The IPRO End Stage Renal Disease Network of New England serves as the Medicare contractor for the New England States of Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont.
IPRO is a national organization providing a full spectrum of healthcare assessment and improvement services that foster more efficient use of resources and enhance healthcare quality to achieve better patient outcomes. To learn more about IPRO please visit the IPRO Website.
What is an ESRD Network?
In 1972, the U.S. Congress voted to provide funds for the treatment of patients with End Stage Renal Disease (ESRD). The Program is administered through the Centers for Medicare & Medicaid Services. Network organizations were legislated to monitor and improve the quality of care provided by dialysis facilities and kidney transplant programs. The country is divided into 18 geographic areas, covering all 50 states and US territories. Each End Stage Renal Disease Network Organization is responsible for serving the dialysis and transplant community in its particular region. Networks are an effective bridge between the federal government, ESRD providers and professionals, and the consumers they serve.
What are the major functions of the Network?
Each Network Organization is responsible for developing its own local objectives and goals that support nationwide priorities mandated by the Centers for Medicare & Medicaid Services and the legislative requirements of Congress. Each Network Organization is required to conduct specific contractual activities to improve patient care, maintain a patient registry, provide educational materials and investigate patient complaints. All ESRD providers are required to participate in Network activities and cooperate in achieving Network goals. Specifically,
Section 1881(c)(3) of the 1986 Social Security Act, which states:
Where the Secretary determines, on the basis of the data contained in the network’s annual report and such other relevant data as may be available to him, that a facility or provider has consistently failed to cooperate with network plans and goals or to follow the recommendations of the medical review board, he may terminate or withhold certification of such facility or provider (for purposes of payment for services furnished to individuals with end stage renal disease) until he determines that such provider or facility is making reasonable and appropriate efforts to cooperate with the network’s plans and goals. If the Secretary determines that the facility’s or provider’s failure to cooperate with network plans and goals does not jeopardize patient health or safety or justify termination of certification, he may instead, after reasonable notice to the provider or facility and to the public, impose such other sanctions as he determines to be appropriate, which sanctions may include denial of reimbursement with respect to some or all patients admitted to the facility after the date of notice to the facility or provider, and graduated reduction in reimbursement for all patients.
The ESRD Network of New England has 4 main functions that incorporate national goals and facilitates their attainment.
- Encourage the selection of renal treatment that will promote the successful rehabilitation of the patient
- Encourage the use of home dialysis and transplantation
- Implement guidelines and criteria relating to the quality and appropriateness of patient care
- Conduct on-site reviews of facilities utilizing the performance guidelines established by the renal community
- Conduct quality improvement projects
- Monitor clinical indicators and distribute facility specific comparative data
- Provide technical assistance to ESRD professionals
- Collect, validate, and analyze ESRD data
- Maintain a broad and accessible patient database
- Conduct quality improvement studies and surveys
- Distribute timely feedback reports
- Evaluate and resolve patient grievances
- Encourage patient representation within the Network and its subcommittees
- Develop educational material for patients and their families
- Promote patient, public, and professional education
- Maintain a resource library of educational materials
- Conduct/organize workshops and conferences on quality of care topics
- Distribute a newsletter to dialysis and transplant facilities