ESRD Patient Contacts

1. ESRD Patient Contacts Understanding and Standardizing Beneficiary Centered Contacts QualityNet 2012 | Baltimore Marriott Waterfront Hotel December 11-13, 2012

2. Welcome

3. Welcome and Housekeeping • Roll Call • Introductions • Purpose of the ESRD Patient Contacts Session • CMS BFCC Aim Review • CMS ESRD Network Scope & Paradigm Shift • ESRD Patient Contact Data Elements

4. Introductions • Presenters • Michael W. Kennedy, PMP, MSMPM • Elena Balovlenkov, RN, MS, CHN • CMS Opening Remarks

5. Purpose of the ESRDPatient Contacts Session

6. Purpose of the ESRDPatient Contacts Session • What are ESRD Patient Contacts? • ESRD Networks have been tasked with tracking ESRD beneficiary contact and grievance information. In the past, it was tracked and managed via the legacy Standard Information Management System (SIMS), and the Network Contact Utility (NCU). • In the future ESRD Network SOW, CMS is moving to a more beneficiary-centered tracking format; thus, it will track specific contacts and grievances information along with beneficiary-centric information. Less inferences will be placed on ESRD facility and personnel contacts information. • Facility contacts specific to patient concerns may be tracked (i.e., placement of new or previously discharged patients).

7. Purpose of the ESRDPatient Contacts Session • What do ESRD Networks need to know about ESRDPatient Contacts? • The future ESRD Networks SOW will still track patient-specific or patient-centric contacts. • A new web-based application, Patient Contact Utility (PCU), will be implemented for ESRD Networks to capture the ESRD patient contacts information. • CMS Regional & Central Office will have access to the PCU for review and assistance. • Timeline for the future web-based PCU is tentatively Spring of 2013. Further updates on timeline will be provided as it is finalized.

8. ESRD Patient Contacts – Web-based Solutions Elicitation

9. ESRD Patient Contacts – Web-based Solutions Elicitation • What are ESRD Networks concerns regarding web-based ESRDPatient Contacts? • Freedom of Information Act (FOIA) • Infrastructure • User visibility (purview and permissions) • ESRD Network roles and access • Data Reporting

10. CMS Beneficiary and Family-Centered Care Initiative

11. CMS BFCC AIM • CMS has a new Beneficiary & Family Centered Care (BFCC) Initiative • Data collection and information is to geared toward the beneficiary and his/her family. • The NCU is shifting towards the PCU to align and meet this initiative for ESRD Networks. • How will shifting NCU to PCU satisfy the new BFCC initiative? • CMS will have real-time access to see and assist on beneficiary contacts and reporting. • This is the next step in aligning with the CMS Case Management process.

12. CMS ESRD Networks Scope • CMS ESRD Networks Scope • CMS is currently rewriting and defining the ESRD Network Organizations Manual for Chapter 7 – ESRD Complaints and Grievances (Chapter 7). • The goal is to have a draft released in time for the 2013 ESRD Networks SOW.

13. CMS ESRD Network Scope • Paradigm Shift • ESRD Networks are not tasked with tracking ALL ESRD contacts, including facility and personnel, but there will be patient-specific tracking of contacts and grievances. • The PCU will be the CMS-approved tracking mechanism for the future SOW patient-specific contacts. • The NCU will not be prohibited from being used for tracking other types of ESRD Networks contacts (i.e., non-patient-specific contacts from facility or personnel). However, CMS reporting and tracking for the ESRD Networks SOW will be through the PCU. • Involuntary Discharge vs. Involuntary Transfer • Averted Discharge

14. ESRD Patient Contact Data Elements

15. ESRD Patient Contact Data Elements • What are ESRDPatient Contacts Data Elements? • Data elements were taken from SIMS, the NCU, and the work done by the ESRD Networks for the Patient Learning Action Network project. • CMS started with the Network-defined data elements and definitions. • CMS reviewed and aligned the definitions with other divisions and agencies within Medicare. • CMS also aligned the definitions to be inclusive and standard with other regulations and statutes for accepted healthcare community-standard definitions for data elements (i.e., mental health…).

16. ESRD Patient Contact Data Elements • Definitions Review • Areas of Concern • Specific Areas of Concern • Barriers to Access • At-Risk for Involuntary Discharge • Involuntary Transfers • Averted Discharges • ESRD Network Actions • Patient Interventions • Patient Education

17. Questions & Answers Michael W. Kennedy 1-813-865-3338 1-601-316-0627 mkennedy@fmqai.com Please copy Elena Balovlenkov (ebalovlenkov@cms.hhs.gov) on all questions and correspondence. This material was prepared by FMQAI: The Florida ESRD Network, under contract with the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. FL-ESRD-2012ESET2C-11-378