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Welcome to the December edition of the Quality Insights Renal Network 4 (QIRN4) Network Notes patient e-newsletter. In this issue, we bring you information about finding the right dialysis facility for you, understanding your healthcare providers, learning about the ESRD QIP, patients stories and holiday tips. We encourage you to contact us (http://www.qirn4.org/Contact-Us.aspx) with any questions, concerns or suggestions. 
DFCwhich dialysis facility is right for you or a loved one?    
Choosing a dialysis facility is an important task. Medicare's Dialysis Facility Compare can help you and your loved ones decide which facility is the right fit. The site offers data that you can use to compare facilities based on the quality of patient care they provide. You can also compare their patient experience survey results. Visit the Dialysis Facility Compare website (https://www.medicare.gov/dialysisfacilitycompare/).   
ProviderMakeSenseDo You Understand your healthcare provider?     
It's important to take an active role in health by talking to your doctor, nurse and pharmacist.  But what if you don't fully understand what they are telling you? Learn some ways ( http://esrdncc.org/wp-content/uploads/2015/10/3.-Questions-for-Better-Health.pdf) to help you get the information you need in a way that you can understand. 
ESRDQIPLearn about the end-stage renal disease quality incentive program (esrd qip)   
The End-Stage Renal Disease Quality Incentive Program (ESRD QIP) was created by Congress in a law called the Medicare Improvements for Patients and Providers Act of 2008. The ESRD QIP aims to make care quality better by paying for better health outcomes, which is a change in the health status of a person, group, or population. The ESRD QIP adjusts payment for ESRD services by measuring how well dialysis facilities provide care. Medicare pays less to facilities that give low-quality care. This way of paying for medical care is called "value-based purchasing." The ESRD QIP was the first Medicare program to use value-based purchasing with the hope that it will reduce healthcare costs while improving medical care.

You may have questions about the ESRD QIP. Here are some common questions:
  • Why did Medicare cover ESRD?
  • How does the ESRD QIP work?
  • Why does the ESRD QIP change from year to year?
  • How does CMS change the ESRD QIP from year to year?
  • What does the ESRD QIP measure?
FacebookHave you found us on facebook? 
QIRN4 posts the latest happenings and interesting insights for the dialysis community on our Facebook page. If you haven't already, please check us out and "like" our page to make sure our posts find their way to your news feed.  

PatientVoicesPatient Voices: One Patient's Journey to Dialysis
"I was 21 years old when I experienced a persistent headache that prompted a visit to my primary care physician (PCP). During this visit, it was noted that my blood pressure was high, my urine had a significant amount of protein and the blood vessels in my eyes suggested signs of hypertension. These findings required a battery of tests, referral to an eye specialist and  kidney specialist (nephrologist), and daily monitoring of my blood pressure. The tests confirmed that I had hypertension and signs of Stage 2 kidney failure. I was placed on medication and a special diet for my hypertension.

As a registered nurse (RN) I religiously followed my physicians' advice and observed healthy lifestyle habits; e.g. good nutrition, adequate sleep, sufficient exercise, avoiding stress, preventing infection, maintaining social support and so on.  My blood pressure was well controlled, but as the years progressed, my kidney function showed gradual and persistent deterioration. Peritoneal dialysis, hemodialysis and A-V fistula placement were discussed during each part of each visit with my nephrologist, but I never arrived at a decision. It has been nearly 30 years since I had the signs of what is now known as End Stage Renal Disease ( ESRD).

In February 2016, my nephrologist informed me that it was time for me to begin dialysis.  Upon hearing the word "dialysis" I cried uncontrollably.  I kept asking myself  "How will I tell my family?" and "What about my job?" The following days involved the placement of a catheter and tests to begin the process of having a fistula placed. I began out-patient dialysis within a week.  I decreased my work hours and feared the worst of effects of dialysis ahead. But then I met other patients at my clinic who were working full-time and others who had just returned from vacations.  I listened to their stories and realized I can still live life to its fullest with dialysis as a part of my life. In August I transferred to a clinic closer to my home.  The staff encouraged me to consider home hemodialysis and I am happy to report I began training this November.  

Reflecting on my journey to dialysis, I want to thank everyone who directly or indirectly cared/advocated for my well-being.  Nurses, techs, nurse managers, nurse practitioners, social workers, dietitians, administrative assistants and most especially my nephrologists. As a patient receiving dialysis, I believe patient engagement is paramount.  I want to encourage dialysis patients to:
  • Actively participate with your own care: ask questions, share your thoughts, feelings, and concerns. As patients, each of us may have the same diagnosis of ESRD, but none of us are the same - we require individualized and culturally sensitive care.
  • Follow the advice of your dialysis team members. These medical personnel have chosen this specialty to advocate for us.
  • When you feel down, talk to someone. You will soon realize that you are not alone.
  • Share your unique experience as a patient by serving as a patient representative at your facility or as a Network 3 Patient Advisory Committee Subject Matter Expert (PAC SME). The PAC SME description and contact information can be found at http://www.qirn3.org."
Submitted by "J" with thanks for your time in reading her ESRD journey.

QuitSmokingare you thinking about quitting smoking?
Are you ready to quit smoking? Maybe your New Year's resolution will be to stop smoking. The American Lung Association website has many resources, including information on coverage for medicines to help stop smoking, counseling  and the Freedom from Smoking program. Learn more. (http://lungusa2.org/cessation2/statedetail.php?stateId=42).


  HolidayEatingTips for eating away from home during the holidays
The holidays present both an exciting time and a challenging time for people on dialysis. Check out these tips from the National Kidney Foundation for eating away from home during the holidays.
  • Bring a dish you know you will enjoy that is a healthy option, so you know you have something nice to eat.
  • Eat a snack before you leave home; if you arrive hungry you probably will eat too much.
  • If it's a buffet, look at all the options and choose foods that are worth eating, and ignore the rest.
  • To avoid grazing, don't stand near or around the food so you aren't tempted to snack.
  • Choose fruits and vegetables served raw; you won't eat too many if you have to chew a lot.
  • If you drink alcohol, have just one glass or have if it over ice in a small glass to limit your fluid. If you choose hard liquor instead of beer or wine, you will get the same effect with less volume.
See more tips on the National Kidney Foundation website. (https://www.kidney.org/content/tips-happy-healthy-holidays-dialysis-diet).

 
Do find this newsletter helpful? Are there things you'd like to see changed? Please take this short survey to provide your feedback. Please submit any items of interest for this newsletter to Deborah Knight (dknight@nw4.esrd.net). 
 
 
610 Freedom Business Center,  
Suite 102 
King of Prussia, PA 19406 
(610) 265-2418 
(800) 548-9205 (patients only) 
(610) 783-0374 (fax) 
This material was prepared by Quality Insights Renal Network 4 under contract with the Centers for Medicare & Medicaid Services (CMS). The contents do not necessarily reflect CMS policy. 

Publication No. ESRD4-110716