Question for U.S. Incenter Dialysis Patients...

[noahvale]

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[Bill Peckham]

This part of the Quality Incentive Program developed by Medicare as directed by MIPPA and implemented along with the bundle in 2011.


The reason for 2014 being a box to check vs 2015 being based on the scores is that they need a baseline to set improvement goals against. So the responses this first year will be used to form the baseline for 2015 but not used to withhold payment in 2014. Clear as mud right?


Here is the QIP jump page ( http://www.cms.gov/Medicare/End-Stage-Renal-Disease/ESRDQualityImproveInit/index.html?redirect=/ESRDQualityImproveInit/ ) Home Dialyzors United are having comment parties if you would like to comment and would like to hear what other dialyzors are saying.

[cattlekid]

I'm no longer in-center, but IMHO, it's all garbage.  I highly doubt that the surveys will really identify what is important to dialyzors.  I know there were a couple of surveys that I saw when I was in-center that didn't even ask one question about what was important to me as a young working individual who just happened to also be on dialysis.

I haven't seen the survey, but I'm sure that my friend who has a PhD in organizational development would love to read over the survey with a fine-tooth comb because I'm sure it's written with a ton of bias. 

Plus, what are you going to do with all of the in-center patients who won't even be able to read or comprehend the survey and its purpose?  I have a feeling there might even be some subversive "coaching" going on by in-center staff about what they want people to fill out on the surveys.

[noahvale]

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[noahvale]

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[Bill Peckham]

This is for in center dialysis patients who receive treatment in U.S. facilities:

Have you recently received a confidential patient satisfaction/dialysis experience survey in the mail conducted by your clinic?  It might be entitled the CAHPS In-Center Hemodialysis Survey (8 pages) with an outside agency contracted to do the tabulation.  If so, was it mentioned in a cover letter that the survey was now a requirement by CMS (Medicare) or only that the facility cares about you and the treatment you are receiving?

It is now a CMS condition of reimbursement for facilities to send out once a year the CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey designed specifically for incenter esrd patients.  The facilities are also mandated to use 3rd party agencies experienced in survey tabulation to guarantee no tampering with the results.  Dialysis centers that do not want to participate and continue to use their own in-house survey methods can do so, but will be penalized by having reimbursement rates lowered.

Just curious as to how transparent dialysis facilities are being across the country.  My facility made no mention of the CMS regulation.  I was leery of the cover letter which came from Emory Healthcare, but was signed by the Director of Clinical Operations - a position not with Emory, but HSM, the management company Emory contracted to oversee its 3 clinics  (HSM also oversees all of Wake Forest Medical Centers dialysis facilities) - with no mention of the HSM connection. 

I contacted the DCO to bring up my concerns that both HSM and Emory were either being deceptive or patronizing.  Of course, she stated that wasn't the intention (all HSM clinics sent the same cover letter!), but she would issue another patient letter further explaining the purpose of the survey.  We'll see...

Also, according to her, this survey is being used for FY2014 and all facilities have to do is document it was done.  Results will not be figured in reimbursement until at least FY2015.  Again, this is what I was told.  Will have to do some checking.

Would you be more honest, less honest or the same knowing the survey is mandated by CMS? 

I don't recall regulations that required units to mail them vs giving them in unit and while they are tabulated by a thrid party the regs don't require them to be administered by a third party. I think your unit is doing a better job than the regs require by mailing them. I could have missed this mail requirement in the final rule but I think this administering piece is a concern, if the surveys are given in the unit and handed back in, in the unit, I would be concerned that dialyzors will not be forthright because they "have to work with these people".

Medicare honestly does want to develop ways that their beneficiaries can interact directly with CMS. I am not sure a paper survey does this but the alternatives that I can think of eg internet, phone calls, all have greater drawbacks.

One thing to keep in mind is that you can be assured that CMS hears your input if you submit a comment during these open comment periods. I read and cataloged every comment submitted on the bundle in 2009 (you can read them here https://spreadsheets.google.com/pub?key=tV1UxhmJkTTj64zTzxVRZYQ&output=html ) and there were two, one in particular, that submitted a photo of themselves and their adorable daughter - a mom and her daughter (I think it is comment 539) - and a comment asking for Medicare to continue coverage for transplant recipients beyond the three years currently available. Her comment wasn't even actionable because it would take congressional action and this was suppose to be comments about the payment bundle but everyone at CMS seems to have read it and sympathized with it. What ever you want to say to CMS, they'll read it and give it consideration if you submit it as a public comment, identify yourself as a beneficiary and submit a photo - ideally with your adorable child but if one is not available be creative.

And if your comment does pertain to the rule it can make a difference, as I think these ( http://www.billpeckham.com/from_the_sharp_end_of_the/2010/01/higher-dialysis-doses-for-better-health.html  )and others made a difference to CMS's thinking.

[noahvale]

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