CRN Conditions of Coverage. What RD’s Need to Know. Objectives. Review background & rationale for changes to the current ESRD regulations. Discuss major changes impacting the RD from the current to the new regulations. 2. Rationale for ESRD Regulation Changes.
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
What RD’s Need to Know
Review background & rationale for changes to the current ESRD regulations.
Discuss major changes impacting the RD from the current to the new regulations
•Increasing realization of the need for regulatory support for an outcomes focus across provider types
• Needed to drive improvements in care
Critical if CMS moves to value-based pricing or pay for performance
Necessary if CMS moves to bundled reimbursement for ESRD care
Changes in technology
Differences in care delivery
Evidence Based Practice: ESRD community coming to consensus on minimum standards of care
QAPI: accepted process of quality assessment across provider types
Electronic data submission required to keep pace with growing ESRD population & need for current data
Interpretive Guidance (IG) is CMS’ interpretation of the Rule ; provides clarification to surveyors & providers
Community input was sought for this guidance
Read the final IG’s that were released Oct 4.
Evaluation of dialysis prescription
Blood pressure and fluid management
Immunization history and medication history
Factors associated with anemia
Factors associated with renal bone disease
Nutritional status (RD)
Psychosocial needs (MSW)
Access type and maintenance
Evaluation of patients abilities, interests, preferences, and goals, including the desired level of participation in the dialysis care process
Evaluation of family and other support systems
Current physical activity level
Need for vocational and physical rehabilitation servicesAssessment Criteria V502-515
Nutrition Assessment will include the following, but are not limited to:
The evaluation of the patient’s nutritional status must be conducted by a qualified RD.
Other members of IDT may contribute to portions of CMPA correlating with the nutritional evaluation (ex: fluid management, co-morbid conditions, dialysis adequacy)
• Poor nutritional status would include failure to thrive symptoms, with loss of body weight and low serum albumin
“The interdisciplinary team (IDT) must develop and implement a written, individualized comprehensive plan of care that…”
Specifies services needed to address patient needs identified by the comprehensive assessment
Changes in the patient’s condition
Includes measurable and expected outcomes
Includes an estimated timetable to achieve outcomes
Outcomes must be consistent with evidence-based practice standards
This may be one document or multiple documents but must be “congruent and reflect the integration of the comprehensive assessment findings of all IDT members.
“The interdisciplinary team must provide the necessary care and counseling services to achieve and sustain an effective nutritional status. A patient’s albumin level and body weight must be measured at least monthly. Additional evidence-based professionally-accepted clinical nutrition indicators may be monitored, as appropriate.”
“If the patient’s mineral metabolism goals are not being attained…the team should identify potential causes and address the barriers that may be preventing the patient from reaching the target values.”
This may include failure to take medications, failure to follow diet, lack of understanding, lack of resources to obtain appropriate foods and/or medications.
Patient education regarding their role in managing diet, medication and bone health is expected.
Measurements Assessment Tool (MAT)
Measurement Assessment Tool (MAT)
Medical injuries and medical errors identification
Hemodialyzer reuse program (if reuse is used)
Patient satisfaction and grievances
Patient (treatment options) education measured annually
Health outcomes: Physical and mental functioning
Health outcomes: Patient survivalAdditional QAPI Regulations