PROGRESS NOTES

ESRD Network 9/10 Summer 2004/Vol XI, No.2

The 2004 NephrologyConference...was held June 10-11, 2004 at theSheraton Chicago Hotel and Towers at301 East North Water Street in Chicago.The BONENT exam was held on June 9th.

The conference was a big success with atotal of 948 in attendance. Over 100 ven-dor representatives were also present.Over the two days, nine meetings wereheld with 39 speakers talking on a varietyof subjects. The Fistula First project andvascular access were the predominanttheme throughout the conference.

The following is a breakdown of theattendance at the meetings.

NEPHROLOGY UPDATE 328DIETITIANS 54SOCIAL WORKERS 61TECHNICIANS 45NURSES 157PHYSICIANS 100ADMINISTRATORS /MANAGERS 108PEDIATRIC RENAL GROUP 50MD/ADVANCED PRACTICENURSE DINNER 40BONENT EXAM 5

Each year, as part of the conference, theNetwork recognizes achievement among itsmembers by presenting awards forindividuals who have made outstandingcontributions to the Network, and also tothose facilities that have gone above andbeyond the minimum to meet networkreporting requirements, both in data and

quality assurance. The Quality AwardLuncheon was held on Thursday, June 10th.Over 350 people attended the lunch.

Receiving the prestigious Dr. Hayes H. DavisService Award, was Jeannette A. Cain,

B.S.R.N., M.S.M.,C.P.H.Q. formerDirector of QualityImprovement for theNetwork. For nearlyfourteen years,Jeannette helped theNetwork to break newground in all areas ofquality improvementand quality assurance.

This award honorsJeannette’s invaluablecontributions to theNetwork. Currently,

Jeannette is affiliated with the Medical College ofVirginia, part of the Virginia Common-wealthUniversity. Working as a Clinical Nurse Analystin Nursing Administration, Jeannette continues tochallenge and inspire those around her.

Receiving the 2004 President’s Award wasJoseph M. Defazio, Assistant Professor at theIndiana University - Purdue University atIndianapolis, School of Informatics, New MediaProgram for his outstanding contributions to theNetwork’s Patient Services Department. Workingwith both undergraduate and graduate studentinterns, Prof. Defazio has been instrumental inthe creation of Kidney Patient News our patient-centered Web site (www.kidneypatientnews.org),

Continued on page 8

Jeannette A. Cain, recipient ofthe Dr. Hayes H. Davis ServiceAward, at the 2004 NephrologyConference Awards Luncheon.

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FISTULA FIRST Update

We are entering the second year of theCMS (Center for Medicare/MedicaidServices) national project “Fistula First”. TheVascular Access Advisory Panel (VAAP), inconcert with The Renal Network, Inc., willcontinue to offer education and supportservices to the renal community.

The first year (2003-2004) of this importantinitiative included eleven EducationCampaigns. Each campaign was designedto reflect the “Fistula First Change Package”as illustrated by the Patient LeadershipCommittee’s Fistula First calendar.

These campaigns targeted nurse managers,medical directors, and advanced practicenurses. The goal was to promote thespread of information and encourage eachfacility to develop a Fistula First programthat will speak to their individual needs.

There were five “Learning Sessions”presented in five centrally located areas.These sessions, presented by The RenalNetwork and hosted by local medicalprofessionals, provided ideas and debate to316 renal professionals representing 24 ofour 26 HSAs (Health Service Areas).

The plans for year two are well under way.Once again The Renal Network will host fivelearning sessions. However we will beexpanding the learning session format toprovide work sessions where local adopterscan come together as a unit to further theirgoals for the Fistula First project.

These “Learning Sessions” will be morecomprehensive and work oriented. Therewill be time for break out sessions, andquestion and answer periods. In this wayrenal professionals can come together topresent and explore ideas and options such

as education tools, data collection tools,and information gathering. CMEs andCEs will be awarded.

We will be introducing WebEx sessions.The WebEx is an interactive, real-timemeeting using the Internet to viewpresentations while participating on aconference call. This tool enablesparticipants to dynamically meet onlineallowing the renal community to cometogether in a unique and exciting way.

Our Web site, www.therenalnetwork.org,will continually be updated with the latestinformation and resource material.

A “Tool Kit” will be developed to promoteearly referral (stage 1-2 CKD). This willbe distributed by The Renal Network tofurther the education and training of staffand patients.

Presently we have “Fistula FirstChampions” in Indianapolis, Indiana,Cincinnati, Ohio, and Columbus, Ohio.We believe as this project continues togrow that champions will emerge frommany areas.

The current “champions” are hosting localinitiatives to increase awareness of theFistula First project, collecting anddisseminating data on vascular access,and sharing ideas and concepts that areproviding success in the area of fistulacreation and preservation.

Our Vascular Access Advisory Panel(VAAP) is designing a “Centers ofExcellence-Superior Achievement inFistula Management” Award. This is anaward that facilities may apply for,demonstrating by quality data, that theteam concept is in place.

Continued on page 3

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Raynel Kinney, RN, CNN, CPHQ, QualityImprovement Director of The RenalNetwork will continue to work with thenational group to guide and direct thisproject in our four state area.

The vision of the VAAP of The RenalNetwork is for each facility to develop a well-rounded Access Management Program.We know that there is much yet to do. Butwith your input and dedication to this projectthe quality of life of the renal disease patientswill continue to improve.

The Renal Network, Inc.Prevalent Fistula Rates

December 2002 – May 2004

The above chart looks at The Renal Network’s prevalent fistula rates by networkand by state. Clearly there has been marked improvement in some areas but thereis still alot of work to be done to acheive our goals.

Continued on page 54

Facilities Reporting > 40%

KentuckyCaldwell County Dialysis, Princeton, KY

DCI- Frankfort, Frankfort, KYFMC - Central Richmond, Richmond, KY

FMC - Louisville, Louisville, KYFMC - Morehead, Morehead, KY

FMC - Prestonsburg, Prestonsburg, KY

OhioAlexis Dialysis Center, Toledo, OH

Davita - Seneca County Dialysis, Tiffin, OHDialysis Centers of Dayton - East, Dayton, OH

FMC - Central Ohio, Columbus, OHFMC - Dialysis Services Mound Builders, Newark, OH

FMC - Heart of Ohio, Marion, OHFMC - Portsmouth, Portsmouth, OH

Fremont Dialysis Center, Fremont, OHGambro Healthcare - Butler County, Franklin, OH

Gambro Healthcare - Columbus East, Columbus, OHGambro Healthcare - Lake County, Madison, OH

Gambro Healthcare - Monroe, Monroe, OHGambro Healthcare - Silverton, Cincinnati, OH

Gambro Healthcare - Western Hills, Cincinnati, OHHillmed Dialysis-Middleburg Heights, MiddleburgHeights,OH

Hillmed Dialysis Center - Rocky River, Rocky River, OHLima Memorial Hospital, Lima, OH

Middletown Regional Hospital Outpatient Dialysis, Middletown, OHPutnam County Ambulatory Care Center, Glandorf, OH

Shelby County Kidney Center, Sidney, OH

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Fistulas in December, 2003

IndianaFMC - Dialysis of Central Ft. Wayne, Ft. Wayne, IN

FMC - Dialysis of Huntington, Huntington, INFMC- Merrillville Dialysis Center, Merrillville, IN

FMC - South Anthony Dialysis Center, Ft. Wayne, INRCG - Noblesville, Noblesville, IN,

RKC of Jasper, Jasper, INSt. Elizabeth Dialysis at Clinton County, Frankfort, IN

IllinoisDavita - Dekalb Dialysis Unit, Dekalb, IL

Davita - Hyde Park Kidney Center, Chicago, ILDavita - Lincolnland, Springfield, IL

FMC - Bridgeport, Chicago, ILFMC - Champaign-Urbana Dialysis Center, Urbana, IL

FMC - Chicago Dialysis Center, Chicago, ILFMC - Glenview Dialysis Center, Glenview, ILFMC - Neomedica - Cumberland, Norridge, IL

FMC- Neomedica - Gurnee, Gurnee, ILFMC - Neomedica - Rolling Meadows, Rolling Meadows, IL

FMC - Neomedica - South Holland, South Holland, ILFMC - North America - Advocate, Niles, IL

Gambro Healthcare - Decatur East Wood, Decatur, ILGambro Healthcare - Effingham, Effingham, IL

Gambro Healthcare - Litchfield, Litchfield, ILGambro Healthcare - Macon County, Decatur, IL

Gambro Healthcare - Springfield Central, Springfield, ILGambro Healthcare - Taylorville, Taylorville, IL

Provena St. Mary’s Hospital, Kankakee, ILQuad Cities Kidney Center, Geneseo, IL,

RCG - MMB Dialysis, Macomb, ILRCG - University Program, Chicago, IL

VA Medical Center - Lakeside, Chicago, IL

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Vocational RehabilitationCounselor SurveyThe Renal Network sent a brief survey to thestate vocational rehabilitation counselors in itsfour state area. Out of the 107 mailed, therewere 23 responses representing 14 differentagencies. The responses were from thefollowing states:

Illinois 7Indiana 14Kentucky 2Ohio 0

The counselors noted that CKD clients areprimarily seeking assistance with going backto school and employment. When asked whatwould facilitate assisting clients with kidneydisease, the need for pertinent medicalrecords was stated the most frequently. Whenasked what hinders assisting CKD clients, theprimary reason given was the difficulty inworking with the dialysis schedule.

The primary suggestion the vocationalrehabilitation counselors had for dialysisfacilities and patients was that staff andpatients needed more knowledge aboutvocational rehabilitation services.

Some comments indicated that there are fewreferrals from dialysis centers and othercomments indicated that patients should knowtheir ability level to help determine what theycan and cannot do.

The Renal Network encourages you to sharemore information about vocationalrehabilitation with your patients and to talk tothe rehabilitation counselor in your area. Themore information that you can learn aboutvococational rehabilitation services and themore the vocational rehabilitation counselorscan learn about dialysis patients, the more thepatients will benefit.

You may want to designate one issue ofyour facility’s newsletter to rehabilitationand perhaps post information on yourbulletin board.

You may also want to invite someone in totalk to patients about the “Ticket to WorkProgram” or going back to school tofurther their education. People could comein and talk to patients in the waiting roomor at a support group meeting or aneducational health fair. Call the Network ifyou need additional information.

CMS Cracks Down on HIPAANon-CompliancePayments Delayed For Electronic PaymentsThat Don’t Meet Standards After July 1

CMS Administrator Mark McClellanannounced last week that CMS will penalizeproviders submitting Medicare claims that donot meet federal standards for electronictransactions by delaying payments fornoncompliant claims. He said electronicclaims submitted on or after July 1 that do notmeet Health Insurance Portability andAccountability Act (HIPAA) standards will betreated as paper claims and will take twoextra weeks to get paid.“The great majority of electronic claims weare receiving meet the required HIPAAstandards,” McClellan said, “but for the thosestill not in compliance there is going to be adelay in getting their money. We are hopingthis will motivate more filers to get intocompliance soon.”

The deadline for HIPAA compliance was lastOctober but, because of poor compliancelevels, CMS implemented a contingency planenabling Medicare to keep processing non-compliant claims from providers unable tomeet the target date. McClellan said 90percent of providers are now in compliance.

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The ESRD ModernizationAct of 2004 (S.2614) …was introduced in the United StatesSenate this July. The text of the bill is nowavailable on-line from Thomas, a sourcefor legislative information on the Internet,(http://thomas.loc.gov/cgi-bin/query/z?c108:S.2614:).The main provisions of the bill are:

I. MODERNIZING THE MEDICAREESRD PAYMENT SYSTEM

• Establishment of annual updateframework for the Medicare ESRDcomposite rate.

II. PATIENT EDUCATION, QUALITY,ACCESS AND SAFETY INITIATIVES

• Support of public and patienteducation initiatives regardingkidney disease.

• Medicare coverage of kidneydisease patient education services.

• Blood flow monitoringdemonstration projects.

III. FINANCING AND COVERAGE FORESRD PATIENTS

• Improving the home dialysisbenefit.

• Institute of Medicine evaluationand report on home dialysis.

IV. SUSTAINABLE ECONOMICS• Modification of physician surgical

reimbursement for dialysis accessprocedures to align incentives forcost and quality.

• Demonstration project foroutcomes-based ESRDreimbursement system.

• GAO study and report on impact ofG-codes

Dialysis Facility Compare WebSite Updated

CMS is pleased to announce the release ofDialysis Facility Compare(www.medicare.gov/Dialysis/Home.asp) in the “next generationcompare” format that provides users withsimple navigation within the tool.

Users will be able to search for dialysisfacilities by State, County, City, Zip or Name.Proximity searches are now available whensearches are made on City or Zip.

In addition, a search can be narrowed tospecific services offered by dialysis facilities.Users will find new text explanations and amore accessible reading level. Users canalso search for additional web resources bypopulation (CKD, Children, Transplant, etc.).

The 2004 NephrologyConference... cont’d form p. 8

The following summarizes the number offacilities honored in each category.

CATEGORY HEMODIALYSIS PERITONEALADEQUACY 102 17ANEMIA 96 18FISTULA RATE 56CATHETER RATE 3SUSTAINING MEMBERS 25 7

Mark your calendar...for The 2005 Nephrology Conference to be heldin Indianapolis, Indiana at the IndianapolisMarriott Downtown on Wednesday, May 25thand Thursday, May 26th.

PROGRESS NOTESAddress Service Requested

The Renal Network, Inc911 E. 86th Street, Suite 202Indianapolis, IN 46240

Jay Wish, M.D.President

Susan A. StarkExecutive Director

Web site: www.therenalnetwork.orgEmail: info@nw10.esrd.net

This newsletter is published under CMS Contracts 500-03-NW09 & 500-03-NW10

Non Profit Org.U.S. Postage

PAIDIndianapolis, INPermit No. 8606

educational materials, such as Kidney Joean interactive CD-ROM game and theVascular Access educational video shorts.

Prof. Defazio wrote, performed andproduced the musical score for TheUninvited Guest, an aninimated videofeature presentation on the impact of kidneydisease on the family, which was premieredduring the awards luncheon.

Also honored at the awards lucheon werethe Trover Foundation Renal DialysisCenter receiving the Facility Award and

The 2004 NephrologyConference...cont’d form p. 1

Tracee Bauer receiving the Patient Award ---each a part of the Robert Felter MemorialAward.

Approximately 187 facilities also receivedawards. CPM data from October-November-December of 2003 wassubmitted by 85% of our hemodialysisfacilities and 69% of peritoneal. Thoseprograms were eligible for awards.To qualify for an award in the anemiacategory, a facility must have achieved ahemoglobin of >= 11gm/Dl in 85% or moreof their patients.For adequacy, a hemodialysis facility musthave achieved a Kt/V of 1.2 in 95% or morepatients.Peritoneal programs attained goals forcreatinine clearance and weekly Kt/V.Facilities were recognized for fistula rates of=40% and catheter rates =10%.Sustaining members are dialysis programsreceiving an award for at least threeconsecutive years.Congratulations to all for a job well done!See page 7 for a summary of the number of facilitieshonored in each category. Also see page 4 for a listingof the facilities that were recognized through the Network‘sFacility Quality Awards Program for achievement in fistularates.

Joseph M. Defazio pictured with Kathi Niccum, PatientServices Director and Dolores Perez, Comminications Director.