2018 CMS Priorities, Goals, and Quality Improvement Activities IPRO - - PowerPoint PPT Presentation

2018 CMS Priorities, Goals, and Quality Improvement Activities

IPRO ESRD Network of New England Network Council Meeting January 17, 2018

Meeting Reminders

• All phone lines have been muted to avoid background noise
• Be present and engaged in the presentations
• Remain open-minded when hearing new initiatives
• Be prepared for active participation and open discussion in the WebEx

chat board –Questions or comments can be submitted at any time –There will be breaks after each section to address items in chat

• p. 2

Agenda Topics

• Overview of IPRO ESRD Program: Network 1
• Emergency Preparedness and Management
• Patient Engagement and Patient Experience of Care
• ESRD Statement of Work (SOW) Option Year 2

–Purpose and Background –CMS Goals / HHS Secretary’s Priorities –Disparities in Healthcare –Collaborations / Learning and Action Networks (LANs)

• Quality Improvement Activities (QIA)
• Information Management
• Closing Comments
• p. 3

Overview of IPRO ESRD Program: Network 1

Danielle Daley, MBA Executive Director

Mission Statement

The Mission of the IPRO End Stage Renal Disease (ESRD) Network Program is to promote health care for all ESRD patients that is safe, effective, efficient, patient-centered, timely, and equitable.

• p. 5

Island Peer Review Organization IPRO

• Founded in 1984
• Not-for-profit organization
• Holds contracts with federal, state, and local government agencies
• Provides services to enhance healthcare quality to achieve better

patient outcomes

• Proven track record of excellent, culture of innovation and breadth
• f expertise
• Implementation of innovative programs that bring policy ideas to life
• Creative use of clinical expertise, emerging technology and data

solutions to make the healthcare system work better

• Headquartered in Lake Success, NY
• p. 6

7

ESRD Networks

8

IPRO ESRD Program

125,297

ESRD Patients

1,786

Dialysis Facilities

52

Transplant Centers

Network 9

IN, KY, OH

Network 6

GA, NC, SC

Network 1

CT, MA, ME, NH, RI, VT Patients: 14,417 Facilities: 194 Transplant: 15

Network 2

NY Patients: 29,607 Facilities: 286 Transplant: 13

Network 9

OH, KY, IN Patients: 33,417 Facilities: 599 Transplant: 14

Network 6

NC, SC, GA Patients: 47,856 Facilities: 707 Transplant: 10

NW2 NW1

IPRO ESRD Network Program Network Service Areas

9 9

State ESRD Patient Census # of Dialysis Facilities # of Transplant Facilities Connecticut 4,317 49 2 Maine 1,069 18 1 Massachusetts 6,795 84 9 New Hampshire 1,063 18 1 Rhode Island 1,189 16 1 Vermont 333 8 1 TOTAL 14,762 193 15

Data Source: CROWNWeb

Network Demographics By State

10 10

Ownership ESRD Patient Census # of Dialysis Facilities American Renal Associates 1,639 23 DaVita 4,724 45 Fresenius Kidney Care 5,835 76 Diversified Specialty Institutes (DSI) 214 3 Dialysis Clinic Inc. 713 9 Independent 1,530 33 Veteran Affairs 107 4 TOTAL 14,762 193

Data Source: CROWNWeb

Facility Affiliation By State

Danielle Daley, MBA Executive Director 203‐285‐1212 ddaley@nw1.esrd.net Cheryl Pettway

• Sr. Program Support Coordinator

203‐285‐1222 cpettway@nw1.esrd.net

1952 Whitney Avenue, 2nd Floor, Hamden, CT 06517 Phone: (203) 387‐9932 Fax: (203) 389‐9902

Network Staff Administration Department

• p. 11

Brittney Jackson, LMSW, MBA Patient Services Director 203‐285‐1213 bjackson@nw1.esrd.net Merari Rosario, MHA Community Outreach Coordinator 203‐285‐1223 mrosario@nw1.esrd.net

1952 Whitney Avenue, 2nd Floor, Hamden, CT 06517 Phone: (203) 387‐9932 Fax: (203) 389‐9902

Network Staff Patient Services Department

• p. 12

Sarah Keehner, RN, BSN, CNN Quality Improvement Director 203‐285‐1214 skeehner@nw1.esrd.net Heather Camilleri, CCHT Quality Improvement Coordinator 203‐285‐1224 hcamilleri@nw1.esrd.net

1952 Whitney Avenue, 2nd Floor, Hamden, CT 06517 Phone: (203) 387‐9932 Fax: (203) 389‐9902

Network Staff Quality Improvement Department

• p. 13

Jaya Bhargava, PhD, CPHQ Operations Director 203‐285‐1215 jbhargava@nw1.esrd.net Krystle Gonzalez

• Sr. Data Coordinator

203‐285‐1225 kgonzalez@nw1.esrd.net

1952 Whitney Avenue, 2nd Floor, Hamden, CT 06517 Phone: (203) 387‐9932 Fax: (203) 389‐9902

Network Staff Data Department

• p. 14

CMS Expectations Role of the Network

• Improve quality of care for

ESRD patients

• Provide assistance to ESRD patients

and providers

• Encourage patient engagement
• Evaluate and resolve patient

grievances

• Collect data to measure quality
• f care
• Support emergency preparedness

and disaster response

• p. 15

Technical Assistance We’re Here to Help

• The Network has tools to help with quality improvement activities

–Catheter reduction –Infection control (NHSN) –Transplant referrals

• The Network provides technical assistance

–Data reporting –Patient safety –Access to care barriers

• p. 16

–Home dialysis –Vocational rehabilitation –Quality Incentive Program (QIP) –Patient/provider conflict

• The Network sponsors educational opportunities

–Face-to-Face Meetings –Webinars –Conference Calls

• The Network shares data

–Comparative Network, state, and facility level –Incidence, prevalent, and demographic statistics –Annual Report

• p. 17

Technical Assistance We’re Here to Help

eNewsletter Provider Insider

• Professional audience
• Sent monthly
• Contact list from facility personnel in

CROWNWeb

• Informational / actionable

–Important updates –Meeting registration –Quality improvement resources –Education

• p. 18

eNewsletter Kidney Chronicles

• Patient audience
• Sent quarterly
• Contact list from self registrants
• Educational

–Treatment options –Quality of life –Patient engagement –Peer mentoring

• p. 19

Questions? Comments?

• p. 20

Emergency Preparedness and Management

Brittney Jackson, LMSW, MBA Patient Services Director Emergency Coordinator

Emergency Management Things to Know

Facility Reporting/Tracking

• Report Facility Status (Open/Closed/Altered)
• Report patient access to care
• Contact the Network to assist with local OEM

coordination efforts

Prepare Patients for an Emergency

• Be prepared patient worksheet
• 3-Day Emergency Diet

Prepare Your Facility for an Emergency

• Technical assistance to facilities to develop

feasible, comprehensive emergency/disaster plans

• p. 22

Emergency Preparedness Final Rule

• Survey and Certification memo dated June 2, 2017

–Appendix Z: Emergency Preparedness Final Rule Interpretative Guidelines and Survey Procedures

• Affects 17 providers and suppliers, which includes dialysis

facilities and transplant centers

• Compliance required for participation in Medicare
• New requirements began November 15, 2017

https://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/SurveyCertEmergPrep/Emergency-Prep-Rule.html

• p. 23

Technical Assistance Final Rule

• How can the Network support facilities in meeting these

requirements? –Please submit questions or comments in chat

• p. 24

Questions? Comments?

• p. 25

Brittney Jackson, LMSW, MBA Patient Services Director

Patient Engagement and Patient Experience of Care

Patient Subject Matter Experts (PSMEs) How PMSEs Support QIAs

• Involved in the development of QIA interventions

and resources

• Encouraged to participate in intervention

implementation at the facility

• PSMEs are asked to:

–Consider becoming a Peer Mentor –Joining the Network Patient Advisory Committee –Share their ESRD journey story with others –Attend meetings led by the Network –Participate in national meetings and technical expert panels

• p. 27

Patient Advisory Committee (PAC) Structure and Function

• PAC members are ESRD patients, family members, or care partners in

dialysis and transplant facilities who provide a link between patients and healthcare providers to: –Promote communication between patients and staff –Inform patients about the ESRD Network

• Mission is to identify and act upon issues of concern to ESRD patients

thereby improving their quality of life

• 18 Regions throughout New England with Chairs

–8-10 facilities per region

• Current Membership

–125 members, representing 77 facilities

• Chairperson: John Visone
• p. 28

Patient Advisory Committee 2018 Goals

• Recruit New PAC Representatives
• Recruitment More PAC Chairs
• Increase awareness about PAC and the Network
• Encourage PAC Representatives to participate in regional

conference calls

• Encourage regularly scheduled meetings with staff and patients
• Increase PAC membership on the closed Facebook group
• Solicit articles for PAC Speaks patient newsletter
• p. 29

Patient Experience of Care Grievances Definition and the Network’s Role

• What is a grievance?
• Network’s Role

–Facilitator –Expert Investigator –Educator –Quality Improvement Specialist –Advocate –Referral Source

• p. 30

Patient Experience of Care Grievance Management and Best Practices

• Development/support robust grievance

process

• Foster environment that encourages

patients, family members, caregivers to voice their opinions

• Encourage positive resolution focused
• utcomes
• Establish an anonymous grievance

process

• Grievance Educational Materials

–2018 New Grievance Poster –Grievance Toolkit

• p. 31

CMS Expectations: Network Responsibilities

• The Network assists with patient grievances

–Evaluate and resolve grievances using a patient centered approach –Follow CMS guidelines, document all Network steps of grievance resolution, and adhere to timeframes –Perform quality of care reviews using an interdisciplinary approach (LMSW / RN) –When necessary, refer cases to the Grievance Committee or Medical Review Board for review

• p. 32

Questions? Comments?

• p. 33

ESRD Statement of Work (SOW) Option Year 2

Danielle Daley, MBA Executive Director

ESRD Statement of Work December 2017 - November 2018

Background & Purpose

• To delineate tasks to be conducted by each End Stage Renal

Disease (ESRD) Network Organization contractor in support of achieving national quality improvement goals and statutory requirements as set forth in Section 1881 of the Social Security Act and the Omnibus Budget Reconciliation Act of 1986

• Tasks in this SOW are intended to align Network activities with:

– Department of Health and Human Services (HHS) National Quality Strategy (NQS) – HHS Secretary Priorities – Centers for Medicare & Medicaid Services (CMS) goals

• p. 35

ESRD Statement of Work December 2017 - November 2018

HHS Secretary’s Priorities 1. Reform, Strengthen, and Modernize the Nation’s Health Care System 2. Protect the Health of Americans Where They Live, Learn, Work, and Play 3. Strengthen the Economic and Social Well-Being of Americans Across the Lifespan 4. Foster Sound, Sustained Advances in the Sciences 5. Promote Effective and Efficient Management and Stewardship

• p. 36

ESRD Statement of Work December 2017 - November 2018

CMS Goals 1. Empower patients and doctors to make decisions about their health care 2. Usher in a new era of state flexibility and local leadership 3. Support innovative approaches to improve quality, accessibility, and affordability 4. Improve the CMS customer experience

• p. 37

ESRD Statement of Work December 2017 - November 2018

Addressing Disparities in Healthcare

• Conduct assessment to identify disparity with the greatest point difference

between disparate and non-disparate groups –Age (65 and older vs. 18-64) –Ethnicity (Hispanic vs. Non-Hispanic) –Facility Location (Rural vs. Urban) –Gender (Female vs. Male) –Race (Population other than White, including African American, Asian, Native American, Pacific Islander, etc. vs. White)

• p. 38

ESRD Statement of Work December 2017 - November 2018

Collaborations

• National Coordinating Center (NCC)
• Kidney Community Emergency Response Program (KCER)
• State Survey Agencies
• CMS Components
• Quality Innovation Networks (QIN-QIOs)
• p. 39

ESRD Statement of Work December 2017 - November 2018

CMS has established Learning & Action Networks (LANs) for each QIA, coordinated by ESRD NCC

• Create a diverse forum to address barriers
• Measurable goals to drive decision making
• Open sharing of best practices
• Change methodology and rapid cycle improvement
• Participate in NCC LAN events
• p. 40

ESRD Statement of Work December 2017 - November 2018

Learning & Action Networks (LANs)

• Patient Experience of Care
• Healthcare Associated Infections (HAI)
• Home Dialysis
• Patient and Family Engagement (PFE)
• Transplant
• Population Health Focused Pilot QIA (PHFPQ)
• p. 41

ESRD Statement of Work December 2017 - November 2018

Learning & Action Networks (LANs) Criteria All LANs

• Ensure participation of all facilities participating QIAs
• Two (2) patients, family members and/or caregivers from each state in the

Network service area HAI, Transplant, and Home Dialysis LANs

• Invite QIN-QIO(s), HIINs, state/local health departments, State Survey

Agencies, long-term care facilities, and regional dialysis leadership

• Minimum of two (2) hospitals from each state in the Network service area
• p. 42

Quality Improvement Activities (QIAs)

Bloodstream Infection Reduction

Heather Camilleri, CCHT Quality Improvement Coordinator

ESRD Statement of Work QIA 1: Patient Safety HAIs

Background

• Contains 3 sub-projects:

– BSI Reduction – LTC Reduction – Healthcare Information Exchange (HIE)

• National goal by 2023: Reduce the

national rate of BSIs in dialysis patients by 50% of the blood stream infections (BSI) that occurred in 2016

• Support NHSN

– Assist Enrollment – Support Completion of NHSN Annual Training – Quarterly Data Checks

• p. 45

Identify 50% cohort of lowest performing BSI facilities in Network for QIA Population Target 20%

• f lowest

performing BSI facilities Target facilities with LTC rate >15% Enroll 20% in QIA Population in HIE

Patient Safety: Reduce Rates of BSIs

Criteria

• Select 50% of facilities in Network service area reporting the highest BSI

rates (~100 facilities) Project Period

• Baseline: January – June 2017
• Re-measurement: January – June 2018

Requirements

• Utilization of CDC Core Interventions
• Conduct Root Cause Analysis (RCA)
• NCC HAI LAN participation
• p. 46

Patient Safety: Reduce Rates of BSIs

Goals

• > 20% reduction in semi-annual pooled

mean among highest 20% BSI rates Data Source

• National Healthcare Safety Network (NHSN)
• p. 47

Patient Safety: Reduce Rates of BSIs

Interventions

• Root cause analysis (RCA) using

“5 Why” Approach

• CDC Making Dialysis Safer

Coalition

• CDC Core Interventions for Dialysis

BSI Prevention

• Discuss infection control at QAPI

meetings

• Share best practices/evidence

based research

• p. 48

Questions? Comments?

• p. 49

Long-Term Catheter Reduction

Sarah Keehner, RN, BSN, CNN Quality Improvement Director

Patient Safety: Long Term Catheters

Criteria

• Select facilities with a long term catheter (LTC) rate of >15% from the BSI

QIA target facilities (~25 facilities) Project Period

• Baseline: June 2017
• Re-measurement: CROWNWeb data as of October 2018 (August 2018

data) Requirements

• Explore correlation between LTC and BSI through CDC Core Interventions
• p. 51

Patient Safety: Long Term Catheters

Goals

• Decrease

aggregate LTC rate of target facilities by at least 2% Data Source

• CROWNWeb
• p. 52

Patient Safety: Long Term Catheters

Interventions

• Vascular Access Coordinator
• Monthly meeting with vascular

surgeons

• RCA of barriers
• Cannulation education for staff
• Staff/ patient fistula education
• Data entry in CROWNWeb
• Sharing best practice
• Particapation in LAN events
• p. 53

Questions? Comments?

• p. 54

Health Information Exchange (HIE)

Jaya Bhargava, PhD, CPHQ Operations Director

• p. 56

Patient Safety: What is and HIE?

Health information exchange (HIE) is the mobilization of health care information electronically across

• rganizations within a

region, community or hospital system.

Patient Safety: Health Information Exchange (HIE)

Criteria

• 20% of the BSI QIA cohort (~20 facilities)

Requirements

• Joining of an HIE or another evidence-based highly effective

information transfer system as approved by the COR and CMS SME Goals

• 20% using HIE

Data Source

• Self-reported
• p. 57

Patient Safety: Health Information Exchange (HIE)

Interventions

• Identifying a state HIE
• Collaborate with Large Dialysis Organizations (LDOs)
• Reduce barriers in accessing information during transitions of care
• p. 58

Questions? Comments?

• p. 59

Heather Camilleri, CCHT Quality Improvement Coordinator

Transplant Coordination

Improve Transplant Coordination Increase Rates of Patients on Waitlist

Criteria

• Include at least 30% of facilities in Network service area (~60 facilities)

Project Period

• Baseline is October 2016 – June 2017
• Re-measurement: data available in October 2018

Requirements

• Monitor/track patient progress through seven steps leading to placement on

transplant waitlist

• NCC Transplant LAN participation
• p. 61

Improve Transplant Coordination Increase Rates of Patients on Waitlist

Track and report to CMS the number of patients in each of 7 steps each month: 1. Patient suitability for transplant 2. Patient interest in transplant 3. Referral call to transplant center 4. First visit to transplant center 5. Transplant center work-up 6. Successful transplant candidate 7. On waiting list or evaluate potential living donor

• p. 62

Improve Transplant Coordination Increase Rates of Patients on Waitlist

Goals

• 10% point increase of eligible

patients placed on transplant waitlist Data Source

• Facility self-reported (numerator)
• CROWNWeb (denominator)
• p. 63

Improve Transplant Coordination Increase Rates of Patients on Waitlist

Interventions

• Transplant referral process and center

criteria

• Kidney allocation system
• Patient self-referral per transplant facility
• Tracking and reporting the 7 steps

leading to a transplant

• Patient SME’s and/or family/caregivers

included at facility level monthly QAPI meetings

• p. 64

Questions? Comments?

• p. 65

Home Dialysis

Sarah Keehner, RN, BSN, CNN Quality Improvement Director

Promote Appropriate Home Dialysis Increase Rates of Patients in Home

Criteria

• Include at least 30% of facilities in Network service area (~60 facilities)

Project Period

• Baseline: October 2016 - June 2017
• Re-measurement: based on data available CROWNWeb in October 2018

Requirements

• Encourage facilities to incorporate the seven steps leading to home dialysis

training into patient education, facility practice, and facility QAPI process

• NCC Home Dialysis LAN participation
• p. 67

Promote Appropriate Home Dialysis Increase Rates of Patients in Home

Track and report to CMS the number of patients in each of 7 steps each month: 1. Patient interest in home dialysis 2. Educational session to determine the patient’s preference of home modality 3. Patient suitability for home modality determined by a nephrologist with expertise in home dialysis therapy 4. Assessment for appropriate access placement 5. Placement of appropriate access 6. Patient accepted for home modality training 7. Patient begins home modality training

• p. 68

Promote Appropriate Home Dialysis Increase Rates of Patients in Home

Goals

• 10% increase in rate of

patients that start home dialysis training Data Source

• Facility self-report in

CROWNWeb training date (numerator)

• CROWNWeb (denominator)
• p. 69

Promote Appropriate Home Dialysis Increase Rates of Patients in Home

Interventions

• Incorporating the seven steps into patient

education and facility practice

• Development and implementation of

Home Dialysis Peer Mentorship Program

• Tracking patients at each stage of the 7

steps and monitoring that patients are being moved to the next step

• Utilization of the Home Therapies Toolkit
• p. 70

Questions? Comments?

• p. 71

Population Health Focused Pilot QIA (PHFPQ)

Brittney Jackson, LMSW, MBA Patient Services Director

Population Health Focused Pilot QIA (PHFPQ) Vocational Rehabilitation

Criteria

• Select at least 10% of facilities in the Network service area (~20 facilities)

Project Period

• Baseline: October 2016 – June 2017
• Re-measurement: September 30, 2018

Requirements

• Patient SME
• NCC PHFPQ LAN participation
• p. 73

Population Health Focused Pilot QIA (PHFPQ) Vocational Rehabilitation

Goals

• Demonstrate at least a five (5)

percentage point increase in referrals to the identified EN and/or VR

• Demonstrate at least a two (2)

percentage point improvement in the number of patients receiving EN and/or VR services Data Source

• CROWNWeb
• p. 74

Root Cause Analysis and Plan-Do-Study-Act Vocational Rehabilitation

RCA

• Conduct a RCA to

identify the barriers to prevalent patients not being referred for VR/EN services PDSA

• Utilize the PDSA

cycle to test the processes initiated to

• vercome barriers
• p. 75

Population Health Focused Pilot QIA (PHFPQ) Vocational Rehabilitation: Interventions

Provider

• Assessment of current referral process in the dialysis facility
• Evaluate changes in life events that could change receptiveness to

vocational rehabilitation Patient

• Increase awareness of vocational rehab and change dialysis facility culture
• Support patients with resources and goal setting tools

Employment Network and Vocational Rehab

• Collaborate with vocational rehabilitation resources to advocate for the

needs of ESRD patients

• p. 76

Common Scenarios ‐ Vocational Rehabilitation

CROWNWeb Category Scenario:

Referred to VR Social worker gave patient phone number for VR Referred to VR Patient is being recommended for VR, but has not agreed to participate Currently in VR Patient went to VR orientation and was assigned a counselor Currently in VR Patient filled out an application Declines VR Patient went to VR orientation and did not follow up after the orientation Declines VR Patient has indicated they do not want to participate in VR program Not Eligible for VR Patient has co‐morbid conditions that prevent them from being able to work Not Eligible for VR Patient is undocumented and does not have a legal right to work in the US Completed VR Patient went through VR program and achieved their VR goals (got job, completed college, etc.)

• p. 77

CROWNWeb Definitions Vocational Rehabilitation

CROWNWeb Reporting Vocational Rehabilitation

• p. 78

Questions? Comments?

• p. 79

Data Management

Jaya Bhargava, PhD, CPHQ Operations Director

CMS Expectations: Facility Responsibilities ESRD Data Collection Systems

• CMS Designated Data Collection Systems

–CROWNWeb - Follow Data Management Guidelines –National Healthcare Safety Network (NHSN)

• ESRD Outcome Reports

–Quality Incentive Program - https://cportal.qualitynet.org/QNet/pgm_select.jsp

• Performance Score Reports and Certificates

–Dialysis Data - http://www.dialysisdata.org

• Dialysis Facility Reports and Dialysis Facility Compare

–In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAPHS) - https://ichcahps.org/

• Third Party Vendor
• p. 81

CMS Expectations: Network Responsibilities Data Reporting Assistance

• Educate facilities to follow CMS Data

Management Guidelines

• Inform providers of upcoming

deadlines

• Streamlined process to inform

facilities of missing data

• Working towards 100% patient level

data submission compliance – CROWNWeb – NHSN

• p. 82

ESRD QIP NHSN

CROWNWeb

CMS Expectations: Facility Responsibilities Data Submission Guidelines

• p. 83

Data System Task Frequency CROWNWeb PART Verification By 5th business day of each month CMS‐2728 Within 10 business days of Date Regular Chronic Dialysis Began CMS‐2746 Forms Within 14 days of the date of death Resolve Notifications and Accretions Within 15 days of issuance Add Key Personnel Within 5 business days of staff changes NHSN Event Data Quarterly Healthcare Personnel (HCP) By May 15th

CMS Expectations: CROWNWeb Data Quality Goals

• CMS issued preliminary

CROWNWeb Data Quality Goals for 2017- 2018

• Established key

indicators and goals are in line with the aforementioned Data Management Guidelines and will be used to assess facility data submission/performance

• p. 84

85 85

Technical Assistance Knowledge Base and Customer Portal

• Level 1 (Self Help): New customer support portal

http://help.esrd.ipro.org/support/home

• Level 2 (Email Technical Assistance): questions submitted

NW1Help@iproesrdnetwork.freshdesk.com

• Level 3 (One‐on‐One Technical Assistance): Use of WebEx “Meet Now”

method for real‐time assistance

• p. 85

Closing Comments

CMS Expectations: Facility Responsibilities

• Participate in Network Quality Improvement Activities (QIAs)
• Inform patients of available Network resources

–Grievance resolution –Educational materials –Peer-to-peer mentoring

• Notify the Network of major events

–Facility emergencies –Leadership changes

• Respond to inquiries and requests for information
• p. 87

CMS Expectations: Facility Responsibilities

• Timely submission of data
• Keep facility personnel information updated in CROWNWeb
• Discuss challenges/barriers

**Communicate with the Network**

• p. 88

ESRD Network of New England Website http://network1.esrd.ipro.org

• p. 89

IPRO ESRD Program Facebook Page https://www.facebook.com/IPROESRDProgram

• p. 90

ESRD Network of New England 2018 Educational Opportunity

6th Annual ESRD New England Fall Meeting

• Tuesday, October 30, 2018

–Mohegan Sun, Uncasville, Connecticut

• p. 91

Questions? Comments?

• p. 92

Presentation Template Draft for Review

April 6, 2017

• p. 1

Corporate Headquarters 1979 Marcus Avenue Lake Success, NY 11042-1002 www.ipro.org

For more information:

Danielle Daley, MBA Jaya Bhargava, PhD, CPHQ Executive Director Operations Director (203) 285-1212 (203) 285-1215 ddaley@nw1.esrd.net jbhargava@nw1.esrd.net Sarah Keehner, RN, BSN, CNN Brittney Jackson, LMSW, MBA Quality Improvement Director Patient Services Director (203) 285-1214 (203) 285-1213 skeehner@nw1.esrd.net bjackson@nw1.esrd.net