Affiliation By Organization ESRD Patient # of Dialysis Ownership Census Facilities American Renal Associates 1,730 24 DaVita 52 5,035 Dialysis Clinic Inc. 9 753 Diversified Specialty Institutes (DSI) 227 3 Fresenius Medical Care 6,102 80 Independent 1,334 28 US Renal Care, Inc. 1 58 Veterans Administration 4 95 TOTAL 15,334 201 Data Source: CROWNWeb 12/2019 10 10
Network 1 Staff Danielle R. Daley, MBA Cheryl Pettway Executive Director Sr. Program Support Coordinator Email: danielle.daley@ipro.us Email: cheryl.pettway@ipro.us Direct: (203) 285-1212 Direct: (203) 285-1222 Agata Roszkowski, LMSW TBD Patient Services Director Community Outreach Coordinator Email: agata.roszkowski@ipro.us Email: TBD Direct: (203) 285-1213 Direct: (203) 285-1223 Sarah Keehner, RN, BSN, CNN Nadine Caruthers, LPN Quality Improvement Director Quality Improvement Coordinator Email: sarah.keehner@ipro.us Email: nadine.caruthers@ipro.us Direct: (203) 285-1214 Direct: (203) 285-1224 Jaya Bhargava, PhD, CPHQ Krystle Gonzalez Regional Operations Director Customer Service Manager Email: jaya.bhargava@ipro.us Email: krystle.gonzalez@ipro.us Direct: (203) 285-1215 Direct: (203) 285-1225 p. 11
CMS Expectations Role of the Network • Improve quality of care for ESRD patients • Provide assistance to ESRD patients and providers • Encourage patient engagement • Evaluate and resolve patient grievances • Collect data to measure quality of care • Support emergency preparedness and disaster response p. 12
Technical Assistance We’re Here to Help • The Network has tools to help with quality improvement activities – Infection prevention – Benefits of home dialysis – Catheter reduction – Peer mentoring – Transplant referrals – Vocational rehabilitation • The Network provides technical assistance – Data reporting – Quality Incentive Program (QIP) – Patient engagement – Patient/provider conflict – Access to care barriers – Patient safety p. 13
Technical Assistance We’re Here to Help • The Network sponsors educational opportunities – Face-to-Face Meetings – Webinars – Conference Calls • The Network shares data – Comparative Network, state, and facility level – Incidence, prevalent, and demographic statistics – Annual Report p. 14
Polling Question Do You Know We’re More Let’s Test Your Are You Your Than Just a Memory Ready? Network? Number
Emergency Preparedness and Management Agata Roszkowski, LMSW Patient Services Director Emergency Management Coordinator 16
Emergency Management Things to Know Facility Reporting/Tracking • Report Facility Status (Open/Closed/Altered) • Report patient access to care • Contact the Network to assist with local OEM coordination efforts Prepare Patients for an Emergency • Be prepared patient worksheet • 3-Day Emergency Diet Prepare Your Facility for an Emergency • Technical assistance to facilities to develop feasible, comprehensive emergency/disaster plans p. 17
Emergency Preparedness Overview The Network 1 Emergency Preparedness and Management Plan Roles during an emergency Mobilization and response of the Network Providing and maintaining support Quality management of the emergency p. 18
Polling Question We Want to Emergency Are You Hear From Frequency Planning Ready? You
Patient Experience of Care Agata Roszkowski, LMSW Patient Services Director 20
Patient Experience of Care Grievances Definition and the Network’s Role • What is a grievance? • Network’s Role – Facilitator – Expert Investigator – Educator – Quality Improvement Specialist – Advocate – Referral Source p. 21
Patient Experience of Care Grievance Management and Best Practices • Development/support robust grievance process • Foster environment that encourages patients, family members, care partners to voice their opinions • Encourage positive resolution focused outcomes • Establish an anonymous grievance process • Grievance Educational Materials – Network Grievance Poster – Forum Grievance Toolkit p. 22
CMS Expectations: Network Responsibilities • The Network assists with patient grievances – Evaluate and resolve grievances using a patient centered approach – Follow CMS guidelines, document all Network steps of grievance resolution, and adhere to timeframes – Perform quality of care reviews using an interdisciplinary approach (LMSW / RN) – When necessary, refer cases to the Grievance Committee or Medical Review Board for review p. 23
CMS Expectations: Support for Access to Care Concerns Reasons for Access to Care Cases: • At-Risk of Involuntary Discharge • Involuntary Discharge • Involuntary Transfer • Failure to Place • Loss to Follow Up p. 24
Patient Experience of Care Community Resources • Involuntary Discharge Resources – Threats are Not Okay Here Poster – Involuntary Discharge Guide • Grievance Management Process Resources – Dialysis Patient Grievance Toolkit • Communication Resources for staff and patients – Applying Net Forward Energy in Patient Care Webinar – Relationship Centered Communication Webinar p. 25
Polling Question We Want to Disruptive Are You Hear From Management Patient Ready? You
Patient Engagement Agata Roszkowski, LMSW Patient Services Director 27
Patient Advisory Committee (PAC) Structure and Function • PAC members are : – Promote communication between patients and staff – Inform patients about the ESRD Network – Reach patients in the New England area • PAC members are selected and nominated by facility staff p. 28
Patient Advisory Committee (PAC) Patient Facility Representative • Involved in the development of QIA interventions and resources • Encouraged to participate in intervention implementation at the facility • Patients are asked to: – Consider becoming a Peer Mentor – Share their ESRD journey story with others – Attend meetings led by the Network – Participate in national meetings and technical expert panels p. 29
Patient Engagement Goals • Utilizing Peer to Peer model • Increase self management behaviors • Social support • Health related quality of life and self-efficiency p. 30
National ESRD Initiatives Danielle Daley, MBA Executive Director 31
ESRD Statement of Work December 2019 - November 2020 Background & Purpose • To delineate tasks to be conducted by each End Stage Renal Disease (ESRD) Network Organization contractor in support of achieving national quality improvement goals and statutory requirements as set forth in Section 1881 of the Social Security Act and the Omnibus Budget Reconciliation Act of 1986 • Tasks in this SOW are intended to align Network activities with: – Department of Health and Human Services (HHS) National Quality Strategy (NQS) – HHS Secretary Priorities – Centers for Medicare & Medicaid Services (CMS) goals p. 32
ESRD Statement of Work December 2019 - November 2020 HHS Secretary’s Priorities 1. Opioid Crisis 2. Health Insurance Reform 3. Drug Pricing 4. Value-Based Care p. 33
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