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End Stage Renal Disease (ESRD) Program
ESRD Network Organizations
Background
The formation of ESRD Network Organizations was authorized in 1978 by Public Law 95-292 which amended Title XVIII of the Social Security Act by adding section 1881. Thirty-two ESRD Network areas were initially established. In 1986, the Omnibus Budget Reconciliation Act of 1986 (P.L. 99-509) amended section 1881c of the Social Security Act to establish at least 17 ESRD Network areas and to revise the Network Organizations responsibilities.
Today, 18 ESRD Network Organizations exist under contract to CMS and serve as liaisons between the federal government and the providers of ESRD services. The Network Organizations are described geographically by the number and concentration of ESRD beneficiaries in each area. Some Networks represent one state, others 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.
CMS, along with input from the renal community, has reshaped the ESRD Networks program's approach to quality assurance and improvement to respond to the need to improve the care of Medicare ESRD patients. This approach, implemented July 1, 1994 by the ESRD Networks, has been named the ESRD Health Care Quality Improvement Program (HCQIP). The change in name not only expresses profound changes that have taken place and will continue, but also emphasizes the mission rather than the organizations that carry out the mission. HCQIP gives the ESRD Networks and CMS a chance to demonstrate that health care provided to renal Medicare beneficiaries can be measurably improved. HCQIP is based on the principle that the Networks can do more to improve the quality and cost effectiveness of care by bringing typical care into line with the best practices rather than by inspecting individual cases to identify erred treatment.
The Forum of ESRD Networks is a national organization that facilitates the exchange of information and ideas among the ESRD Network Organizations. All 18 ESRD Network Organizations belong to the Forum.
Since 1989 a peer review program called medical case review has been a major Network activity. Networks have looked at individual medical records in most facilities, reviewing and comparing care to national guidelines (screening criteria). Networks have made a significant impact upon the quality of care delivered to ESRD patients. For example, in 1990 few dialysis facilities were regularly measuring the adequacy of dialysis. Now, as a result of Network/CMS medical case review, virtually all facilities regularly measure treatment adequacy. Over this same time period, the United States Renal Data System (USRDS) had documented a decline in mortality rates among dialysis patients. The USRDS is the national ESRD registry authorized by law to assemble and analyze data on the treatment and management of end stage renal disease. Networks continue working to assess and improve the quality of ESRD care as they coordinate with CMS to implement the principles and tools of continuous quality improvement and focus on patient outcome.
Networks ability to collect and submit timely and accurate data directly contributes to the success of the USRDS. In addition to incidence, prevalence and treatment data, Networks conduct extensive data abstraction for special studies which allow the renal community to determine major predictors of mortality and morbidity. Network data are used by each network's own Medical Review Boards, federal and state agencies and renal-related organizations to make informed decisions about treatment options and health care policy.
A number of federal agencies (CDC, FDA, OSHA, CMS) use the Network system to collect and/or disseminate information. Networks provide a mechanism for rapid dissemination of new information to ESRD providers and patients. Networks also provide technical expertise to CMS regarding the operation of Medicare's ESRD program.
Renal patients have a direct access to Networks for problems related to the quality of their treatment through the grievance resolution mechanism. Many Networks offer "800" numbers as well as local and regional patient advisory committees. CMS also publishes a brochure for renal patients explaining two important measures that show how well hemodialysis is working. This brochure is called "It's Your Life...Know Your Number."
