A new Harvard Business Review article on “The Value of Teaching Patients to Administer Their Own Care” includes an example of a self-care dialysis program at the Central Texas Nephrology Associates clinic in Waco, Texas. Some excerpts:
“In 2016, nearly 40% of CTNA’s 751 patients performed their own dialysis while experiencing fewer hospitalizations and a lower mortality rate than patients receiving dialysis the conventional way. Patients delivering their own dialysis experienced better outcomes and the health system minimized costs by avoiding unnecessary hospital visits.”
The “Providers’ role changed from performing every step of the process to serving as coaches and supporters of patients doing their own care. The resulting redeployment of staff resources led to higher productivity and throughput for the clinic.”
“Regardless of the setting, a successful approach to patient-administered self-care requires the following:
“Patients or caregivers must be prepared and willing… Care organizations need to develop a standard process for training patients… Practitioners must be trained to support patient-administered care, …to see themselves as coaches and the patient as an integral partner, …[to] recognize that patients’ capabilities to provide their own care may differ and evolve over time, and …to connect with the patient…
“A standard protocol should be developed [including] …methods for distributing equipment, supplies, and medication …how patients and providers should respond to adverse events …easy access to outpatient and inpatient services to address any needs that arise.
“A care organization that has [an outcome]-based-payment system will have a much easier time adopting the self-care model …Patient-administered care realizes savings by avoiding spending in the first place; in a fee-for-service model, this is lost revenue.”
ANNA Greater Puget Sound Chapter 503 will host the Renal Update 2017 conference in Lynnwood WA on March 2-3, 2017. Topics include htn, hospitalization reduction, medical marijuana, vascular access, peritonitis, poverty, living donation, pediatric PD and AKI, ethics, dialysis outcomes, Ca/PO4/PTH, and challenging personalities. There will be no on-site or mail-in registration, so registration must be completed online by 11:30 pm PST on February 23, 2017. There is a discount for registration completed before 11:30 pm PST January 20, 2017. For the full agenda and registration details, see https://s3-us-west-2.amazonaws.com/nwrn.org/files/N/2017RenalUpdate.pdf .
CMS has published changes to DFC, detailed at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-10-28.html . ICH-CAHPS, Standardized BSI Ratio (SIR), and Pediatric PD Kt/V have been added to DFC, but not to the Star Ratings. Changes have been made to the way the Star Ratings are calculated, and adjustments have been made to the way the Vascular Access, Kt/V, Standardized Readmission Ratio (SRR), and Hypercalcemia components of the Star Ratings are measured. All of these changes are included in the DFC update made October 28, 2016.
Changes for CY2017 include adjustments to the Outlier Policy, Home/Self-Dialysis Training Add-On Payment, and Acute Kidney Injury provisions.
PY2019 will see two NHSN measures – DE reporting and BSI clinical – combined into a new Patient Safety Domain, and substantive changes to the Hypercalcemia clinical measure.
For PY2020, the Standardized Hospitalization Rate clinical measure and Ultrafiltration Rate reporting measure will be added, and the Mineral Metabolism reporting measure will be replaced by a reporting measure for Serum Phosphorus.
CMS has discovered an error in the calculation of the Standardized Readmission Ratio (SRR) that affects most facilities. The measure has been recalculated and is available for preview in your facility’s
Some planned readmissions were inadvertently excluded. In the recalculation, 11% of facilities nationwide show an absolute difference in SRR of more than 0.05. About 100 facilities changed SRR category on DFC. Use the Comments & Inquiries tab on https://www.DialysisData.org if you have questions on the SRR recalculation.