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
  • citizenship

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.