For years, end-stage renal disease professionals at Medicare-certified dialysis facilities and transplant centers have followed a manual, and sometimes cumbersome, process of submitting data regarding their service offerings and treatment delivery efforts to the Centers for Medicare & Medicaid Services via a data provisioning process known as the ESRD Medical Information Facility Survey. Today, this process is completed via the agency's annual ESRD Facility Survey (CMS-2744) form, which requires those completing the form to obtain and mail a paper copy to their appointed ESRD Network office. Due to the manual nature of the process, it can sometimes take weeks to verify if the reported information is accurate or if it must be corrected.
To provide facilities with a simpler and accelerated means of reporting this information, CMS chose to incorporate fields supporting the CMS-2744 form into its CROWNWeb data collection system. This decision to transfer the CMS-2744 data collection effort to the CROWNWeb system aligns with the requirements outlined in the updated Conditions for Coverage for ESRD Dialysis Facilities, which call for the electronic submission of administrative and clinical data by all Medicare-certified dialysis facilities.
The annual ESRD Facility Survey
Each year, dialysis centers certified by Medicare to administer services to ESRD patients must provide information regarding their service offerings and treatment delivery efforts to CMS via the ESRD Medical Information Facility Survey. Dialysis facilities report these data via the CMS-2744A form, while transplant centers utilize the CMS-2744B form to report their data. The annual ESRD Facility Survey is designed to collect information concerning treatment trends, utilization of services, and patterns of practice in treating ESRD patients. This survey covers activities that take place at these care centers within a cal endar year, and must be submitted to the provider's geographically assigned ESRD Network office The ESRD Facility Survey data have given CMS, research ers, and the ESRD community an opportunity to evaluate the medical and social impact of ESRD care at the local, regional, and national levels. Some of the information obtained from the surveys has been used to update CMS' Dialysis Facility Compare (DFC) website. Additionally, ESRD Networks have utilized this information to assist their facilities with developing and maintaining plans to support national programs such as vocational rehabilitation. These resources, however, rely on timely and accurate submission of CMS-2744 data. ESRD Networks must compile and evaluate data submitted by all facilities in their jurisdictions, and submit these data to CMS each year by early April. For both ESRD Networks and facilities, this manual process and deadline for submission means that a large amount of effort is expended to compile these critical reports.
CROWNWeb: An overview
The Information Age has transformed the methods that organizations use to transfer and receive data, and the speed at which those data can be transmitted. CMS has taken advantage of these technological advances to develop a system that allows dialysis providers to submit and access their patient and facility details in a matter of seconds rather than weeks. CROWNWeb, which was initially released in 2009 to a select group of dialysis provid ers as part of a "phased-in" release, represents a move away from the historical paper-based data collection methods. CROWNWeb is a Web-based data-collection system that allows participating facilities to securely sub mit and review patient-based data (both clinical and non clinical) in real time.
More than 460 dialysis providers throughout the nation are currently using CROWNWeb during the system's Phase Ill Pilot. This release is providing CMS an opportu nity to analyze users' experience with CROWNWeb before it is released for use by all Medicare-certified dialysis facilities, as well as to test additional security measures that have been put in place to ensure the secure access and transmission of critical patient and facility data in the system. Since its initial release, CROWNWeb has been modified and enhanced to incorporate feedback from the renal community and to expand the system's func tionality. The latest release boasts more than 40 new and enhanced features. The system will continue to be updat ed to help improve usability, and to address the increasing data management needs of the renal community.
CMS-2744 via CROWNWeb
Once CROWNWeb is released nationally, facilities will use the system to electronically submit their CMS-2744 forms to their respective ESRD Networks for acceptance. The system will enable facilities to be a part of the ESRD Facility Survey data submission process from beginning to end by giving them the ability to view the form's status as it goes through the various levels of approval and finalization. Facilities will initiate the data submission effort by using CROWNWeb to create a "draft" version of the CMS-2744 form. CROWNWeb will automatically transfer data from the system's admission and discharge records to populate the facility's dialysis patient details fields on the CMS-2744 form. Facilities will need to enter their treat ment and staffing details on the form, and correct any errors that are discovered during validation before submitting the form for review.
Similar to the current process, facilities will submit their CMS-2744 form to their ESRD Network for review. However, facilities will now be able to know when some one at the ESRD Network office has reviewed the data by checking CROWNWeb's "Status Change Updates" section. The ESRD Network office will either accept the data to allow the form to go though the finalization process, or it will inform the facility that corrections are needed by rejecting the form. (See Figure 1 for a diagram of CROWNWeb's CMS-2744 data submission and finalization process.)
The CMS-2744 module in CROWNWeb will include all of the fields on the traditional paper-based CMS-2744 form and will capture the same data, for example, on the num ber of patients who restarted dialysis and details regarding the number of patients who stopped receiving treatments. However, the system will also include new attributes that will help ESRD Networks provide a better analysis of the submitting organizations. These new attributes include:
- Date of patient vocational rehabilitation
- Date of patient employment and school status
- Status and date of Medicare enrollment
- Status and date of patient
Uses for the CMS-2744 data
Over the years, some of the data submitted by facilities on the CMS-2744 have been used to assist ESRD patients and their caregivers with making informed decisions regarding treatment options. Facility-based details report ed on the CMS-2744, such as the number of dialysis sta tions and the types of dialysis services offered, have been uploaded onto CMS' DFC website, where they are used by the ESRD patient community and their caregivers when selecting locations for treatment. With CROWNWeb, CMS will continue efforts to equip beneficiaries with the tools needed to evaluate dialysis facilities in their area by continuing to populate the DFC website with current CMS-2744 data.
Furthermore, ESRD Networks throughout the United States use CMS-2744 data to pinpoint areas in which they can assist renal care providers with CMS-mandated initiatives, and improve patient outcomes. ESRD Networks have used the survey's vocational rehabilitation data to identify facilities that require assistance with promoting vocational counseling and job placement options. Networks also use these data to find areas where home modalities are either unavailable or underutilized.
For more information on CROWNWeb's CMS-2744 data submission process and for an overview of the modifications and enhancements added to the system, visit the Project CROWNWeb website at www.projectcrownweb.org, or go to www.qualitynet.org and click on the ESRD tab.
The work on which this publication is based was performed under Contract Number HHSM-500-2011-00157G, titled "CROWNWeb Outreach, Communication, and Training," funded by the Centers for Medicare & Medicaid Services, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or poli? cies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or orga? nizations imply endorsement by the U.S. government.
The author assumes full responsibility for the accuracy and completeness of the ideas presented. The author wel? comes comments on the ideas presented; please send comments to CRAFT@ProjectCROWNWeb.org. Publication Number: FL-JOSOW-20120TCT22-2-12711
This article originally appeared in the April 2012 issue of Nephrology News & Issues.