Medicare Patients Should Expect Better Care at
Dialysis Centers, Says CMS
CMS issues final rule to update Medicare
‘conditions for coverage’
5 tips to prevent CKD below
March 4, 2008 – Senior citizens should expect a
higher quality of care when receiving dialysis, according to an
announcement yesterday from the Centers for Medicare & Medicaid Services
(CMS), that it has released a final rule that will modernize the
Medicare conditions for coverage for the nation’s dialysis centers.
“The final regulation will enhance the quality of
care available to more than 336,000 Medicare beneficiaries with
End-State Renal Disease (ESRD) who receive dialysis treatment from more
than 4,700 Medicare-approved renal dialysis facilities across the U.S.,”
according to CMS.
(Read CMS Fact Sheet below news report
and find link to final rule.)
The regulation reflects important clinical and
scientific advances in dialysis technology and standards of care
practices. The regulation also updates the current requirements that
were first published in 1976.
“By bringing the standards of care for dialysis
patients up to date, we are improving the health and quality of life for
thousands of Medicare beneficiaries,” said CMS Acting Administrator
Kerry Weems. “With the new rules, people living with ESRD can be assured
that they are getting the best care possible.”
The final rule went on display today at the Office
of the Federal Register and will be published April 4, 2008.
Five Tips to Prevent Chronic
Kidney Disease: National Kidney Month
March 4, 2008 – March is National Kidney Month and Fresenius
Medical Care North America, operator of a leading network of
dialysis clinics, encourages Americans to take steps to keep
their kidneys healthy and to detect kidney disease early. People
with kidney disease may not have symptoms until the disease is
advanced and they need dialysis treatment or a transplant.
“We
know that people who have diabetes, high blood pressure or a
family history of kidney disease are at higher risk, so it’s
important that they try to maintain a healthy lifestyle,” said
Joseph Pulliam, MD,Vice President, Medical Affairs for
Home Therapies at Fresenius Medical Care.
Chronic kidney disease (CKD) is a progressive disease. When CKD
gets worse, it can lead to kidney failure, called end stage
renal disease (ESRD). People who have ESRD need a kidney
transplant or dialysis – a life-sustaining treatment typically
required every other day to clean waste products from the blood.
CKD
also disproportionately affects senior citizens,
African-Americans, Hispanics, Asians and American Indians.
Five Tips to Help Prevent CKD
1.
See your doctor regularly, especially if you have diabetes, high
blood pressure or a family history of kidney disease. Keeping
your diabetes and blood pressure under control may help prevent
CKD or slow it down.
2.
If you smoke, quit. Smoking can accelerate kidney disease.
3.
Work with your doctor and healthcare team. Tell them about any
changes in your health.
4.
Follow all medication and diet changes prescribed by your
doctor.
5.
Take an active role in your healthcare. Educate yourself about
kidney disease and its treatments.
Fresenius Medical Care provides “patient-friendly support and
detailed information” on kidney disease and dialysis through its
website:
www.ultracare-dialysis.com.
For more information on dialysis clinics in your area, please
call 1-866-4-DIALYSIS (1-866-434-2597).
These regulations will serve as minimum standards
that dialysis facilities must meet in order to meet to be certified
under the Medicare program. These conditions for coverage are part of
the Medicare survey and certification process.
The rule focuses on the importance of patient
rights, patient safety and the patient’s participation in the
development of his or her own plan of care. Each facility is required
to develop a quality assessment and performance improvement (QAPI)
program that would track the facility’s performance in patient health
outcomes. This regulation also reduces the detailed and burdensome
requirements that dialysis facilities had to meet previously and
provides flexibility for facilities to use their resources to meet the
needs of individual patients and achieve better outcomes of care.
“This rule was designed with patient care in mind.
We’ve added requirements for facilities to conduct a comprehensive
assessment of the patient’s health condition when starting dialysis
treatment, as well as to work with an interdisciplinary team to develop
an individualized care plan for every patient,” said Barry M. Straube,
M.D., CMS Chief Medical Officer and Director of CMS’ Office of Clinical
Standards & Quality.
“Facilities must work with patients to achieve and
maintain the best possible outcomes of care,” Straube said. “We’ve also
added important protections to assure that all facilities develop a
quality improvement system that helps them better assess patient
outcomes and make positive changes that will improve health care
delivery.”
Beneficiaries will benefit by the following updates
in the rule:
● Adopts updated Centers for Disease Prevention
and Control (CDC) guidelines for hemodialysis facilities to increase
patient infection control procedures.
● Adopts updated American Association for
Medical Instrumentation (AAMI) water quality guidelines to promote safer
water for dialysis use.
● Requires defibrillators in every dialysis
facility, to allow facility staff to respond rapidly to individuals that
may be having a heart attack.
● Incorporates sections of the 2000 Life Safety
Code, which upgrades fire safety standards.
● Expands patient rights protections, including:
> A requirement to inform beneficiaries of
their right to have advance directives,
> A facility-level grievance process that
explains how a facility must respond to a patient’s grievance, and
> A policy that provides a 30-day written
notice to the patient before a facility can involuntarily discharge a
patient.
● Requires a comprehensive patient assessment
based on current medical practices and the patient’s unique needs.
● Requires a personalized patient plan of care,
based on current standards of care
● A facility-level quality assurance and
performance improvement (QAPI) program to demonstrate how the facility
will improve the quality of care it provides to patients.
● Minimum qualifications and training
requirements for patient care technicians.
● Increases Medical Director involvement in the
outcomes of the QAPI program and involuntary transfers or discharges.
The final rule meets CMS’s overall goal of
protecting patient safety, enhancing ongoing quality improvement, and
improving patients’ experience receiving dialysis services. CMS
continues to work to improve the quality of health care by measuring and
improving outcomes of care, educating health care providers about
quality improvement opportunities, and educating beneficiaries to make
good health care choices.
Conditions
for Coverage for End Stage Renal Disease Facilities
Overview
The Centers for Medicare & Medicaid Services (CMS)
has issued a final rule that establishes new Conditions for Coverage (CfCs)
that dialysis facilities must meet to be certified under the Medicare
program. This final rule:
(1) focuses on the patient and the quality of care provided to the
patient,
(2) establishes a performance monitoring program for facilities,
(3) encourages patients to participate in their plan of care and
treatment, and
(4) eliminates many outdated procedural requirements from the previous
conditions for coverage, yet preserves strong standards that promote
meaningful patient safety, well-being, and continuous quality
improvement.
This final rule reflects the advances in dialysis
technology and standard care practices since the requirements were first
issued in 1976.
Background
ESRD is permanent failure of the kidney that is
irreversible and requires a regular course of dialysis or kidney
transplantation to maintain life. Dialysis is the process of cleaning
the blood and removing excess fluid artificially with special equipment
that takes the place of the kidney function.
The existing ESRD CfC rule was originally adopted
in 1976. In these existing requirements for dialysis facilities, CMS
emphasized the policies and procedures that must be in place to support
quality patient care, and focused on a facility’s capacity to furnish
quality care in 1976.
To determine if an ESRD facility is to be certified
by Medicare, the State survey agency performs an on-site survey of the
facility using the standards in the ESRD CfCs. The ESRD facility is
considered Medicare certified and eligible for Medicare payment if the
survey finds that a facility complies with the conditions for coverage
and all other Federal requirements are met. Medicare payment for
outpatient maintenance dialysis is limited to facilities meeting the
ESRD CfCs.
On February 4, 2005, CMS published in the Federal
Register a proposed rule titled “Conditions for Coverage for End Stage
Renal Disease Facilities.” In that rule, CMS proposed a number of
revisions to the existing requirements and proposed adding new
requirements that ESRD dialysis facilities must meet in order to be
certified under the Medicare program such as a new requirement for
facilities to develop a quality assessment and performance improvement
program.
CMS’s Commitment to Improved Quality Outcomes
Revising the ESRD requirements is part of our
larger effort to modernize regulations and improve the availability of
quality-of-care information; to promote transparency; and to move toward
a patient outcome‑based system that focuses on quality assessment and
performance improvement. Revising the conditions for coverage will
encourage improvement in outcomes of care for beneficiaries by requiring
that all facilities report data on CMS’s existing clinical performance
measures (CPMs). The collection and reporting of the ESRD CPMs is an
effective tool to facilitate quality improvement. This requirement will
allow CMS to track improvements in several outcomes for those
individuals with end-stage renal disease that receive dialysis
services.
Highlights of Provisions in the Final Rule
Include
> Updated CDC
guidelines for hemodialysis facilities
> Updated AAMI
water quality guidelines
> Defibrillators
in every dialysis unit
> Incorporates
sections of the 2000 Life Safety Code for fire safety
> Option for
patients to have an advance directive
> Facilities
provide written notice 30 days before a patient is involuntary
discharged
> Facilities
perform clinical assessment within 30 days, or 13 hemodialysis
treatments, of patient starting treatment
> Home dialysis
water purity requirements based on updated AAMI standards
> Facility-level
quality assurance and performance improvement program
> Minimum
qualifications and training requirements for patient care technicians (PCTs)
> Responsibility
of Medical Director for Quality Assessment and Performance Improvement (QAPI)
and involuntary transfers or discharges
