QIA: Support Gainful Employment of ESRD Patients · Common Scenarios - Vocational Rehabilitation CROWNWeb Category Scenario: Referred to VR Social worker gave patient phone number

QIA: Support Gainful Employment of ESRD Patients

Lisa Hall, MSSW, LICSW

[email protected]

Background

• In 1972 Medicare was expanded to cover people requiring dialysis and transplant because Congress was promised that most patients would work.

– This promise has not been realized

Why VR?

• Research shows that people on dialysis who work have better quality of life

– More physically able

– Less pain

– Better general health and energy

– More likely to have a health plan through work

– Better physical functioning predicts fewer and shorter hospital stays – and a longer life

VR QIA

• 10% of Network 16 providers (22 facilities)

• Increase VR referrals by 5%

• Increase patients receiving VR services by 2%

• Final measure is September 2018

Requirements

• Attend scheduled webinars

• Complete Attestation form by January 19th

• Monthly reporting in CROWNWeb the VR status for all patients ages 18-54

• ESRD NCC Population Health Focused Learning and Action Network calls (bi-monthly)

• Increase patient engagement at your facility

Network 16 Technical Assistance

• Root cause of low referral and utilization of VR

• Development of interventions

• VR tools/recommended practices

• Assist patients and facility staff with addressing barriers

Monthly Data Submission

• Update monthly in CROWNWeb the VR status for all patients ages 18-54

– By the 10th business day of each month

– February – October 2018

VR Monthly Validation

• Update changes in patient status in CROWNWeb AS they occur – Effective date MUST be date the change occurred

• Social worker review CROWNWeb 2018 CMS-2744 Report by the 5th business day

• After review, make updates/corrections in CROWNWeb by the 10th business day – VR Status

– Employment Status

– School Status

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.)

Common Scenarios - General Scenario Action Required

Patient is no longer at my unit All information is still required if patient was at your unit as of the end of the survey year.

I do not know the date the patient changed statuses

Use the earliest date you are sure of the patient’s status.

I made the change in CROWNWeb but it is not reflected on my 2744

Regenerate the survey after you made the change

Verify the Effective Date in CROWNWeb is PRIOR to 2017

CROWNWeb status is blank but the patient has a status that will not affect the 2744

Update CROWNWeb

I am trying to update the effective date on the patient attributes page, but the date is grayed out

If you are changing the date only, but not the status, you must change it from the Patient Attributes History page.

I do not have the option to “Edit Patient” or “View Patient Attribute History”

Contact the Network. You may have lost the scope to make the change if the patient has left your facility.

Error Messages

Error-The effective date for a change to patient employment status must be after the most recent previous change to this patient attribute. Please use the Patient Attribute History page to view or edit the history of this attribute. Action Needed: You cannot add a prior date to the Patient Attributes page. You must make the change from the Patient Attributes History page

VR Toolkit

• Will be developed with input from:

– Patient advisors who have achieved VR goals

– Stakeholders: Social workers, VR Personnel, CMS

– Social Security Work Incentive Advisors

• Work incentives are under-utilized

• Patients active with VR prior to transplant will not undergo a medical case review after transplant – Can keep their benefits for up to 7 years and 9 months after

transplant!

VR Success Story

• Esther

– Dialysis patient active with VR

– Received a kidney transplant

– 4 year degree

• VR paid for books, most of tuition, job search expenses

– Medicare continued to pay for transplant meds beyond the usual 3 years

– Now is a full time nurse

Questions?

[email protected]