Presentation to ANNA November 13, 2013 IPRO ESRD Network of New York 2013 Stakeholder Collaboration and Community Outreach The Patient as Consumer: Patient Centered Care at the Dialysis Unit Presentation to ANNA November 13, 2013 End-Stage Renal Disease Network of New York 1

Today’s Goals Introduce: Patient/Family/Care Partner Engagement in the ESRD Community and with the CMS Conditions for Coverage The Concept of the Patient as Customer in the Healthcare Setting Patient Centered Care Medicare’s Quality Incentives for ESRD Providers Provide Empowerment Resources End-Stage Renal Disease Network of New York

The Regulations The ESRD Conditions for Coverage are the minimum health and safety rules that all Medicare and Medicaid participating dialysis facilities must meet. The April 15, 2008 ESRD Conditions Final Rule modernizes Medicare's ESRD health and safety conditions for coverage and updates CMS standards for delivering safe, high-quality care to dialysis patients. The revised regulations are patient-centered; reflect improvements in clinical standards of care, the use of more advanced technology, and, most notably, a framework to incorporate performance measures viewed by the scientific and medical community to be related to the quality of care provided to dialysis patients. End-Stage Renal Disease Network of New York

The State Survey Agency The Enforcement The State Survey Agency The new ESRD Core Survey Process: • Promotes the use of ESRD data to focus on areas of potential risk within each ESRD facility; • Incorporates a “culture of safety” into a robust Quality Assessment and Program Improvement review; and • Utilizes infection control Checklists developed jointly by the Agency for Healthcare Research & Quality (AHRQ), the Centers for Disease Control & Prevention (CDC), and CMS. The new ESRD Core Survey process is an outcomes-focused, risk-based approach to ESRD surveys, with the determinations of “risk” to ESRD patients based upon data (from ESRD surveys and ESRD literature) and professional judgment (from ESRD surveyors, ESRD patient leaders, technical experts, ESRD Network leaders, and professional and organizational leaders). The new ESRD Core Survey process begins with a focus on 1/3 of the ESRD survey tags as the most critical tags for ESRD safety and quality risks. The new ESRD Core Survey Process also: • Promotes the use of ESRD data to focus on areas of potential risk within each ESRD facility; • Incorporates a “culture of safety” into a robust Quality Assessment and Program Improvement review; and • Utilizes infection control Checklists developed jointly by the Agency for Healthcare Research & Quality (AHRQ), the Centers for Disease Control & Prevention (CDC), and CMS. End-Stage Renal Disease Network of New York

Interpretive Guidelines “Vtags” Interpretation Interpretive Guidelines “Vtags” Excerpt from V501 an interpretation of CfC § 494.80 Condition: Patient assessment. “The interdisciplinary team (IDT) is composed of the members designated in the regulations, including the patient or a patient designee if the patient so chooses. Patients must be given the option and encouraged to participate in their assessment and care planning process.” End-Stage Renal Disease Network of New York

Assistance, Education and Oversight The ESRD Networks ESRD Networks work with consumers and ESRD facilities and other providers of ESRD services to refine care delivery systems to make sure ESRD patients get the right care at the right time. The Program's responsibilities include: •Assuring the effective and efficient administration of benefits •Improving quality of care for ESRD patients •Collecting data to measure quality of care •Providing assistance to ESRD patients and providers •Evaluating and resolving patient grievances End-Stage Renal Disease Network of New York

Evolution of Care: The Three Aims AIM ONE: Better Care for Individuals Focus on Patient/Family/Care Partner Engagement End-Stage Renal Disease Network of New York

What is Patient Centered Approach to Care? End-Stage Renal Disease Network of New York 8

The Patient as Customer Communication: Words Matter. Are we providing Medical Care or are we providing HEALTHCARE? This requires a philosophy change. health care or healthcare n. The prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions. End-Stage Renal Disease Network of New York

POLL How many of you feel that Patients don’t want to be engaged? End-Stage Renal Disease Network of New York

Dialysis Healthcare Center A Healthcare Center does more than just treat an illness. Prevention Treatment Management of Illness: By working together with patient/family/care partner and the interdisciplinary team, you are managing ESRD, teaching management skills and supplying tools that can empower and encourage self management. Preservation of mental and physical well-being Prevention: The most dramatic therapy that there is, dialysis is renal replacement therapy, which prevents death. Treatment: Dialysis centers also treat: anemia, bone mineral metabolism (and….) Management of Illness: By working together with patient/family/care partner and the interdisciplinary team, you are managing ESRD, teaching management skills and supplying tools that can empower and encourage self management. Preservation of mental and physical well-being: End-Stage Renal Disease Network of New York

The Patient as Customer . An Engaged Patient is: more likely to develop good health habits, such as following wellness regimens* more tuned into messaging from healthcare providers and, more likely to make follow-up appointments, take prescribed drugs and keep up with treatments *What if we viewed the Annual Care Plan as the Annual “Wellness Plan”? Engaged patients work with their healthcare providers to manage illness and prevent future complications rather than just seek treatment after illness occurs. This preventive approach can dramatically reduce the costs associated with medical care End-Stage Renal Disease Network of New York

The Patient as Customer RETHINK: “The Customer is always right” Patients/Customers are the experts in how they are feeling/reacting to their care. With the right communication skill sets, both patients/customers and provider staff will be able to work together as part of the interdisciplinary team. With understanding and effective communication, the patient will be engaged, empowered, and "right". End-Stage Renal Disease Network of New York

EMPATHY We are ALL Patients According to Jodi Halpern, MD, PhD author of “What is Clinical Empathy?” in the Journal of General Internal Medicine: “Empathy involves being moved by another’s experiences. In contrast, a leading group from the Society for General Internal Medicine defines empathy as “the act of correctly acknowledging the emotional state of another without experiencing that state oneself.” The involvement of the patient becomes more complex as the patient's disease becomes more complex. *Article Source: http://EzineArticles.com/4762852 End-Stage Renal Disease Network of New York

Breaking the Cycle of Stress©2013 Virgo Publishing LLC. “Understanding the adjustment process that each patient experiences can help you show compassion and separate yourself from their emotional response to their treatment.” ©2013 Virgo Publishing LLC End-Stage Renal Disease Network of New York

Breaking the Cycle of Stress©2013 Virgo Publishing LLC. “Cultivating kindness for difficult patients and for your team will help reduce stress within the clinic. It also helps to break your personal cycle of stress because your attitude is absorbed by everyone around you and contributes to reducing their stress level. Breaking this cycle can improve everyone’s experience.” ©2013 Virgo Publishing LLC End-Stage Renal Disease Network of New York

Patients, Practitioners, Family Members: WE NEED YOU: We are looking for best practice scenarios to share with the community. If you or your facility have examples of what you are doing right, please let us share your success! Ronald Mills, PAC Representative, Marjorie Basser Dialysis Center Living on dialysis since 2009: When he isn’t working, coaching or at dialysis, he is diligently supporting his family, cooking dinner, spending time with his extended family & friends and living a life packed with love and admiration. The IPRO ESRD Network of New York Patient Advisory Committee Awards this Recognition of Achievement to Mr. Ronald Mills for his success in his education, in his career and in his personal life all while trying to maintain the grueling physical and mental hardship of living with ESRD. End-Stage Renal Disease Network of New York

Four Rules to Customer Service #1. Be accessible. Try to find a way for patients to talk to an available staff member. #2. Listen to your patients. #3. Deal with complaints constructively. ……… ....Drum roll please………….… End-Stage Renal Disease Network of New York

Shameless Plug for the Five Diamond Program #4. Train staff to be helpful, courteous, and knowledgeable. Five Diamond Approach to Patient Safety In-service Training Modules Communication &  Professionalism: The Patient Whisperer:Compassionate Care for Challenging Situations Providing Patient-Centered Care When Patients Have Concerns Fistula First Caring Through the End: Final Stage of Chronic Kidney Disease Professionalism in the Dialysis Setting Professionalism in Dialysis Care Decreasing Dialysis Patient-Provider Conflict (DPC) An Introduction to the DPC Project (PowerPoint ) DPC Tracking Tool and Instructions DPC Conflict Pathway DPC Tips on Cultural Awareness Improving Communication in Patient-Provider Relations article Preventing Conflict in Dialysis: The Value of Customer Service article End-Stage Renal Disease Network of New York

2013 and Beyond Patient and Family Engagement An "engaged patient" is one who is fully involved in, and enthusiastic about their health, and thus will act in a way that promotes optimal health in the chronic treatment setting. End-Stage Renal Disease Network of New York 20

How Can We Engage Patients? Start small. ESRD is a marathon, not a sprint. Often patients want to feel that you are there for them.  Sometimes they are not looking for lengthy discussions and overly involved detailed information.  They want simple, accurate and informative information that is pertinent to them and presented in a genuine manner.  They want to feel that they matter, and any questions they may have are not insignificant.  They want to feel valued and respected. End-Stage Renal Disease Network of New York

Medicare and Quality Incentives: A Service to ESRD Customers End-Stage Renal Disease Network of New York

The Quality Incentive Program (QIP) WHY? CMS developed the ESRD QIP to be the nation's first pay- for-performance (also known as "value-based purchasing") quality incentive program as mandated by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) section 153(c). This first-of-its-kind program provides the ESRD community with the opportunity to enhance the overall quality of care that ESRD patients receive as they battle this devastating disease. ESRD QIP Rules and Regulations CMS issued its final rule for the first year of the ESRD QIP, 2012, in December 2010, and issued its final rules for the second and third years of the ESRD QIP, 2013 and 2014, in November 2011, and the fourth year of the QIP, 2015, in November 2012. More information is available at : DialysisReports.org End-Stage Renal Disease Network of New York 23

The Quality Incentive Program (QIP) HOW? How will the QIP inform and empower beneficiaries? A. Beneficiaries will be able to make a more informed decision about choosing a dialysis facility. Beneficiaries and their families will be able to assess the performance of their current or planned facility and compare the performance of that facility against a national average. The scoring methodology is straight-forward and yields easily understood numbers which allow beneficiaries to rank facilities based on their performance on the quality measures. Q. Will the QIP improve the quality of care for dialysis patients? A. The QIP is intended to provide financial incentive for providers/facilities to improve quality of care delivered to their patients. While most facilities will likely meet or exceed the national standards for the measures, those that do not will receive a payment reduction from CMS. End-Stage Renal Disease Network of New York 24

The Quality Incentive Program (QIP) WHO? The Network is charged by CMS to support the ESRD QIP for Performance Improvement. We will: Provide education and technical support for targeted facilities related to QIP measures Maintain knowledge on QIP measures, measure specifications, resources available to facilities. Assist in making facilities aware of their QIP Performance Score Report Support facility data submission Oversee the timely and accurate submission of facility data Serve as a resource for facility users Actively support facilities’ QIP related quality data submission The QIP Certificate (Performance Score Card) is updated annually based on QIP measurements, and should be prominently posted at the dialysis facility. Also available on line at dialysis facility compare http://www.medicare.gov/dialysisfacilitycompare End-Stage Renal Disease Network of New York 25

Poll How many of you feel that engaging patients is a process, and that you are equipped to take the first step? End-Stage Renal Disease Network of New York

2013 Learning and Action Networks Please join us! Patient and Family Engagement Learning and Action Network (PeLAN) Healthcare Acquired Infections Learning and Action Network (HAI LAN) Transplant LAN Promoting patient engagement, safety, and a healthier renal community. Conference Calls, Webinars, Quality Improvement Activities Marketing Campaigns and Tools and Resources A quarterly patient led and focused group to discuss and develop ways to encourage and engage patients at the facility level. The PeLAN will develop educational materials for patients and ESRD provider staff to help educate on the Quality Incentive Program* (QIP) and discuss the impact of new QIP policies on patient care. The PeLAN will be part advocacy, part outreach and part sharing of stories, to keep the Network, PeLAN members and the ESRD Community informed on practices that influence dialysis care, and to inform the Network on how these policies are working at the patient level. Developed to include patients, family members/care partners and practitioners. Patients will be the majority of this LAN, but in order to make this work, we need ESRD stakeholders, and Dialysis facility staff to join us on the conference calls and webinars. All are welcome. End-Stage Renal Disease Network of New York 27

Patient Engagement: An Engaged Patient will be your best customer. The Network has initiatives to help you: Promote patient self-management. Promote and participate in patient support groups in the ESRD community Provide systematic education and supportive interventions to increase patient skills and confidence in the management of their health problems. Provide patients with the following information to address health literacy and cultural issues: Basic information about the patient’s treatment An understanding of and assistance with building self-management skills Need for regular assessment (monthly clinical, annual comprehensive) of progress of the patients treatment Collaborative goal setting Problem-solving support Implement a standardized assessment of patient-self-management needs and activities. Understand cultural issues that may impact patient’s self-management. End-Stage Renal Disease Network of New York 28

New This Year: Kidney Chronicles, a monthly e-Newsletter for Patients as Consumers Transplant Talks The Networks FIRST Patient designed Quality Improvement activity

Let’s change this: End-Stage Renal Disease Network of New York 30

To this: At the 2012 Hudson Valley Patient Meeting, Denise Brooks, PAC Rep for the Westchester AKC was awarded with a Patient Advisory Committee Recognition of Achievement Award, recognizing over 30 years of Denise living with ESRD. The award was presented by Chris Scalamandre, Network QIC. Denise is surrounded by her care team: Eileen Cupertino, Dietician, T.C. Gallagher, Charge Nurse, Judy Hubert, Nurse Manager, Rhonda Halpern, Social Worker. End-Stage Renal Disease Network of New York 31

Synchronicity: Patient Projects Addressing Compliance, Polypharmacy and Transitions of Care Fred A: “The missing link in ESRD treatment is the psychological component to establish behavior modification tools for patients and families to adapt to living with ESRD” Lacy V: “a tool to help patients track their treatments/appointments/meds, and develop a competition around it at the facility level to see who has filled theirs out” End-Stage Renal Disease Network of New York

Please Share Patient/Family/Care Partner Engagement in the ESRD Community and with the CMS Conditions for Coverage The Concept of the Patient as Customer in the Healthcare Setting Patient Centered Care Medicare’s Quality Incentives for ESRD Providers Empowerment Resources “Each time a person acts to improve the lot of others... he sends forth a tiny ripple of hope… those ripples build a current that can sweep down the mightiest walls…” Robert F. Kennedy (1925 - 1968) End-Stage Renal Disease Network of New York

Remembering Superstorm Sandy Are YOU and your patients prepared? Nassau Facilities: 21* Population: 1976* Suffolk Facilities: 18 Population: 1589* *Data from 1/13, 2 temporary closures in Nassau County Sunday: Ran extra shifts Monday: Shifts in the early AM Tuesday: 2 Nassau County facilities catastrophic closure By Thursday, 11/1: Nassau: 5 facilities on generator; Suffolk: 1 facility closed, 1 on generator.

Facility Report: Best Practice East End Dialysis (85 patients): Opened on Sunday,10/28/12, and dialyzed all of Monday’s patients. All patients and families were informed by telephone, as well as Nursing Homes and transportation. All staff members were informed via telephone, text and email. Monday, 10/29 all of our Tuesday patients were dialyzed. All patients, staff, Nursing Homes and transportation were notified. Tuesday, 10/30/12 the unit was closed due to Super Storm Sandy. Wednesday 10/31 the unit opened at its regular time. Report by Tracey Lynde, RN, CNN End-Stage Renal Disease Network of New York

Anna L. Bennett: abennett@nw2.esrd.net Contact Community Outreach Coordinator: Anna L. Bennett: abennett@nw2.esrd.net (516) 209-5578 The presenter with her IDT @ St. Luke’s Roosevelt Renal Transplant Clinic. CORPORATE HEADQUARTERS 1979 Marcus Avenue Lake Success, NY 11042-1002 REGIONAL OFFICE 20 Corporate Woods Boulevard Albany, NY 12211-2370 www.ipro.org End-Stage Renal Disease Network of New York