ESRD (End Stage Renal Disease) Network Program

ESRD (End Stage Renal Disease) Network Program

What is an ESRD Network?

An ESRD Network is defined in the Code of Federal Regulations (CFR), at 42 CFR Part 405, Subpart U as all Medicare-approved ESRD facilities in a designated geographic area specified by CMS. These regulations require ESRD treatment facilities to be organized into groups called Networks in order to promote a system of effective coordination. As an organized Network, dialysis and transplant providers can coordinated patient referral and access to resources in a more efficient manner.

What is the ESRD Network Program?

Congress enacted modifications of the Medicare ESRD Program on June 13, 1978 (PL 95-292) to improve cost-effectiveness, ensure quality of care, encourage kidney transplantation and home dialysis, and assist patients to return to work. This legislation amended Title XVIII of the Social Security Act by adding Section 1881, which designated ESRD Network areas and established a statutory requirement for the Network Organization Program, consistent with criteria determined by the Secretary of the Department of Health and Human Services. The ESRD Network Organizations act as the administrative governing body to the Network and liaison to the Federal government. To help achieve coordinated delivery of ESRD services, representatives of hospitals and health facilities serving dialysis and transplant patients in each area of the country are linked with patients, physicians, nurses, social workers, dietitians, and technicians into Network Councils. There are 18 Network Organizations across the United States and in the territories of the United States.

Why does CMS have an ESRD Network Program?

CMS relies on the Network Organizations to develop a relationship with the dialysis professionals, providers, and patients and create a collaborative environment to improve patient care. One of the primary functions of the Network Organizations is to assist CMS in understanding the needs of ESRD patients by including patients in quality improvement activities and meetings with CMS. CMS directs the Network Organizations through the development of a contract. CMS reevaluates the quality improvement activities in the contract and the goals the Network Organization are required to meet annually. Title XVIII Section 1881 of the Social Security Act requires each Network Organization of each network be responsible for:

• Encouraging, consistent with sound medical practice, the use of the treatment settings most compatible with the successful rehabilitation of the patient and the participation of patients, providers of services, and renal disease facilities in vocational rehabilitation programs;
• Developing criteria and standards relating to the quality and appropriateness of patient care and with respect to working with patients, facilities, and providers in encouraging participation in vocational rehabilitation programs; and network goals with respect to the placement of patients in self-care settings and undergoing or preparing for transplantation;
• Evaluating the procedure by which facilities and providers in the Network assess the appropriateness of patients for proposed treatment modalities;
• Implementing a procedure for evaluating and resolving patient grievances;

• Conducting on-site reviews of facilities and providers as necessary, utilizing standards of care established by the Network Organization to assure proper medical care;
• Collecting, validating, and analyzing such data as are necessary to prepare the reports and to assure the maintenance of the registry; and
• Identifying facilities and providers that are not cooperating toward meeting Network goals and assisting such facilities and providers in developing appropriate plans for correction

Current Activities for the ESRD Network Organizations

The current contract for the Network Organizations has quality improvement activities designed to decrease the rate of blood-stream infections, increase the rate of kidney transplants, and increase the rate of patients dialyzing at home on a national scale. The Network Organizations must choose a fourth quality improvement activity from: decrease number of dialysis patients being hospitalized, increase the number of patients that have a plan of care to address pain or depression, or increase the number of patients that are receiving assistance to return to work. In addition to the quality activities in the contract, Network Organization maintain the data in CROWNWeb for the patient registry outlined in the Social Security Act, Section 1881 and the Quality Incentive Program (QIP). The Network Organization have always engaged patients, but this contract has specific requirements to engage patients and caregivers in quality improvement activities and other activities. The Network Organizations promote improved communication between patients and dialysis providers. However, patients can always call Network Organizations to resolve grievances and access to care issues between patients and dialysis facilities.

ESRD Network Organization Reports to Health and Human Services Secretary

The Network Organizations are required to submit an annual report to the Secretary on July 1 of each year which shall include a full statement of the Network’s goals, data on the Network’s performance in meeting its goals, identification of those facilities that have consistently failed to cooperate with Network goals, and recommendations with respect to the need for additional or alternative services or facilities in the Network in order to meet the Network goals, including self-dialysis training, transplantation, and organ procurement facilities.