CMS has proposed that they improve their payments to rural hospitals, in an effort to improve rural health in the US. While this isn’t directly relevant to ESRD, it will certainly be relevant whenever a kidney patient needs services at a hospital in a rural area. Find the Proposed Rule and Request for Comment at https://www.govinfo.gov/content/pkg/FR-2018-05-07/pdf/2018-08705.pdf, and a Notice of Corrections at https://www.govinfo.gov/content/pkg/FR-2018-06-20/pdf/2018-13152.pdf. Comments are due by June 25, 2019. For background information see https://www.cms.gov/blog/putting-our-rethinking-rural-health-strategy-action and https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2019-IPPS-Proposed-Rule-Home-Page-Items/FY2019-IPPS-Proposed-Rule-Regulations.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending.
- In mid-June 2019 a series of presentations on Infection Control, offering free CME/CE credits to physicians, nurses, and pharmacists, will expire. CDC and Medscape produced them in 2017 with the intention that they’d be valid for two years. The six presentations include Risk Recognition, Environmental Services, Medical Equipment, Nonsterile Gloves, Hierarchy of Controls, and Injection Safety. Find them at https://www.cdc.gov/infectioncontrol/training/cme-info.html.
- The Joint Commission Speak Up series includes a poster and short video in English and Spanish on Infection Prevention. Find these tools and many more at https://www.jointcommission.org/topics/speak_up_infection_control.aspx. The Speak Up series also includes resources on Five Ways to Be Active in Your Care at the Hospital for dialysis and diabetes patients, on Avoiding a Return Trip to the Hospital, on Depression, on Organ Donation, on Pain, and many other topics. Find them all at https://www.dropbox.com/sh/3e5uml0tk6myy4s/AAB0a91UJK8p8-VkokWD0q2Ga?dl=0.
- The Oregon Patient Safety Commission suggests giving your facility a Patient Safety Culture Survey, such as those provided by the HHS Agency for Healthcare Research and Quality (AHRQ). While they don’t have a Survey specifically for dialysis facilities, most of the questions on any of their surveys are directly applicable or can easily be adapted. For details see https://oregonpatientsafety.org/news-information/patient-safety-alerts/add-patient-safety-culture-surveys-to-your-prevention-toolbox/945/.
- AHRQ will present a June 12, 2019 webinar on Best Practices for Web-Based Surveys on Patient Safety Culture; register at https://westat.webex.com/mw3300/mywebex/default.do?nomenu=true&siteurl=westat&service=6&rnd=0.14765443759873476&main_url=https%3A%2F%2Fwestat.webex.com%2Fec3300%2Feventcenter%2Fevent%2FeventAction.do%3FtheAction%3Ddetail%26%26%26EMK%3D4832534b00000004055fc9090fc824db69d4fc807faaa82be8a7e2f6b039075465c816eb25f825d0%26siteurl%3Dwestat%26confViewID%3D123809633363065597%26encryptTicket%3DSDJTSwAAAARxY3pJMqWtIxlWNZjpy6DEzK3qsti–1Bsvb7DlIp51Q2%26#utm_source=SOPSanc&utm_medium=Email&utm_campaign=20190422.
- The CDC Safe Healthcare Blog makes a good frequent reminder about the ever-present danger of infection, and how to respond to it effectively. It’s post for this week is titled Clean Hands Count to Keep Patients Safe from Healthcare Associated Infections. Find the post and the Blog at https://blogs.cdc.gov/safehealthcare/clean-hands-count-to-keep-patients-safe-from-healthcare-associated-infections/.
The ESRD National Coordinating Center has prepared a list of “Key Messages” for National Care Transitions Week, which you can find at https://s3-us-west-2.amazonaws.com/nwrn.org/files/N/NCC/NCC.NCTA.Keys.pdf. Other useful materials on the ESRD NCC website include:
- Care Transitions 201: CMS Webinar at https://esrdncc.uat.hsag.com/en/resources/professionals/care-transitions/care-transitions-201-cms-webinar/.
- Questions about You (and your hospital stay) at https://esrdncc.uat.hsag.com/contentassets/8bcc6caabcc74d48bb23802fa99dce95/nw15_sitdontstand-questions-about-you_final_508.pdf.
- We’re Not Being Nosy – We Care (so we want to know all about your hospital stay) at https://esrdncc.uat.hsag.com/contentassets/72339be2095d4906ba06b538680d531c/nw15_notbeingnosy_final_508.pdf.
CMS will present an April 9, 2019 Quarterly Measures webinar on the ESRD QIP SHR Standardized Hospitalization Ratio measure. For details see https://register.gotowebinar.com/register/6298808943011603459.
As part of a contract with the University of Michigan to develop a quality measure on Hospital Emergency Department Visits, CMS has issued a call for public comments, which are due by 13 November, 2017. For more information and comment instructions, see https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/PC-Currently-Accepting-Comments.html#0001 .
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.”
Find the article at https://hbr.org/2017/06/the-value-of-teaching-patients-to-administer-their-own-care .
A recording of the January 9, 2017 Network Council Call has been placed on the Northwest Renal Network website, along with a pdf of the slides from the webinar. The call described the current Network contract structure and obligations, with emphasis on this year’s Quality Improvement Activities and CROWNWeb requirements and protocols. Find the recording at https://healthinsight.adobeconnect.com/p6sn4hjkmow/?proto=true and the slides at https://s3-us-west-2.amazonaws.com/nwrn.org/files/qia/2017/2017NW16NetworkCouncilPresentationFinal.pdf .