In The Know: How Dialysis Facilities Report Patient Data
By Oniel Delva
According to the Centers for Disease Control and Prevention (CDC), most people with kidney disease are not aware of their condition.1 Further, based on a study conducted by CareMore Health Plan—a medical group serving the senior population in five states—a large percentage of individuals with end stage renal disease (ESRD) do not see their nephrologist or primary care physician on a regular basis, and are not engaged in end-of-life planning.2 It is important to recognize that as an ESRD patient, you are the primary advocate for your health. A growing body of evidence demonstrates that patients who are more actively involved in their health care experience better health outcomes and incur lower costs.3 Accordingly, it is important that you are involved in and understand all aspects of your medical care. You should ensure that you fully understand dialysis treatment options, recommended dietary regimens, care team developments, and patient data management.
Do you know how Medicare-certified dialysis facilities report their patient care data to the Centers for Medicare & Medicaid Services (CMS) for analytical purposes?
Since June 2012, all Medicare-certified dialysis facilities and select transplant centers throughout the nation have utilized CROWNWeb—a CMS-mandated data collection system—to securely report administrative and clinical data to CMS. Since its release, CROWNWeb has served as a data source for various CMS initiatives that have measured the quality of care provided by dialysis and transplant facilities throughout the United States and US territories.
CROWNWeb is used by more than 6,000 dialysis facilities and approximately 30 kidney transplant centers to report important patient data, such as information provided on the CMS-2728 ESRD Medicare Entitlement and/or Patient Registration form (which is used to help activate Medicare benefits), and monthly patient lab results directly to CMS.
Measuring Patient Care
One of the CMS projects that CROWNWeb supports is a quality improvement program that measures how well dialysis facilities provide care. Known as the End Stage Renal Disease Quality Incentive Program (ESRD QIP), this initiative assists with ensuring that well-performing dialysis facilities are properly compensated. Each facility receives a score based on information from Medicare claims, the monthly reporting of anemia management and mineral metabolism data via CROWNWeb, the reporting of infection data via the CDC’s National Healthcare Safety Network system (NHSN), and whether the facility worked with CMS-approved third party vendors to administered a patient-experience survey known as the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey.
Each month, dialysis facilities must draw labs and run tests to monitor information such as the effectiveness of treatments administered. Nephrologists order lab work to see how well dialysis is working for patients. If a doctor sees that a patient’s blood is not being adequately cleaned, changes are made to help ensure that better treatment is provided. This type of information is considered as part of the Clinical Measures component of the ESRD QIP. Facilities’ outcomes are compared to other facilities’ performance on a national scale, as well as their own performance in the previous year. Information is also collected and reviewed on patients’ hemoglobin/hematocrit and serum phosphorus values.
Quality measures based on CROWNWeb data were developed with the needs of Medicare beneficiaries in mind. They are designed to encourage facilities to improve the care provided to patients that have ESRD, and to help improve Medicare’s ESRD program in general, by paying dialysis facilities based on the quality of care that they deliver not the quantity. CMS calculates the quality of care provided by a facility by looking at the facility’s performance on multiple quality measures.
For More Information
ESRD patients who want to obtain more information on the CROWNWeb system or learn about how their treatment information will be reported can enter “Patients and CROWNWeb” in the Search box on the myCROWNWeb website at www.mycrownweb.org. Information about the system is also available at CMS’ CROWNWeb site at www.qualitynet.org via the ESRD tab. Additionally, for further information regarding the ESRD QIP, visit http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/index.html, which provides a wide variety of information including answers to Frequently Asked Questions, detailed discussions about the rules for each payment year, and other helpful references. ESRD QIP technical specifications can be accessed at http://www.dialysisreports.org/ESRDmeasures.aspx. Additionally, questions regarding the program can be sent to CMS’ ESRD QIP team at ESRDQIP@cms.hhs.gov.
The work on which this publication is based was performed under Contract Number HHSM-500-2011-00157G, titled “CROWNWeb Outreach, Communication, and Training,” funded by the Centers for Medicare & Medicaid Services, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. Publication Number: FL-OCT-OCT-10312014-01
- Centers for Disease Control and Prevention. Diabetes, High Blood Pressure Raise Kidney Disease Risk. (2014). Retrieved October 3, 2014 from http://www.cdc.gov/features/worldkidneyday/.
- (2012). Retrieved October 3, 2014 from http://downloads.cms.gov/files/H0544-C-CareMore-Health-Plan-Chronic-or-Disabling-Condition-ESRD-.pdf.
- Health Affairs. Heath Policy Briefs – Patient Engagement. (2013). Retrieved October 3, 2014 from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=86.