Centers for Medicare & Medicaid Services (CMS) Activities

Professional Education and Outreach

This section describes education and outreach to health professionals of the Federal government related to chronic kidney disease.

Centers for Medicare & Medicaid Services (CMS)

The recently concluded CMS 9^th Statement of Work (SOW) for Medicare's Quality Improvement Organizations (QIOs) focused on improving the quality, safety, and efficiency of health care services delivered to Medicare beneficiaries. One quality improvement effort required of the QIOs was to reduce the progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD). Each QIO was required to:

1. Focus on three clinical areas, each with a corresponding clinical measure. These areas included 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.
   
   
2. Use collaboration as a means of achieving sustainable CKD system level changes. All QIOs were required to monitor the effect of their CKD interventions on disparities and take immediate corrective action if disparities in care are increasing. QIOs could 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 was to make sure that the QIOs were providing CMS beneficiaries with the best quality of care through the use of available tools as they worked 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 and concluded in June 2011.

Other activities included 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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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.

Centers for Medicare & Medicaid Services (CMS)

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
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) provided technical assistance and support to select Quality Improvement Organizations (QIOs) that were 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 represented 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 promoted early detection of CKD and proper medication treatment to slow the progression of the disease. It also addressed 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 facilitated 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 supported 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 was held by Virginia Health Quality Center.

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.

Centers for Medicare & Medicaid Services (CMS)

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
Maria Ciccanti
Phone: 410-786-3107
Email: maria.ciccanti@cms.hhs.gov
Web: www.esrdncc.org

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Surveillance

This section describes surveillance activities and programs of the Federal government related to chronic kidney disease.

Centers for Medicare & Medicaid Services (CMS)

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.

Other surveillance efforts include monitoring and on-site support surveys and enforcement procedures. CMS also provides certification for new suppliers and services.

Contact Information
Sharon Last
Phone: 816-426-6457
Email: sharon.last@cms.hhs.gov