Centers for Medicare & Medicaid Services (CMS)
Quality Improvement/Evidence of Therapy
This section describes current quality improvement and evidence of therapy programs of the Federal government related to chronic kidney disease.
The Dialysis Facility Compare (DFC) contains information about Medicare certified dialysis facilities. Included is facility and contact information, location, types of services, and certification date; as well as quality outcome data for anemia, adequacy of hemodialysis, and survival rates for each facility. DFC allows patients and their family members, as well as professionals, to compare the quality of dialysis facilities across the country, and to access a variety of kidney and dialysis resources. Users are also able to find facility services and quality measures.
The facility information and data comes from two CMS Administrative Data sources: Standard Information Management Systems (SIMS) and Renal Management Information System (REMIS). The quality measure data for anemia and adequacy of hemodialysis comes from end-stage renal disease (ESRD) claims data and the survival data calculated using SIMS and REMIS. The ESRD Networks verify, update, and send data in SIMS to Medicare monthly. REMIS is a database maintained by Medicare with data about dialysis facilities. It includes demographic, medical claims, payment, and entitlement data on people with Medicare who have ESRD; certification and other information for Medicare-certified ESRD providers; and aggregate ESRD patient information.
Contact Information
Name: Thomas Dudley
Phone: 410-786-1442
Email: Thomas.dudley@cms.hhs.gov
Web: www.medicare.gov/dialysis
The Prevention Quality Improvement Organization Support Center (QIOSC) as contracted by the Centers for Medicare & Medicaid Services (CMS) provides technical assistance and support to select Quality Improvement Organizations (QIOs) that are partnering with community representatives, primary care physicians, nephrologists and vascular surgeons to improve care for patients with chronic kidney disease (CKD). QIOs working on this project represent beneficiaries in Florida, Georgia, Missouri, Montana, Nevada, New York, Rhode Island, Tennessee, Texas, and Utah as well as the United States Virgin Islands.
The CKD Quality Improvement Project promotes early detection of CKD and proper medication treatment to slow the progression of the disease. It also addresses the need for patients who are approaching kidney failure to receive timely counseling to enable safer, higher-quality access to dialysis through a fistula.
The Prevention QIOSC facilitates this important work of the CKD QIOs by:
- Engaging expert stakeholders and partners
- Developing and/or disseminating tools
- Providing educational information and resources
- Identifying QIO barriers, lessons learned, and success stories
- Synthesizing and disseminating “what works” information
- Making the “business case”
Additionally, the Prevention QIOSC supports the goals of the End Stage Renal Disease Networks through partnering with the Fistula First Breakthrough Initiative (FFBI) contractor, Mid-Atlantic Renal Coalition.
The Prevention QIOSC contract is held by Virginia Health Quality Center.
Contact Information
Robin Weil, MSHA, RN, CPHQ
Phone: 804-289-5351
Email: rweil@vaqio.sdps.org
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Public Education & Outreach
This section describes current patient outreach and education programs of the Federal government related to chronic kidney disease.
CMS maintains a partnership with the National Kidney Foundation of Hawaii: Kidney Options for Patient Empowerment Program (KOPE). The CMS Pacific Area Representatives have conducted three educational sessions with patients, family members, caregivers, and social workers for dialysis facilities. These sessions include presentations regarding Medicare eligibility, coverage, Part D, low-income subsidy health information, and other resources for chronic kidney disease and end-stage renal disease patients.
Contact Information
Yvette Williams
Phone: 410-786-6844
Email: Yvette.williams@cms.hhs.gov
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Delivery & Payment of CKD Care
This section describes delivery and payment of chronic kidney disease care provided by the Federal government.
CMS is conducting a demonstration project, entitled Care Management for High Cost Beneficiaries. One of the participating sites has designed its interventions based on beneficiaries with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The project focuses on the maintenance of patients with level 4 and level 5 CKD progressing to ESRD without a past acute in-patient episode. Disease management is directed by nephrologists in supplementary clinics to identify potential problems and avoid complications, coordination of early intervention plans, and prevention of acute hospitalizations stays.
Contact Information
Abe Hollander
Phone: 410-786-7874
Email: abraham.hollander@cms.hhs.gov
The Medicare End Stage Renal Disease Program is a national health insurance program for people with end stage renal disease (ESRD). Initially, ESRD Network areas were established to encourage self-care dialysis and kidney transplantation and to clarify reimbursement procedures in order to achieve more effective control of the costs of the renal disease program. Subsequently, the Social Security Act was amended to establish at least 17 ESRD Network areas and to revise the Network Organizations responsibilities.
Currently, 18 ESRD Network Organizations exist under contract to CMS and serve as liaisons between the federal government and the providers of ESRD services. The number and concentration of ESRD beneficiaries in each area define the Network Organizations geographically. Some Networks represent one state, and others represent multiple states. The ESRD Network Organizations' responsibilities include: the quality oversight of the care ESRD patients receive, the collection of data to administer the national Medicare ESRD program, and the provision of technical assistance to ESRD providers and patients in areas related to ESRD.
In addition, the ESRD Network Coordinating Center (NCC) provides centralized coordination and support for the ESRD Network Program. The NCC's primary responsibilities include collection, maintenance and distribution of ESRD information; coordination of national activities, including training initiatives; facilitation of special projects, and administrative support services, such as the planning of meetings and summary reports for ESRD Networks and CMS' ESRD Network Program.
Contact Information
Lynn Riley
Phone: 410-786-1286
Email: lynn.riley@cms.hhs.gov
Web: www.esrdncc.org
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Professional Education & Outreach
This section describes education and outreach to health professionals of the Federal government related to chronic kidney disease.
CMS issued a 9th Statement of Work (SOW) for Medicare’s Quality Improvement Organizations (QIOs) to improve the quality, safety, and efficiency of health care services delivered to Medicare beneficiaries. One quality improvement effort required of the QIOs is to reduce the progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD). Each QIO is required to:
- Focus on three clinical areas, each with a corresponding clinical measure. These areas include detection of CKD in diabetic beneficiaries; appropriate medication treatment, such as angiotensin converting-enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) to slow the progression of CKD; and adequate counseling prior to initiation of dialysis as evidenced by placement of an arteriovenous (AV) fistula for hemodialysis patients.
- Use collaboration as a means of achieving sustainable CKD system level changes. All QIOs must monitor the effect of their CKD interventions on disparities and must take immediate corrective action if disparities in care are increasing. QIOs may opt to engage in the following three optional tasks: supporting companion CMS quality initiatives, improving CKD care via electronic health records, and decreasing CKD care disparities identified in their state.
CMS’ goal is to make sure that the QIOs are providing CMS beneficiaries with the best quality of care through the use of available tools as they work with consumers, primary care providers, hospitals, and other caregivers to refine the nation’s care delivery systems. QIOs began work on the CKD quality initiative in August 2008.
Other activities include the coordination of educational efforts to primary care providers and laboratories to encourage the reporting of eGFR testing to aid in early detection of CKD.
Contact Information
Yvette Williams
Phone: 410-786-6844
Email: Yvette.williams@cms.hhs.gov
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Surveillance
This section describes surveillance activities and programs of the Federal government related to chronic kidney disease.
CMS maintains a list of end-stage renal disease (ESRD) contacts that is distributed (via email) regarding issues that are significant to ESRD providers. CMS maintains a partnership with the National Kidney Foundation and other organizations on issues of interest to ESRD and chronic kidney disease patients, such as information about the availability of low-income subsidy for low-income beneficiaries and caregiver efforts.
Contact Information
Barbara Cebuhar
Phone: 202-260-1020
Email: Barbara.cebuhar@cms.hhs.gov
Other surveillance efforts include monitoring and on-site support surveys and enforcement procedures. CMS also provides certification for new suppliers and services.
Contact Information
Roger Perryn
Phone: 816-426-6416
Email: roger.perryn@cms.hhs.gov
This information was reviewed by KICC agency representatives. It may not reflect new or future agency activities. For more information, please contact the listed representatives. |
