July 2008

Volume #03

What's In This Issue.

(Clicking on the links below will take you to the specific articles)

Fistula First AV Fistula Utilization Rates by Urban Area Cannulation Training in Louisiana CROWNWeb Information Louisiana Pandemic Flu Training 2008 Fall Pediatric Renal Symposium Save The Dates!!! Workshop Information

FFBI Cannulation DVD Evaluation "HIPAA – SECURITY" 2007 Annual Report Facility Resource Materials Are Coming!!!! Insights Into ESA Responsiveness - Webex

Fistula First AV Fistula Utilization Rates by Urban Area

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We are very pleased to announce the achievement of the Network 13-specific CMS performance target of 47.0% AVF utilization by March 2008.  This achievement is only possible through the hard work and efforts of the dialysis health care professionals and hemodialysis patients in Arkansas, Louisiana, and Oklahoma.  MANY THANKS!!! 

Our new CMS-established performance target of 52.0% AVF utilization has now been set with a timeline of March 2009.  It should be recognized that the 52.0% target is a Network 13-specific performance target vs. the National target of 66% AVF utilization by March 2009.  The target is established using a quality deficit formula to address the variability of outcomes and practice across the country.  While we are proud of the recent achievement, our efforts must stay focused towards continuous quality improvement in this area. 

We must do better with our incident (new) ESRD hemodialysis patients.  Our Network continues to rank “WORST” at initiating hemodialysis with an AVF and “TOO HIGH” at initiating hemodialysis with catheters.  While we always hear reports that the new patients are never seen before starting hemodialysis, the available data analysis suggests otherwise and so we must look to the processes involved in vascular access management for CKD stages four and five.   All of our patients must be evaluated and referred for the appropriate permanent vascular access placement (hopefully AVF or AVG) in a timely manner.  In most cases, the referral should not be for a permanent catheter.  

Please make use of the various QI tools available to develop and/or implement vascular access management processes to address your facility-specific/patient-specific needs.  The latest Vascular Access Trends Report will be mailed out shortly for your review, discussions, and use in your facility-specific QI activities.  In the meantime, here is an analysis by region.  Where does your region rank?

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Network 13 holds Cannulation Training Sessions in Louisiana

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ESRD Network 13 QI nurses, Cheryl George RN, and Shelly Valadez RN recently visited Lafayette and New Orleans to present five training sessions on Vascular Access Cannulation.  Ninety-one nurses and patient care technicians from area dialysis facilities attended the free educational opportunity.  Participants learned various cannulation techniques, assessment skills, how to monitor for stenosis, and tips for how to create a successful buttonhole.  Time was provided in each session to practice on “dummy” cannulation arms.  A video excerpt from the CMS “Cannulation of the Arteriovenous Fistula (AVF)” DVD was shown, which featured Dr. Beathard, performing an excellent physical assessment of an AVF.  The CMS “Cannulation of the Arteriovenous Fistula (AVF)” DVD may be viewed online at http://fistulafirst.org/.  The two free CEU’s associated with the DVD expired June 2008, however, this material continues to be a valuable resource for new caregivers, and a great refresher for those with many years of experience.

The following were just a few comments made about the training sessions:

“I plan to go over everything taught today with my staff.  It was a great refresher for me.  Thanks!”

“Very good, very informative.  Both speakers were excellent.”

“I learned how to assess stenosis by raising the patients arm.  I thought this was great!”

If you would like to learn more about evaluation and cannulation techniques (e.g., buttonhole, rope-ladder, etc.), please call or email the ESRD Network 13 QI staff. 

Demonstration Stations:

Practice makes perfect!

Participants practice cannulation techniques.

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News from the Data Department … CROWNWeb is Almost Here!

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Reprinted with permission from FMQAI, The Florida ESRD Network’s professional publication, Access

Electronic Data Submission Requirement

Part of the new conditions for coverage requires the submission and maintenance of electronic patient and provider records for all ESRD dialysis facilities. This requirement takes effect on February 1, 2009.  To support this mandate, CMS announced CROWNWeb, a web-based software application that dialysis facilities will use to submit data.  Use of CROWNWeb for data submission by February 1, 2009 is mandatory to support CMS’s goals of quality improvement and performance assessment, as well as to ensure prompt claims processing and reimbursement.

CROWNWeb Overview

CROWNWeb is designed to collect patient records, clinical performance measures (CPMs) and facility data.  It includes a listing of dialysis facilities, as well as employees and patients within each facility. Data provided to the Network will be loaded into CROWNWeb and patients will be assigned to the facility primarily responsible for their treatment. Your facility will create 2728 and 2746 forms using this system, and you can print copies of these forms for Social Security before submitting the data electronically. You will be able to transfer patients from one facility to another as required, as currently handled using the monthly Patient Activity Reports (PARs). Once you enter admission information on a patient into CROWNWeb, you will be able to view pertinent information related to his/her ESRD history. In addition, CROWNWeb can generate reports to assist you in maintaining required records and ensuring that Social Security receives required information.

Facility Staff

CROWNWeb contains a facility staff module that tracks your personnel and their roles within your facility.  CMS and the Networks grant a facility administrator (an individual responsible for maintaining CROWNWeb data at your facility) permission to add and edit facility staff to the list, and the facility administrator may modify the permissions of facility staff to access certain data within CROWNWeb based on a need-to-see basis.

Patients

Patients are assigned to the facility primarily responsible for their treatment. Facilities can easily transfer patients to other facilities for transient care or in the event of an emergency. Staff members will be able to search for patients within their facilities who meet specific criteria. Once they locate the patient, they can view and edit the information for the selected patient and see a list of any forms that they may need to submit for that patient.

Facility personnel will create and submit 2728 and 2746 forms for patients using an on-screen data entry system. This will include generating an original, as well as submitting a supplemental or re-entitlement form 2728. To save time, CROWNWeb pre-populates the patient information on the form using any data that already exists in the database. If all information needed to complete and submit the form is not available, you can save the form temporarily until you obtain the additional data, then continue to work the form through completion. Once all required information is entered, you can submit the 2728 to CMS and the Networks electronically, as well as print out the paper version for the physician signature (in blue ink), as required by Social Security.

The 2746 form will also pre-populate using any data that already exists in the database, and you can save these for completion later. When you submit either form, the system will review what was entered to ensure all required information has been filled in and will notify you if there is missing data.

Security and Cost

CROWNWeb uses an encryption technology that assures privacy, confidentiality and security for electronic communications consistent with applicable HIPAA and Privacy Act statutes and related regulations.  CROWNWeb also meets applicable security criteria included in the CMS Information Security Acceptable Risk Safeguards (ARS) policy, which contains a broad set of CMS security controls based upon National Institute of Standards and Technology (NIST) requirements.

Access to CROWNWeb will be provided to dialysis facilities free of charge once a verification and authorization process is completed.

Training

CMS will offer two types of training on CROWNWeb to Network 13 ESRD facilities:

Online training will be provided at no cost to the facility.  The core CROWNWeb training program will consist of a series of online courses totaling approximately two hours.  This core instruction will cover the main functions of CROWNWeb, with additional modules being available.  While face-to-face training may require you incurring travel costs, the actual training will be available at no cost to the facility.  Attending face-to-face training is not mandatory but will be available for facilities that prefer this method of instruction.

Network 13 CW Training Schedule
AR, Little Rock:  1/9/2009 - 1/13/2009- 3 sessions, 1day/session
LA, New Orleans: 1/15/2009 - 1/20/2009- 4 sessions, 1day/session
OK, Oklahoma City: 1/26/2009 - 1/27/2009 - 2 sessions, 1day/session

If you have any questions regarding CROWNWeb, please visit the CROWNWeb web site at http://www.fmqai.com/ESRD/CROWNWeb/, or contact the CROWNWeb team directly via e-mail at CRAFT@nw7.esrd.net.

FFBI Cannulation DVD Evaluation

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FEEDBACK, PLEASE!!!!

Back in October of 2007, the Fistula First Breakthrough Initiative (FFBI) DVD Series:  “Cannulation of the AV Fistula” was distributed to all independent, small corporate dialysis units in Network 13 as directed.  The FFBI is now interested in your feedback regarding this tool.  Please visit the evaluation linked below.  Please complete and forward as directed to the FFBI office if possible.  Thanks for your assistance. 

 

Evaluation of DVD Package: Cannulation of the AV Fistula

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HIPAA – SECURITY – It's The Law

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Email is NOT a secure means for submitting patient data to the Network.  The Network Patient Confidentiality and HIPAA Guidelines Memo (provided to facilities in March, 2008), outlines what actions are taken if the Network receives protected health information (PHI) via email, as well as alternative, secure means for submitting patient information.  To download or view this memo click go to www.network13.org, and click on the HIPAA/Privacy Policy bar on the lower left side of your screen.              

Additional “plain language” information regarding the HIPPA privacy rule can be found at  http://www.hhs.gov/ocr/privacysummary.pdf.   To view the entire Rule, and for other additional helpful information about how it applies, see the OCR website: http://www.hhs.gov/ocr/hipaa.

If you have questions specific to sending patient information to the Network, please feel free to contact the Network Data Manager, Cindy Smith at csmith@nw13.esrd.net or Security Officer, Nellie Hedrick at nhedrick@nw13.esrd.net.

Be alert, be aware, security breaches can be a BIG deal!

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Louisiana Pandemic Flu Training

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CONTINUING EDUCATION ANNOUNCEMENT:
Louisiana Pandemic Flu Training 
LINK:  http://nccphp.sph.unc.edu/training/HEP_LFLUP/certificate.php
FREE CME’s (1.5 CEU’s) for Louisiana Health Care Professionals.  In collaboration with the University of North Carolina Center for Public Health Preparedness, the State of Louisiana’s Pandemic Flu Clinical Forum – Educational Subcommittee has developed a Web-Based training course.  The course will:

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Network 13 Annual Report - 2007
Now Available

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The ESRD Network 13 2007 Annual Report is now available for download from the ESRD Network 13 website.  Just click on this link http://www.network13.org/data_report.asp#ar.  Or go to www.www.network13.org, where, under the data tab, you can click on Reports and then Annual Reports.  There is a wealth of information available here regarding the activities of Network 13 during the previous calendar year, as well as a number of useful data tables in introduction, section 6 and the appendices.   And please, let us know if there is any additional information you would like to see in our Annual Reports!

2008 Fall Pediatric Renal Symposium

The 2008 Facility Resource Materials (FRM) Are Coming!!!!

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Be on the lookout for the newly updated 2008 FRM CD!  It is in its final stages of review and will be available shortly.  We will be providing WebEx sessions in September to review and discuss the available resources.  The FRM has updated information in the areas of

1. NETWORK 13 INFORMATION

2. NETWORK 13 DIRECTIVES

• NETWORK STANDARDS (Overview):  These standards are established by the Network with the expectation that all ESRD facilities will comply accordingly towards the provision of quality care within the renal health care community.
• NETWORK RECOMMENDATIONS (Overview):  While not at a ‘standards’ level, the following recommendations are to be strongly considered for implementation as applicable within your renal organization.
• NETWORK 13 GRIEVANCE POLICY:  All ESRD facilities are required to inform their patients of the Network’s grievance policy and their right to complain and/or file a grievance.
• NETWORK 13 HIV POLICIES:  All ESRD patients have the right to privacy, as well as equal treatment as directed by the Office of Civil Rights.
• NETWORK 13 PROCEDURE:  ALTERNATE SANCTION RECOMMENDATION:  All ESRD facilities are directed to participate towards the achievement of Network goals and objectives (e.g., Quality Improvement, Data Registry, Complaints/Grievances, etc.).  Alternate sanction recommendations are directed and/or implemented at the direction of the CMS Region VI Office, Dallas, TX
• CONCEALED WEAPONS: Sample Policy:  The Network provides a sample-concealed weapons policy for use in the renal communities as necessitated by state law or corporate directive

3. ESRD-RELATED RESOURCES FOR PROFESSIONALS AND PATIENTS

4. CONTINUOUS QUALITY IMPROVEMENT (CQI) / TOOLS

5. QUALITY IMPROVEMENT ACTIVITIES

6. DATA ABSTRACTION ACTIVITIES

7. INFECTION CONTROL RESOURCES

8. PATIENT SERVICES RESOURCES

9. NETWORK 13 DISASTER PLANNING RESOURCES (Web Only)

10. MEDICARE PART D RESOURCES

11. KIDNEY TRANSPLANT RESOURCES

12. CLEARINGHOUSE LIBRARY

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