Table of Contents

Table of Contents ................................................................................................................ 1

Executive Summary ............................................................................................................ 3

Introduction ......................................................................................................................... 6

CMS’ End Stage Renal Disease Network Organization Program (ESRD Network

Program) ......................................................................................................................... 6

Medicare Coverage for Individuals with ESRD ............................................................. 6

History of CMS’ ESRD Network Organization Program............................................... 6

ESRD Network 9’s Role in Improving the Quality of ESRD Care ................................ 7

Figure 1 – 2013 Estimates General Population – Indiana, Kentucky & Ohio Age, Race &

Ethnicity Information* ........................................................................................................ 7

Population ........................................................................................................................... 7

Network Goals ................................................................................................................ 9

Profile of Patients in the ESRD Network 9 ...................................................................... 10

Service Area ...................................................................................................................... 10

Improving Care for ESRD Patients................................................................................... 11

Vascular Access ............................................................................................................ 11

Patient Safety ................................................................................................................ 12

Patient Safety: Support for the National Healthcare Safety Network (NHSN) ........ 12

Patient Safety: Healthcare-Acquired Infection Learning and Action Network (LAN)

................................................................................................................................... 13

Patient Safety: Reducing Rates of Healthcare-Acquired Infections ......................... 13

Support for the ESRD Quality Improvement Program (ESRD QIP) ........................... 15

Provider Education........................................................................................................ 17

Contributions to the Professional Literature ................................................................. 21

Ensuring Data Quality................................................................................................... 21

Disparities in ESRD Care ................................................................................................. 24

Patient and Family Engagement ....................................................................................... 33

Education for ESRD Patients and Caregivers ............................................................... 33

Patient Engagement Learning and Action Network (LAN) ......................................... 34

Support for ICH CAHPS .............................................................................................. 36

Grievances and Access to Care ......................................................................................... 37

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Grievances and Non-Grievance Access to Care Cases Referred to State Survey

Agencies ........................................................................................................................ 38

Recommendations for Sanctions................................................................................... 38

Recommendations to CMS for Additional Facilities .................................................... 38

Emergency Preparedness and Response .......................................................................... 39

Data Tables ....................................................................................................................... 42

Appendix. Network Staffing and Structure .................................................................... 104

Network Boards and Committees ............................................................................... 104

2014 Board of Directors Positions by Category ............................................................. 106

2014 MRB Positions by Category – ESRD Network 9 and ESRD Network 10 ............ 108

2014 Patient Advisory Council – ESRD Network 9 & ESRD Network 10……………………….110

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Executive Summary During 2014, ESRD Network 9, working within the states of Indiana, Kentucky and Ohio, collaborated with its many stakeholders to improve the quality of care for 31,631 end stage renal disease (ESRD) patients receiving treatment in 565 providers of dialysis therapy and 14 transplant centers. Working in partnership with dialysis providers, ESRD Network 9 implemented the CMS Three-Part Aim Strategy in the following manner: AIM 1: Better Care for the Individual through Beneficiary and Family Centered Care Within the Network 9 service area, 565 dialysis facilities participated, in the National Healthcare

Surveillance Network (NHSN), which impacted 31,631 patients receiving dialysis treatment in

those units.

Within the Network 9 service area, 99 facilities participated in the Long Term Catheter

Reduction Initiative, impacting 7,121 patients receiving dialysis treatment in those units. This

subset of 99 facilities increased the AFV In Use Rate and reduced the LTC In Use Rate during the

nine months of the project (outcome calculated using data submitted by the facilities).

Within the Network 9 service area, 40 facilities participated in the Centers for Disease Control

(CDC) bi-annual surveys to review facility infection surveillance practices, impacting 2,666

patients receiving dialysis treatment in those units.

Within the Network 9 service area, 150 facilities conducted CDC Hand Hygiene Audits, which

impacted the 11,848 patients receiving dialysis treatment in those units. Additionally, data

provided by the NHSN system showed a reduction in BSI rates from 1.502 per 100 patient

months in the fourth quarter of 2013 to 0.653 per 100 patient months in the fourth quarter of

2014, in the 150 participating units.

A Grievance Quality Improvement Activity (QIA) was conducted within the Network 9 service

area with five facilities participating, impacting 464 patients within those units. The project

attained its goal to educate on good patient and staff communications techniques and to reduce

grievances.

A QIA, developed by the Patient Engagement Learning and Action Network (PE LAN), was

conducted within the Network 9 service area, with 100 facilities participating, impacting 7,464

patients. The goal was to increase the patient voice within those units through adoption of the

Network Patient Representative Program. The goal of 10% adoption rate was exceeded, with

82% of facilities establishing the NPRP.

An educational campaign on Increasing Adherence to Binder Prescription, developed by the PE

LAN, was conducted within the Network 9 Service Area, with 69 facilities participating,

impacting 5,606 patients. The goal was to increase patient participation rate of reporting binder

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adherence by 10%. The goal was exceeded with 75% of patients reporting binder adherence,

based on data obtained from the subset of facilities in the project. Additionally, 84% of the

participating facilities recorded an increase in the proportion of patients with phosphorus levels

within normal limits, based on CROWNWeb data provided by the National Coordinating Center.

An educational campaign on Transition of Care, developed by the PE LAN, was conducted within

the Network 9 Service Area, with 111 facilities participating, impacting 5,606 patients within

those units. The goal of 5% of patients receiving education was exceeded with 27% of patients

requesting and receiving information. The data was gathered directly from the facilities

participating in the project.

Additionally, Network 9 conducted the following AIM 1 outreach and education activities for the

dialysis providers within the Network 9 service area:

o Resolved 89 grievances through one-on-one counseling

o Provided 29 educational webinars to renal healthcare professionals and patients

o Achieved 1,316,229 web hits – www.therenalnetwork.org

o Achieved 435,042 web hits – www.kidneypatientnews.org

o Achieved 4,396 looks, likes and shares on Facebook

o Achieved nearly 2,500 subscribers to Renal Outreach, free newsletter for

patients

AIM 2: Better Health for the ESRD Population Within the Network 9 service area, the On the Road to Home Population Innovation Pilot Project was conducted in 25 facilities, impacting 3,100 patients. The participating facilities went from a baseline of 16.3% patients on home therapy to 19% patients on home therapy by September 2014 (outcome calculated using data submitted by the facilities). The referral to home therapy rate for facilities participating in the project was 16.4% (outcome calculated using data submitted by the facilities). AIM 3: Reduce Costs of ESRD Care by Improving Care The Network provided continuous support and assistance to users of CROWNWeb through the

following activities:

o Responded to 2,956 requests for technical assistance during the year

o Presented monthly webinars for training and support of CROWNWeb users

The Network supported the ESRD Quality Improvement Program (ESRD QIP) by advising all

facilities on how to access and understand their Performance Score Reports and Performance

Score Certificates. Less than 5% of dialysis providers received a payment reduction.

These goals were accomplished through the efforts of the many dedicated volunteers, both patients and professionals, serving on Network Committees: Patient Advisory Council, Medical Review Board, Board of Directors, Patient & Family Engagement Learning & Action Network (PFE

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LAN), and the Health-Acquired Infection Learning & Action Network (HAI LAN). Complete details of each of these achievements are described in this annual report.

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Introduction

CMS’ End Stage Renal Disease Network Organization Program (ESRD Network Program) The End Stage Renal Disease Network Organization Program (ESRD Network Program) is a national quality improvement program funded by the Centers for Medicare & Medicaid Services (CMS). CMS is a federal agency, part of the U.S. Department of Health and Human Services. CMS defines end stage renal disease (ESRD) as permanent kidney failure in an individual who requires dialysis or kidney transplantation to sustain life. Under contract with CMS, 18 ESRD Network Organizations, or ESRD Networks, carry out a range of activities to improve the quality of care for individuals with ESRD. The 18 ESRD Networks serve the 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, American Samoa, Guam, and the Northern Mariana Islands.

Medicare Coverage for Individuals with ESRD Medicare coverage was extended to most ESRD patients in the U.S. under the Social Security Act Amendments of 1972 (Public Law 92-603). Individuals with irreversible kidney failure are eligible for Medicare if they need regular dialysis or have had a kidney transplant and they meet (or their spouse or parent meets) certain work history requirements under the Social Security program, the railroad retirement system, or federal employment.

History of CMS’ ESRD Network Organization Program Following passage of the 1972 Amendments to the Social Security Act, in response to the need for effective coordination of ESRD care, hospitals and other health care facilities were organized into networks to enhance the delivery of services to people with ESRD. In 1978, Public Law 95-292 modified the Social Security Act to allow for the coordination of dialysis and transplant services by linking dialysis facilities, transplant centers, hospitals, patients, physicians, nurses, social workers, and dietitians into Network Coordinating Councils, one for each of 32 administrative areas. In 1988, CMS consolidated the 32 jurisdictions into 18 geographic areas and awarded contracts to 18 ESRD Network Organizations, now commonly known as ESRD Networks. The ESRD Networks, under the terms of their contracts with CMS, are responsible for: supporting use of the most appropriate treatment modalities to maximize quality of care and quality of life; encouraging treatment providers to support patients’ vocational rehabilitation and employment; collecting, validating, and analyzing patient registry data; identifying providers that do not contribute to the achievement of Network goals; and conducting onsite reviews of ESRD providers as necessary.

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ESRD Network 9’s Role in Improving the Quality of ESRD Care Network Strategies and Innovations, Inc. (NSI) is an independent, not-for-profit corporation that holds contracts with CMS for ESRD Network 9, ESRD Network 10 and ESRD Network 12. NSI maintains offices in Indianapolis, Indiana for the administration of ESRD Network 9 and ESRD Network 10, which are held under the dba identity of The Renal Network. NSI has an office in Kansas City, Missouri for ESRD Network 12, which is held under the dba identity of the Heartland Kidney Network. This Annual Report addresses the contract administration of ESRD Network 9, which has responsibility for the states of Indiana, Kentucky and Ohio. Population information in the following paragraphs is taken from “State Population Estimates: 2013 Estimates, U.S. Census Bureau Quick Facts, Indiana, Kentucky and Ohio," U.S. Department of Commerce, Bureau of the Census,” www.census.gov. The total population in the three-state area covered by Network 9 is 22,604,475 About two-thirds of the population of Indiana lives in urban areas. Indianapolis is the state capital and the largest city in Indiana, with a population of over 1,000,000. Other urban areas (with populations greater than 100,000) are Fort Wayne, Gary, Evansville and South Bend. The population of Kentucky is about evenly divided between rural and urban dwellers. Urban centers (with populations greater than 100,000) are Louisville, Lexington, Owensboro, Covington, Bowling Green, Paducah, Hopkinsville, and Ashland. The Kentucky state capital is Frankfort. About three-quarters of the population of Ohio live in urban areas. Urban centers (with populations greater than 100,000) include Cleveland, Columbus (the state capital), Cincinnati, Toledo, Akron, Dayton, and Youngstown. Race, ethnicity, age, and gender characteristics for each state are illustrated in Figure 1.

Figure 1 – 2013 Estimates General Population – Indiana, Kentucky & Ohio Age, Race & Ethnicity Information*

Indiana Kentucky Ohio

Population 6,596,855 4,413,457 11,594,163

State Rank 16th 26th 7th

White 84% 89% 83%

Black 9% 8% 12%

Other 7% 3% 5%

Hispanic 6% 3% 3%

Under 19 24% 23% 23%

19 – 64 62% 63% 62%

65 & Over 14% 14% 15%

Male 49% 49% 49%

Female 51% 51% 51% *U.S. Census Bureau, State & County Quick Facts, Indiana, Kentucky & Ohio http://quickfacts.census.gov

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ESRD Network 9’s service area had 31,631 ESRD patients, 565 providers of dialysis therapy, and 14 transplant centers; characteristics are illustrated in Table A, Table B, and Table C.

Table A. Dialysis Facilities and Transplant Centers in the ESRD Network 9 Service Area, as of December 31, 2014 Category Number

Number of Dialysis Facilities in ESRD Network 9 Service Area* 565

Number of Transplant Centers in ESRD Network 9 Service Area* 14 Source of data: End Stage Renal Disease National Coordinating Center (ESRD NCC) report to ESRD Forum. *Counts of dialysis facilities and transplant centers may include a small number of facilities that closed during the calendar year but did not have a closing date recorded in CROWNWeb as of December 31, 2014.

Table B. Number of Dialysis Facilities in the ESRD Network 9 Service Area and Number and Percent of Dialysis Facilities Offering Dialysis Shifts Starting after 5 PM, as of December 31, 2014 Category Number Percent

Number of Dialysis Facilities in the ESRD Network 9 Service Area* 565

Dialysis Facilities in the ESRD Network 9 Service Area Offering Dialysis Shifts Starting after 5 PM*

93 16.4%

Source of data for number of dialysis facilities: End Stage Renal Disease National Coordinating Center (ESRD NCC) report to ESRD Forum. Source of data for dialysis facilities offering dialysis shifts starting after 5 PM: NCC Gap Report “Shifts After 5 PM.” *Counts of dialysis facilities may include a small number of facilities that closed during the calendar year but did not have a closing date recorded in CROWNWeb as of December 31, 2014.

The Network acts as a liaison to the community of dialysis providers and dialysis patients in the states of Indiana, Kentucky and Ohio, representing the goals of the ESRD Network Program as promoted by CMS. As outlined in this report, the Network:

Acts as a change agent for quality improvement to the provider community, promoting the adoption of improved standards of care in vascular access, vaccination, dialysis treatment modality and transplantation, patient safety and other aspects of ESRD treatment.

Examines data to uncover potential disparities in care for dialysis patients and works with providers, patients and community organizations to reduce these inequities of care.

Assists in the resolution of patient grievances.

Assists in cases of involuntary discharge and involuntary transfers of dialysis patients to avert, or resolve, the incidents to the degree possible.

Empowers patients to direct their care through increased awareness of ESRD and its treatment and encourages dialysis providers to embrace patient centered care in the day to day delivery of care.

These activities are developed under the direction of stakeholders serving as volunteer advisors on Network committees, directing a professional staff of Network employees to implement Network programs, fully described in the Appendix: Network Staffing and Structure.

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Network Goals In accordance with the legislative mandate for the ESRD Network Program, ESRD Network 9 shares the goals of the Centers for Medicare & Medicaid Services (CMS) for the ESRD Network Program to promote positive change relative to triple AIMs outlined in the National Quality Strategy (NQS) and CMS priorities:

AIM 1: Better Care for the Individual through Beneficiary and Family Centered Care AIM 2: Better Health for the ESRD Population AIM 3: Reduce Costs of ESRD Care by Improving Care

ESRD Network 9 strives to lead transformation by:

Serving as conveners, organizers, motivators, and change agents

Leveraging technology to provide outreach and education

Serving as partners in quality improvement with beneficiaries, practitioners, health care providers, other health care organizations, and other stakeholders

Securing commitments to create collaborative relationships

Achieving and measuring changes at the patient level through data collection, analysis, and monitoring for improvement

Disseminating and spreading best practices including those relating to clinical care, quality improvement techniques, and data collection through information exchange

Participating in the development of a CMS national framework for providing emergency preparedness services

Ensuring representation of Medicare beneficiaries in shared decision making related to ESRD care in order to promote person-centeredness and family engagement

Protecting Medicare beneficiary access to quality dialysis care, especially among vulnerable populations

Identifying opportunities for quality improvement at the individual facility level and providing technical assistance

Promoting all modalities of care, including home modalities and transplantation, as appropriate, to promote patient independence and improve clinical outcomes

Facilitating processes to promote care coordination between different care settings

Ensuring accurate, complete, consistent, and timely data collection, analysis, and reporting by facilities in accordance with national standards and the ESRD QIP

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Profile of Patients in the ESRD Network 9 Service Area

The ESRD Network Program collects data on incident (new) ESRD patients, prevalent (currently treated) dialysis patients, and renal transplant recipients. ESRD Network 9 uses data on clinical characteristics of patients —including primary cause of ESRD, treatment modality, and vascular access type—to focus its outreach and quality improvement activities.

Table C. Clinical Characteristics of the ESRD Population in the Network Area, Calendar Year 2014 Category Number Percent

Incident (New) ESRD Patients

Number of Incident ESRD Patients, Calendar Year 2014 9,165

Primary Cause of ESRD among Incident ESRD Patients

Diabetes 4,054 44.2%

Glomerulonephritis 536 5.8%

Secondary Glomerulonephritis/Vasculitis 146 1.6%

Interstitial Nephritis/Pyelonephritis 272 3.0%

Hypertension/Large Vessel Disease 2,481 27.1%

Cystic/Hereditary/Congenital Diseases 284 3.1%

Neoplasms/Tumors 200 2.2%

Miscellaneous Conditions 909 9.9%

Not Specified 283 3.1%

Prevalent Dialysis Patients

Number of Prevalent Dialysis Patients as of December 31, 2014 31,535

Treatment Modality of Prevalent Dialysis Patients as of December 31, 2014

In-Center Hemodialysis or Peritoneal Dialysis 27,625 87.6%

In-Home Hemodialysis or Peritoneal Dialysis 3,910 12.4%

Vascular Access Type at Latest Treatment among Prevalent In-Center and In-Home Hemodialysis Patients as of December 31, 2014*

Arteriovenous Fistula in Use 15,836 57.3%

Arteriovenous Graft in Use 5,001 18.1%

Catheter in Use for 90 Days or Longer 3,249 11.8%

Renal Transplants

Number of Renal Transplants, Calendar Year 2014 1,139

Transplant from Deceased Donor 737 64.7%

Transplant from Living Related Donor 206 18.1%

Transplant from Living Unrelated Donor 184 16.2%

Donor Information Not Available 0 0%

Mortality

Number of Deaths of ESRD Patients, Calendar Year 2014 6,440 Source of data (except vascular access data): CROWNWeb Annual Report tables. Source of vascular access data: End Stage Renal Disease National Coordinating Center (ESRD NCC) Fistula First Catheter Last (FFCL) Dashboard. *Vascular access information reported in this table is based on facility-level data submitted to CMS. CMS has identified issues with data transmission and the application of vascular access data definitions and is correcting these errors by working directly with stakeholders and through the Networks.

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Improving Care for ESRD Patients ESRD Network 9 works closely with ESRD patients, patients’ family members and friends, nephrologists, dialysis facilities and other healthcare organizations, ESRD advocacy organizations, and other ESRD stakeholders to improve the care for ESRD patients in the Network’s service area, which includes Indiana, Kentucky and Ohio. Under contract with CMS, ESRD Network 9 is responsible for identifying opportunities for quality improvement and developing interventions to improve care for ESRD patients in the Network’s service area; identifying opportunities for improvement at the facility level and providing technical assistance to facilities as needed; promoting the use of best practices in clinical care for ESRD patients; encouraging use of all modalities of care, including home modalities and transplantation, as appropriate, to promote patient independence and improve clinical outcomes; promoting the coordination of care across treatment settings; and ensuring accurate and timely data collection, analysis, and reporting by facilities in accordance with national standards.

Vascular Access The vascular access improvement project for 2014 was titled 2014 Long Term Catheter Reduction Initiative. This project was designed as a part of the CMS Fistula First/Catheter Last (FFCL) Initiative. Facilities chosen for the 2014 Catheter Reduction project had a long term catheter in use rate (defined as 90 days in use or longer) of greater than or equal to 10% of hemodialysis patients and an arteriovenous fistula (AVF) in use rate of less than 68% in use as of September 2013. A total of 99 facilities in Network 9’s service area participated in the project. The Network offered three webinars focused on promising practices in vascular access. Participation in the webinars was a requirement for the project facilities. All facilities in the Network were invited to the webinars, and continuing education credits were provided for nurses and patient care technicians.

January 16, 2014 Working with the Community to Improve Vascular Access presented by Mohammad Hasnain, MD

May 20, 2014 Thinking Outside the Catheter: Strategies to Reduce Long Term Dialysis Catheter Use presented by Tim Pflederer, MD

November 11, 2014 It Takes a Team to Decrease Long Term Catheter Rates presented by Lisa Johnstone and Pam Beller

Project facilities reported their vascular access outcomes monthly to Network staff. Having the data monthly allowed for rapid cycle intervention, one on one, with struggling facilities. Feedback reports were provided to project facility staff for use in their monthly quality meetings.

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Outcomes The goals established by CMS were to decrease the Long Term Catheter In-Use rate by 2 percentage points and increase the AVF In-Use rate by 3.2 percentage points for all Network facilities; this goal was later waived by CMS. Based on data collected monthly, directly from the subset of 99 facilities enrolled in the Long Term Catheter Reduction Initiative project, the following improvements were noted:

Aggregate AVF In-Use Rate for project facilities increased by 4.3 percentage points (51.9% up to 56.2%)

Aggregate Long Term Catheter in use rate decreased by 2.5 percentage points (14.5% down to 12.0%)

Patient Safety Patient Safety: Support for the National Healthcare Safety Network (NHSN) The National Healthcare Safety Network (NHSN), sponsored by the Centers for Disease Control and Prevention (CDC), is the nation’s most widely used healthcare-associated infection tracking system. NHSN provides facilities, states, regions, and the nation with data needed to identify problem areas, measure progress of prevention efforts, and ultimately eliminate healthcare‐associated infections. Since 2012, the ESRD Networks have been actively involved in assisting CDC with implementation of NHSN. In support of the QIP final rule, the Network was tasked to support new and returning facilities to enroll in the NHSN database, and to support facilities in reporting Dialysis Event data. The Network has established itself as the group administrator for the Network area dialysis facilities and was directed to obtain group administrator rights from every facility. Lastly, the Network was charged with assisting facilities in ensuring that data are entered into NHSN accurately and in a timely manner. Throughout 2014, the Network supported all facilities in ESRD Network 9’s service area in enrolling and complying with CMS rules regarding data submission into NHSN. The facility staff was also given directions to join the Network group so Network staff could access their infection data. During 2014, facilities were required to submit monthly data into NHSN in order to receive the maximum number of points in the ESRD Quality Incentive Program (ESRD QIP). Facilities delinquent in their monthly reporting were contacted by Network staff. In June and December of 2014, the CDC provided an NHSN Enrollment Status Report to the Network. The report listed the facilities that had enrolled in NHSN and indicated if they had joined the Network group. Those facilities not yet in the Network group were sent instructions on joining. New facilities that had not yet enrolled were contacted with instructions for enrolling in NHSN. During 2014 the Network performed monthly NHSN data checks from April through November, using a CDC-created checklist to identify potential data entry errors. Data were reviewed to identify potential errors in both denominators and numerators. The Network was instructed to review the following:

1. Identify facilities with unusual changes in census data from month to month 2. Identify facilities with unusual percentages of access types from month to month 3. Identify facilities with no reported dialysis events for three consecutive months

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4. Identify facilities with high central venous catheter (CVC) rates with no reported BSIs for three consecutive months

Facilities with potential errors were contacted and asked to confirm the data or correct the errors in NHSN. Results of the data checks were reported to CMS every month. The Network also performed a bi-annual review of the 10 facilities with the highest BSI rates and the 10 facilities with the lowest BSI rates by means of telephone interviews. During the months of May and October, Network staff interviewed facility staff, using the CDC survey tool to identify surveillance and prevention practices. During these interviews, facility staff who reported using incorrect dialysis event protocols, or misunderstood the protocol, were educated and provided resources. A summary of the survey findings was provided to CMS.

Patient Safety: Healthcare-Acquired Infection Learning and Action Network (LAN) A LAN is an ongoing collaboration among community partners representing a broad range of organizations and professions. Regularly scheduled LAN meetings provide an opportunity for members to share knowledge, skills, and resources to address an identified quality of care issue through collaborative problem solving. In 2014, ESRD Network 9 established a Learning and Action Network (LAN) focused on patient safety in dialysis facilities, with a specific focus on reducing rates of healthcare-acquired infections (HAIs). The membership of the HAI LAN includes representatives from State Survey Agencies in the Network service area, the CMS-funded Quality Improvement Organizations (QIOs) in the Network’s service area, the CDC, state HAI coordinators, Medical Review Board members, facility staff, and patients. Network 9 invited all of its facilities to participate on the HAI LAN and all educational opportunities were offered Network-wide. The HAI LAN activities were designed to allow facility staff to monitor infections and implement tools and processes in order to reduce bloodstream infection rates (BSI) in the adult ESRD population. Interventions included CDC-developed tools and resources located on the CDC website. Best practices were identified and shared with the LAN members. Webinars were held quarterly for LAN facilities throughout 2014, as follows:

February 13, 2014: Infection Prevention Core Practices: Critical Activities in the Dialysis Setting. Ruth Carrico, PhD, RN, FSHEA, CIC, Associate Professor, University of Louisville, presented.

April 22, 2014: Preventing HAIs through Auditing. CDC infection prevention resources were reviewed. Use of the CDC audit tools was explained and demonstrated.

August 26, 2014: Thinking Outside the Box: HAI Audit. Barb Breckler, QI Director, ESRD Network 16 and Vicki Colley from a DaVita facility in Ohio, spoke on involving patients in auditing staff for proper hand hygiene.

December 16, 2014: HAIs Past Present and Future. Sharlyn Bogner, QI Director, ESRD Network 12, reviewed HAIs.

Patient Safety: Reducing Rates of Healthcare-Acquired Infections The Network was directed by CMS to assist facilities in reducing Dialysis Facility Event rates by:

Working in collaboration with CMS and CDC to increase NHSN enrollment by actively promoting

awareness of and access to NHSN.

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Using CDC technical assistance and tools in enrolling facilities and encouraging accurate

reporting of data.

Sharing best practices in the area of reducing HAIs.

In-center hemodialysis facilities have been required to enter dialysis events into NHSN since 2012. Infection rates have shown improvement over time.

Network 9 Service Area - 2014 Bloodstream Infection Rates (Positive Blood Cultures reported per 100 patient months for fistula, graft, and catheter patients combined)*

State Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q4 2014

Indiana 0.649 0.630 0.537 0.654 0.551

Kentucky 0.685 0.592 0.461 0.402 0.340

Ohio 1.090 1.005 0.978 1.114 0.914

Network 9 0.902 0.830 0.767 0.862 0.711

* Data obtained from the National Healthcare Safety Network (NHSN)

In May the Network prepared a report comparing each facility’s Access Related Bloodstream Infection rates with state and national rates. Data compared was from fourth quarter 2012 through fourth quarter 2013. The reports were emailed to all in-center hemodialysis facilities.

HAI Quality Improvement Activity The Network implemented a QIA with at least 20% of hemodialysis facilities (N=150 facilities/11,848 patients) performing a minimum number of monthly observations of hand hygiene, using CDC tools. The project focused on monthly audits to assess and reinforce adherence to CDC recommended practices. All facilities were instructed to complete three different audits of their staff every month. The audits identified areas for improvement and education toward desired practices. Facility staff members participating in the project were provided instructions on using the audit tools and reporting monthly results to the Network. Facilities were instructed to conduct the following observations monthly:

1. At least 30 hand hygiene opportunities per month using the CDC hand hygiene audit tool. 2. At least 10 total catheter connection/disconnection audits per month using the CDC catheter

connection/disconnection tools. 3. At least 10 fistula/graft cannulation observations per month using the CDC AV fistula and graft

cannulation tool. The goal of the project was for facilities to perform at least the minimum number of CDC recommended observations per month (30 hand hygiene/10 catheter connection or disconnection/10 fistula or graft cannulations). Monthly results were reported to CMS electronically using the CMS Dashboard Input Form. All of the audit facilities were performing the recommended number of observations by the end of the project. The 150 facilities reporting audit results to the Network also showed an improvement in BSI rates over the course of the project. Fourth quarter 2013 data showed 446 BSIs (1.502 per 100 patient months) reported by the audit facilities. Fourth quarter 2014 showed only 256 BSIs (0.653 per 100 patient months) reported by the same facilities.

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Grievance Quality Improvement Activity: Understanding Patient Concerns This QIA involved five dialysis facilities that had staff-related grievances filed with the Network during quarter one of 2014 and at least one grievance in 2013. The project was conducted during the months of May through September 2014. The goal of the project was to increase effective communication between patients and staff and educating both groups about the Network grievance process, in order to decrease the number of grievances filed. The participating facilities identified a patient to be their Network Patient Representative (NPR) who would share information directly with other patients. The Network provided education for facility staff and the NPRs on setting up a Network Patient Representative Program (NPRP), effective communication tips, becoming Patient Whisperers (interacting in a sensitive manner and using appropriate communication methods), listening skills, conflict management, and the Network grievance process. Analysis consisted of measuring the reduction in the rate of grievances that occurred during participation in the project with the goal of at least a 1% reduction (n=1). The numerator was the number of new grievances and the denominator was the patient census at the participating facilities. There were no staff related grievances reported to the Network during the project and the goal was achieved.

Support for the ESRD Quality Improvement Program (ESRD QIP) The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires that CMS select measures, develop a scoring methodology, and implement a payment reduction scale relating to facility performance. This process is called the ESRD Quality Incentive Payment (ESRD QIP). Through the ESRD QIP, a percentage of the facility’s dialysis payment is contingent on the facility’s performance on a specific set of measures.

y = -0.14x + 1.50

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0.5

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1.5

2.0

2.5

3.0

Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q4 2014

BSI

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Bloodstream Infection Rates per 100 Patient-Months: All Access Types

Data from the National Healthcare Safety Network (NHSN)Blue Line = Network 9 BSI Rates per QuarterBlack Line = Linear Trend Q4 2013-Q4 2014

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The ESRD QIP is monitored within each dialysis provider by a staff member who is designated as the Master Account Holder (MAH). In June, 2014 MAH passwords were reset in preparation for the July 2014 posting of the preview 2014 Dialysis Facility Reports and 2015 Performance Score Reports. Dialysis Facility MAHs were informed about the process. The MAH is responsible for creating individual user accounts and setting permissions for authorized individuals within their dialysis units. Prior to viewing reports, the MAH must set up user accounts and assign permissions for appropriate personnel. The Network sent information to the MAHs regarding accessing the reports and the timeline for submitting comments and inquiries. Facility staff was assisted as needed by Network staff. Facilities were encouraged to review the reports and submit comments or inquiries as necessary.

An MAH list for all facilities was maintained and updated regularly by the Network. The list was submitted to CMS and the University of Michigan Kidney and Epidemiology Cost Center (UM-KECC) quarterly. The 2015 Performance Score Reports were based on three clinical measures (75% of total score) and four reporting measures (25% of total score) using data from 2013, as follows. Clinical Measures:

Kt/V dialysis adequacy

Anemia management

Vascular access type Reporting Measures:

NHSN data submission

ICH CAHPS administration

Anemia management

Mineral metabolism monitoring Quality Improvement Activities and Educational Campaigns planned for 2015, such as Raising the Bar (increasing phosphorus binder use), should assist project facilities with their QIP scores. The final Performance Score Report and Performance Score Certificates were posted in December 2014 on the dialysisreports.org website. Facilities were required to display both English and Spanish copies of the certificates in an area easily visible to the public. Facilities had until January 15, 2015 to download the certificate before the dialysisreports.org website ceased to operate. Certificates must be displayed continuously throughout the year. Payment reductions were based on Total Performance Scores as reported on the Performance Score Report. Payment reductions will affect Medicare reimbursement in 2015 in amounts ranging from 0.5% to 2.0%. Facilities receiving ≥ 60 points out of a possible 100 points will receive no payment reduction.

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ESRD QIP Guidelines for Payment Reduction

Total Performance Score (TPS) Percentage of Payment Reduction 60 or more points 0%

50 – 59 points 0.5%

40 – 49 points 1.0%

30 – 39 points 1.5%

29 or fewer points 2.0%

ESRD Network 9 – 2015 Payment Reduction Facilities

0.5% 1.0% 1.5% 2.0% Total Indiana 5 2 0 0 7

Kentucky 3 0 0 1 4

Ohio 13 0 1 2 16

Network 9 Total

21 2 1 3 27

Facilities receiving a payment reduction on the preview report were contacted by Network staff in July. The Network staff explained to the facility staff the process of submitting formal inquiries in an attempt to correct the score if errors had been made in the calculation. These corrections of errors can serve to decrease or eliminate the payment reduction.

Provider Education The Renal Network, representing both ESRD Network 9 and ESRD Network 10, has established several methods for the delivery of education to providers and patients, as well as to share information with all stakeholders.

Websites To maximize its reach into the communities that it serves, The Renal Network, on behalf of ESRD Network 9 and ESRD Network 10, maintains two websites:

• The Renal Network (TRN): www.therenalnetwork.org

• Kidney Patient News (KPN): www.kidneypatientnews.org

Each site provides an Internet presence targeted to meet the needs of the populations that the Network serves. KPN provides valuable resources to patients and their family members and friends, and the community at large. The TRN site is an organizational site and is geared toward dialysis staff, renal professionals, and other renal community professional stakeholders. By creating and maintaining individually focused websites, the Network is able to serve patients and renal staff, its two main constituencies, in a more efficient and effective manner. The Renal Network website: www.therenalnetwork.org The primary focus of the TRN website is to provide dialysis staff and renal professionals with the information and tools needed to improve patient quality of care and patient quality of life.

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The TRN site provides an overview of the Networks’ strategic goals and the latest Network policies and procedures, including guidelines to facilitate the implementation of critical changes in the CMS ESRD Prospective Payment System (PPS), the ESRD Conditions for Coverage (CfC), CROWNWeb, and the Fistula First/Catheter Last (FF/CL) initiative. The TRN site provides access to training materials and educational opportunities to assist with the execution of continuous quality improvement (CQI) activities and special projects. It also provides a reliable point of reference for emergency and disaster planning and preparedness, and alerts. In addition, the website contains information to assist facilities in handling challenging patient situations, potential discharges, rehabilitation referrals, palliative care and quality of life issues. Data and other tracking resources are provided to assist facilities in measuring and evaluating their own performance. The site also seeks to provide a gateway to existing resources and tools by providing links to reliable online sources. TRN: www.therenalnetwork.org Site Activity During 2014, www.therenalnetwork.org received 1,316,229 web hits. The following chart illustrates the most top 10 most visited pages on the site.

TRN – 2014 Top 10 Page Views

Page Total

Quality Improvement Resources 5,798

Patient Services 5,686

TRN Resources (posters) 5,418

Quality Improvement 4,395

Continuous Quality Improvement Plan 4,159

Data Services 3,608

Book Resources 3,115

Fistula First 2,819

Alerts (Safety Alerts) 2,395

CROWNWeb 2,223

Non-Adherence 2,228

Kidney Patient News: www.kidneypatientnews.org TRN has maintained the patient website www.kidneypatientnews.org since 2001. The KPN site is devoted to topics of interest to patients and family members. It contains articles and resources on CKD, vocational rehabilitation, transplantation, treatment modalities, advance directives, and end-of-life issues.

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KPN: www.kidneypatientnews.org Site Activity In 2014, www.kidneypatientnews.org received 435,042 web hits. The following chart illustrates the top 10 most visited pages on the site.

Kidney Patient News – 2014 Top 10 Page Views

Page Total Treatment - Problems With Dialysis 17,762

Diet – Cookbooks (resource page) 4,398

Learning to Live With Kidney Failure: A Patient’s Perspective 2,107

The Renal Diet (resource page) 2,026

Peritoneal Dialysis 1,501

Chronic Kidney Disease 1,421

Quality of Care 1,146

Dialysis Treatment 1,022

Resources (resources home) 968

Vocational Rehabilitation 924

BFLN Change Packages 887

Social Media: Facebook

The Renal Network Facebook page, shared by ESRD Network 9 and ESRD Network 10, continued to grow

during 2014. TRN Facebook posts reached a total 4,396 users during the year, who opted to like, and

often to share, the messages. The site is designed for patients, dialysis facility staff, and the general

public. Multiple posts are provided weekly. Post topics include patient stories, national patient news,

health and wellness resources, a renal health tip of the week, national campaigns and events (e.g.,

World Kidney Day and National Preparedness Month), Network programs/events/webinars (such as the

“On the Road to Home” series), and occasional motivational/inspirational posts. Posts utilize different

formats, including videos, blogs, images/photos, and links to resources (such as pages on the CMS and

the CDC websites). Examples of posts include the following:

Patient Stories:

Network 10 LAN member Lana Schmidt’s story on home hemodialysis featured on local news (posted 3/5/14)

Peritoneal Dialysis video (YouTube) (posted 5/24/14)

Patient Story: Quinetta Taylor (posted 6/18/14)

Patient story and blog: Jim McFarlin (posted 6/20/14) National Patient News:

AAKP National Patient Meeting registration and information (posted 5/10/14) Health and Wellness Resources:

Free webinar for patients on nutrition, sponsored by AAKP (posted 4/15/14)

NNI story, “Major Sign of Kidney and Heart Damage Often Ignored” (posted 4/29/14)

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CDC CE course on Infection Prevention, for outpatient hemodialysis healthcare workers (posted 5/8/14)

Meeting announcement: Kidney Patient Support Group program, “Kidney Basics” (posted 6/10/14)

Silent Epidemic: Kidney Disease in the African-American Population (posted 7/20/14)

Free health screenings in Carbondale, IL (posted 8/8/14)

Ebola resources: CDC Hand Hygiene Audit Tool (posted 10/21/14)

Patient advocates as part of the care team (posted 12/10/14) Renal Health Tip of the Week:

Know your food's potassium levels: chayote squash (low), oranges (medium), or kiwi (high). (posted 2/18/14)

Try pasta salad as a side instead of potato salad. (posted 6/2/14)

Always order your medications on time so you will have enough in case of an emergency. (posted 9/8/14)

Try apple pie or cobbler instead of pumpkin pie, and use whipped cream instead of ice cream. (posted 11/10/14)

For kidney-friendly baking try two egg whites for one whole egg, low calorie sweeteners instead of sugar and unsweetened applesauce for oil. (posted 12/15/14)

National Campaigns and Events:

American Diabetes Association Alert Day (posted 3/25/14)

April is National Donate Life Month (posted 4/10/14)

Prescription Drug Take-Back Day (posted 4/25/14)

National Preparedness Month: evacuation and emergency communication plans (posted 9/2/14)

Network Programs/Events/Webinars:

Treatment Modality workshop – Louisville, February 27, 2014 (posted 1/23/14)

On the Road to Home series – April 29 event in Columbus (posted 4/4/14)

“Thinking Outside the Catheter – Strategies to Reduce Long Term Dialysis Care Use” (TRN webinar) (posted 4/24/14)

Motivational/Inspirational Posts:

“Empathy: The Human Connection to Patient Care” (Cleveland Clinic video) (posted 4/18/14)

“Every Day May Not Be Good, But There is Something Good in Every Day” (posted 8/6/14)

On The Road To Home Trip Kit A “Trip Kit” was developed for the On the Road to Home AIM 2 Innovation Pilot Project. The kit was designed to provide “one stop shopping” for anyone looking for information on home dialysis. At the end of the project, the resources were collected on a Web page and promoted for use by all dialysis facilities. The kit included:

“Help I Need Dialysis” (from the Medical Education Institute)

Home Modality Treatment Options Poster

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Road Map for use to track progress

Resources and Web links for patients and staff education

Video “Being Me Again, Lives Transformed by Daily Home Hemodialysis”

Video “Life Choices, Treatment Options”

Patient stories

“On the Road to Home” buttons

5 Diamond Patient Safety Program Network 9 continued its participation in the national 5 Diamond Patient Safety Program during 2014. The program, which is administered by ESRD Network 5, transitioned from a traditional program with paper submissions to an online format. This streamlined both the reporting responsibilities for participating dialysis facilities as well as the monitoring and approval processes for Network 9. At year end, Network 9 had 99 facilities participating in the program, and 50 of those facilities achieved or sustained 5 Diamond Status for the year 2014.

Ebola Crisis In response to information received from the CDC and the Kidney Community Emergency Response (KCER) coalition, the Network developed a page on the Web site www.therenalnetwork.org dedicated to resources on Ebola. The Network titled the page “Prepare for the Possibility.” At the time, many rumors and otherwise false reports were circulating in the public as well as the healthcare community, so the Network used this public platform to present an objective response to the situation. Information was directed at what can be done NOW – Educate-Vaccinate-Take Precautions. This page has been updated as new information has been received. The Network used this as an opportunity to encourage patients and professionals to get a flu shot to maintain optimum health, as an example of available vaccinations to ward off the very real health threat of influenza. The link to the information was shared with medical directors and administrators.

Contributions to the Professional Literature In October 2014, a publication strategy was developed outlining several potential publications based on Network projects. One such project was the Population Health Innovation Pilot Project: Project D: Promote Appropriate Home Dialysis in Qualified Patients. A writing team was assembled for this project consisting of Network staff working on the project, the Network Director of Information Systems and Statistical Analysis, and interested Medical Review Board members. Calls were scheduled to discuss appropriate approaches to publications and venues for dissemination of findings. The venue selected was the National Kidney Foundation’s Spring Clinical Meeting, which was to take place in Dallas, Texas, in March 2015. An abstract on the demographic characteristics that predicted transitioning from in-center dialysis to home dialysis was developed as a collaborative effort among the team members and vetted by the CMS COR and CMS editor. The abstract was submitted for consideration on December 1, 2014 and accepted on December 24, 2014 for poster presentation during the spring meeting.

Ensuring Data Quality CMS implemented a new national ESRD software system in 2012 called CROWNWeb. CMS requires that ESRD facilities participate in essential CROWNWeb activities.

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ESRD Network 9 supports the efforts of ESRD facilities in its service area in submitting CROWNWeb data by providing several key support systems and by relaying and reviewing key information received from CMS and/or other CMS contractors. A three-pronged process has been implemented to technically support, train and monitor ESRD facilities regarding CROWNWeb data population.

Technical Support: ESRD Network 9 provides technical assistance to ESRD facilities through telephone-based support, available to facilities Monday through Friday, from 7:30 a.m. until 5:00 p.m. EST, holidays excluded. Email support is offered to facilities as a secondary means of technical support, so that facility staff can ask specific questions as convenient to their work schedules. Email support allows a quick turnaround for response, with most email requests answered within one business day. ESRD Network 9 also provides website-based resources and references for facilities to access as a tertiary means of support. The following figures show monthly 2014 facility technical support levels provided by Network 9.

*Data Source: Network 9-collected data Training: ESRD Network 9 provides one-on-one training and support sessions on a daily basis as need is identified. ESRD Network 9 also refers facility staff to the CMS ProjectCROWNWeb.org website for standard training topics, as CMS has developed a very robust CROWNWeb training system. ESRD Network 9 distributes a technical newsletter on a monthly basis, touching on current CROWNWeb topics of interest. Monitoring: ESRD Network 9 monitors CROWNWeb data participation rates on a monthly basis and notifies facilities via e-mail and one-on-one telephone communication in order to encourage facilities to promptly enter data. ESRD Network 9 has implemented a standardized monthly e-mail notification form that indicates what data elements are missing in CROWNWeb, so that facilities can act on this information. Data for these monthly e-mail notifications is provided by CMS and/or CMS contractors.

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Notable Success - CROWNWeb Vascular Access Data Completeness: CROWNWeb ESRD patient vascular access data entry participation rates improved significantly in 2014. The participation rate is important in that it demonstrates that the CROWNWeb software has been successfully adopted as the national data warehouse to store ESRD patient-related data.

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Disparities in ESRD Care Network 9 participated in the AIM 2 Population Heath Innovation Pilot Project to encourage the use of home dialysis therapy. The Network 9 project, titled On The Road to Home, was developed, launched and completed during the year. Throughout the project, Network 9 used innovative approaches to reach the disparate population of African American patients, as well as the general patient population. Home modality educational meetings were conducted for patients and staff in the project facility regional areas (Louisville, KY; Cincinnati, OH; Columbus, OH; and Cleveland, OH) featuring David Rush, a well-known African American renal patient and hip hop artist. Mr. Rush described his experiences with in-center dialysis and home hemodialysis and how home dialysis improved his quality of life and allowed him to receive a living-related donor kidney transplant. Most presenters at the home modality meetings were African American and dialyzing at home. They described why they chose home dialysis and the changes that have occurred since beginning home dialysis. The Network staff also recruited African American home dialysis patients to speak to the patients and staff before and after the meetings, as well as to conduct follow-up telephone calls following the meetings. Network staff brought together a group of African American home patients, called the African American Home Patient Forum, to identify and address barriers to African Americans utilizing home therapies. As materials were developed, Network 9 ensured that African Americans were represented in all literature and videos. Due to the shortage of peritoneal dialysate that began in summer 2014 and persisted through year-end, and the subsequent limiting of new patients starting peritoneal dialysis as a home dialysis choice, the goal for this project was reduced from a 7 percentage point to a 2.5 percentage point improvement for 2014, and the disparity goal was waived. Within the subset of project facilities, Network 9 increased patients on a home modality from 16.3% to 19.0%, exceeding the 2.5 percentage point improvement goal; the cumulative referral to home therapy achieved was 16.4%. Steps toward goal were recorded and submitted monthly via the Dashboard Information Form (DIF). The following table, using data from CROWNWeb, shows the baseline information recorded at the beginning of the project, and the final outcomes at the conclusion of the project.

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2014 ESRD Network 9 Dashboard Information Form – AIM 2 Measures

Measure Population Baseline Sept 2014

M16-D1a: Eligible Patients Receiving Home Hemodialysis or Peritoneal Dialysis rate – Disparate Group SOW Reference: C.4.2.G.

# Disparate Group Eligible Patients Receiving Home Hemodialysis or Peritoneal Dialysis (African American)

174 203

# Disparate Group Eligible Patients in Target Facilities (African American)

1,894 1,832

Ratio 0.092 0.111

M16-D1b: Eligible Patients Receiving Home Hemodialysis or Peritoneal Dialysis Rate - Non-Disparate Group SOW Reference: C.4.2.G.

# Non-Disparate Group Eligible Patients Receiving Home Hemodialysis or Peritoneal Dialysis (White)

353 384

# Non-Disparate Group Eligible Patients in Target Facilities (White)

1,406 1,296

Ratio 0.251 0.111

M17-D1: Eligible Patients Receiving Home Hemodialysis or Peritoneal Dialysis Rate SOW Reference: C.4.2.G.

# Eligible Patients Receiving Home Hemodialysis or Peritoneal Dialysis

544 603

# Eligible Patients in Target Facilities

3,340 3,171

Ratio 0.163 0.190

Data above is CROWNWeb data provided by the Network Coordinating Center (NCC), as reported in the Dashboard Information Form (DIF)

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In additional to the DIF data, information was collected from the subset of AIM 2 project facilities on patients who were referred to home dialysis during the course of the project. At the end of the pilot project, the following referral outcomes were achieved.

Network 9 Innovation Pilot Project 2014 - On the Road To Home Outcomes Patients Referred to Home*

FEB MAR APR MAY JUN JUL AUG SEP

# Patients Referred

34 88 54 66 64 104 64 50

Project Facilities Patient Population

3,207 3,203 3,214 3,211 3,210 3,214 3,195 3,171

Percentage 1.1% 2.7% 1.7% 2.1% 2.0% 3.2% 2.0% 1.6%

Cumulative Percentage

1.1% 3.8% 5.5% 7.6% 9.6% 12.8% 14.8% 16.4%

*Data provided by subset of facilities enrolled in the AIM 2 Innovation Pilot Project.

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PROJECT RETROSPECTIVE - DATA ANALYSIS

The first step in the process of selecting a topic was analysis of the home dialysis populations using CROWNWeb data provided to the Network by the National Coordinating Center (NCC). Network 9 had only 11% of total patients using a home dialysis modality, well below the CMS ≤85% threshold for the project. In Network 9’s service area, the in-center hemodialysis patient population to be impacted (at least 10% of in-center hemodialysis patients) was n=2,783, with the disparate subpopulation identified as African Americans with a disparity differential of 15.23%. The Network 9 disparity was calculated using the fourth quarter 2012 Network 9 data from CROWNWeb that was provided by the NCC.

Disparity Analysis

Network 9 Difference

Race

White 12.99% 6.01 percentage points

Non-White 6.98%

Ethnicity

Hispanic 9.47% 1.57 percentage points

Non-Hispanic 11.04%

Gender

Male 11.15% 0.36 percentage points

Female 10.79%

Age

<65 13.46% 5.28 percentage points

≥65 8.18%

Location

Urban 11.73% 4.03 percentage points

Rural 7.69%

PARTNERSHIPS The next step was to conduct outreach activities to the renal community to look for partners and encourage general support of the project. Dialysis facilities were selected as the first partners in this effort. In ESRD Network 9’s service area, 25 facilities were chosen:

Indiana – 6

Kentucky – 4

Ohio – 15

Patients in these facilities represented 12% of the Network 9 patient population, with home patients comprising 16.28% of the population. The disparity differential for African Americans in these facilities was 15.23%.

The Network then formed a steering committee of stakeholders to help in the design and implementation of the project.

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On the Road to Home Steering Committee

Michael Kraus, MD MRB Member/Director of Home Hemodialysis-Indiana University

Marcia Silver, MD MRB Member /FMC

Sandra Hashman, CHT MRB Member /Indiana University

Craig Fisher, Ph.D., LCSW MRB Member/Independent

Helen Neale, MSW MRB & PAC Member/DaVita

Mary Ellen Brabec, RD, LD MRB Member/ DaVita

Lorraine Edmond PAC & MRB Member

Beth Smith, RN MRB Member /Nationwide Children’s Hospital

Peter DeOreo, MD MRB Chair/Centers for Dialysis Care-Cleveland

Hap Pierce, CHT MRB Member /DaVita

Francine JnBaptiste, RN MRB Member /FMC

Amanda Northrop, RN MRB Member/Renal Advantage, Inc.

Pam Kent, MS, RD The Cleveland Clinic

Andrew Lazar, MD Centers for Dialysis Care-Cleveland

Lana Schmidt PAC & MRB Member, Home Dialyzers United

Brenda Colley FMC Regional Quality Manager

Kelli Lester Baxter/Home Alliance

Dori Schatell Medical Education Institute

Todd Brading NxStage

Rebecca Haire University of Louisville/Home Program

Leslie Wong, MD The Cleveland Clinic

PROJECT DESIGN & ATTRIBUTES Based on the CMS requirements for the Networks’ Pilot Innovation Projects and the stated goal, the steering committee met in person and via webinar to develop the project. The first factor to consider was the requirement for attributes as stated by CMS, so the steering committee designed the project activities ensuring that all attributes were put to use. Project attributes to be incorporated into the project were:

1. Rapid cycle improvement 2. Customer focus and value to beneficiaries, providers, and CMS 3. Sustainability 4. Innovation 5. Boundarilessness 6. Unconditional Teamwork

1. RAPID CYCLE IMPROVEMENT A root cause analysis tool in the form of a facility culture questionnaire was developed for participating facilities to use to identify their barriers to home modality initiation. Interventions included resources and webinars that were geared to the facility need based on the barriers. Best practices were also provided to the targeted facilities. Home dialysis programs provided home dialysis rates on a monthly

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basis. The reports included the number of patients who began training as well as completed training. Information provided on the reports also identified referral sources such as in-center facilities or physician group practices so that Network staff could intervene with those groups that were not referring to home modalities. Network staff contacted those facilities or physicians to discuss changes to processes to ensure rapid cycle improvement such as:

Did they have the right tools/resources

Encouraged them to send their patients and staff to the regional meetings

Offered to connect them with someone in region to brainstorm with

Encouraged them to see if they were entering data correctly in CROWNWeb

2. CUSTOMER FOCUS AND VALUE TO BENEFICIARIES, PROVIDERS AND CMS Patient Value: Patients reported that home dialysis options allowed them to take more control of their dialysis schedule and as a consequence to exercise more control of their day-to-day activities. This renewed sense of freedom and decision making related to their treatment is credited by patient focus group members with improving their quality of life. Network staff involved patient SMEs as well as participating facility patients in all home modality improvement activities so the patient voice was utilized to develop initiatives. Patients already on home dialysis were present at the patient meetings and were identified with a green ribbon as the “Home Team”. Provider Value: Providers ensured patients were afforded a choice in their modality which should decrease facility overhead. (Lacson E, Lazarus JM, Himmelgarb J, Ikizler TA, Hakim RM: Balancing fistula first with catheters last. Am J Kidney Dis 2007; 50: 379-395) illustrated that peritoneal dialysis therapy results in improved outcomes, greater patient satisfaction, and lower overall costs.) Operationally, moving eligible patients to home dialysis allows clinics to overcome chair capacity limits. Identifying eligible home dialysis patients reduces the cost and time associated with expanding hemodialysis chair capacity. CMS Value: CMS should realize a decrease in costs due to better outcomes with fewer hospitalizations. According to the 2012 USRDS Annual Report (U.S. Renal Data System, USRDS 2012 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2012), the per person Medicare ESRD cost for in-center hemodialysis patients was $87,561 compared to $66,751 for peritoneal dialysis patients. Another study (Shih YC1, Guo A, Just PM, Mujais: Impact of initial dialysis modality and modality switches on Medicare expenditures of end-stage renal disease patients. Kidney Int. 2005 Jul;68(1):319-29) suggests that peritoneal dialysis is the economical initial dialysis modality from an expenditure perspective. The longer the patient is on peritoneal dialysis or home hemodialysis the better the economic advantage even if the patient has to switch modalities because the cost savings are sustained.

3. SUSTAINABILITY The Innovation Pilot Project evaluated the culture of the facility to determine the facility-specific disparities to be targeted. Identification of barriers and best practices assisted dialysis facility staff in developing programs to educate patients and facility staff. Medical directors and home training nurses were expected to use Network home modality resources and the Web page for training patients on an ongoing basis. In addition, the Network Patient Representative Program (NPRP) assisted facility staff in promoting home modalities through information provided by the Network. The Network ensured that

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in-center facilities and physician group practices were aware of the modality training programs used by the Large Dialysis Organizations (LDOs) and the LDO contact persons. The implementation of these LDO training programs will allow project facilities to sustain what was learned and put into place during the project, ensuring that all patients receive modality education and social support to be able to choose the modality best suited to each patient. A summary of the project with all resources and tools is on The Renal Network website on a page titled “On the Road to Home”. The link to the page was sent to all facilities in the Network and facility staff members are referred to the page if they need ideas, resources and/or tools.

4. INNOVATION Network staff evaluated the processes that were in place in targeted facilities to educate patients and family members on modality choice and patient empowerment. The Network collaborated with industry stakeholders and local stakeholders in the targeted areas to provide two hour workshop/informational type meetings to area patients and facility staff. These meetings included presentations by social workers, dietitians, nephrologists, nurses, and other patients. The keynote speaker at all of the meetings was David Rush who is an African American rap artist who toured with PitBull, a nationally known rap artist. The tour visited 40 cities throughout the United States. Mr. Rush was able to do his own home hemodialysis while touring. The Network partnered with patient Harvey Wells to plan RV visits to dialysis facilities in a recreational vehicle (RV). He carried a home dialysis machine in his RV and worked with another home hemodialysis patient to demonstrate a dialysis treatment in the RV.

There were opportunities for patients to sign up for additional education and/or for the next step to change to a home modality. In addition, Network staff evaluated whether the targeted facilities had a patient centered culture by questioning participating facility staff and patients to get their perception of patient involvement at the facility level. Specifically, focus was to determine if the facility promoted patient involvement in governing body, support groups, and encouraged patients to take part in their own care and care planning. Network staff brought patients, family members, and facility staff together to develop goals, identify barriers to home modality choice, and change facility culture. Network staff and Patient Engagement LAN members educated through individual and joint meetings and utilized patient representatives at each facility to engage patients in modality choice.

5. BOUNDARILESSNESS A Home Modality Steering Committee assisted with project design and interventions. The steering committee consisted of representatives from academic institutions, home dialysis programs, DaVita, Fresenius Medical Care (FMC), regional dialysis organizations, independent dialysis organizations, the Medical Education Institute, NxStage Medical, Inc., Baxter, social worker consultants, and patients.

6. UNCONDITIONAL TEAMWORK This was a joint project with the Network Patient Services and Quality Improvement Departments. Collaboration with Networks 12 and 16 was vital to the development and execution of patient and staff meetings as well as providing trip kits and other resources to patients and project facility staff. A Facility Culture Survey was developed from a template used in Network 16. Home programs participated in staff and patient home modality educational meetings by displaying equipment and answering patient questions.

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Partnerships and Coalitions

The Network works in partnership with many organizations within the community to ensure that Network projects and activities are implemented and goals are met. These coalitions and partnerships are described throughout this report, including relationships with dialysis and transplant providers, the Kidney Community Emergency Response (KCER) Coalition, and the volunteers who comprise the Network boards and committees. Other partnerships that have not been described in other sections of the Annual Report include the following:

State Survey Agencies The Network is in communication with the State Survey Agencies (SAs) in Indiana, Kentucky and Ohio. The state surveyors routinely contact the Network when making visits to facilities to gather information regarding patient complaints, involuntary discharges (IVDs), participation in Network projects and general Network concerns. Bi-monthly meetings are held between the Network, representatives of the SA and CMS to provide updates on Network activities and to learn about citations being issued by the SA, and other concerns the state surveyors may have. Topics discussed in 2014 included QIP updates, the 5 Star Rating System, Network QI projects, Network LANs, emergency preparedness, saline shortage, P.D. fluid shortage, IVDs and grievances, retaliation against patients who file grievances, Ebola, nursing home dialysis, and NxStage home dialysis therapy.

Vascular Access Advisory Panel (VAAP) A subcommittee of the Medical Review Board composed of physicians, nurses, social workers, patient care technicians and patients work with the Network QI staff to develop quality improvement activities related to vascular access projects. Members of the group also provide peer-to-peer mentoring with medical directors of facilities struggling to overcome barriers.

Affinity Groups Two regions in Network 9’s service area have strong vascular access coalitions referred to as vascular access affinity groups. Network staff members participate with each affinity group. Each of these groups, one in central Indiana and the other in Cincinnati, meet monthly to discuss vascular access barriers and initiatives in their community. Each group has a mission and vision statement to help guide their activities. In 2014 each group created pamphlets, outlining their purpose and goals, which they distributed at ESRD meetings and to other stakeholders such as primary care physicians. The central Indiana group provided a CKD Symposium for primary care physicians and internists in September 2014. The goal of the symposium was to help reach out to the primary care physicians to help them understand appropriate referral for treatment of kidney disease, such as when to request a nephrology consult and the importance of referral for vascular access. The agenda consisted of the following topics:

Changing the Culture of Catheters

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From Nephrology to PCP: We Are Not Stealing Your Patients. The Role of PCP in ESRD

Survival Outcomes in CKD Patients for Early vs. Late Referral to Nephrology

Proteinuria

Why Serum-Creatinine Levels are Not Enough to Determine DCD-The Usefulness of Calculating GFR

Top 10 Reasons for Hospitalist to Request Nephrology Consult

CVC Placement Procedure/Risk of Infection

Save the Veins

Patient Panel

The Benefits of Early Education

Patient Resources-The Renal Network and Kidney Foundation

Dietary Restrictions for CKD/ESRD Patients

From Referral to Kidney Transplant

CKD and Hypertension

Family History of CKD: How Important Is It?

Presenters at the symposium represented the two major nephrology groups in the region, surgeons and interventionalists from the three major hospital systems, national LDO staff, local patients, The Renal Network, and the National Kidney Foundation. Approximately 70 individuals were in attendance. Evaluations provided positive feedback to the symposium organizers.

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Patient and Family Engagement

Education for ESRD Patients and Caregivers The Renal Outreach The Renal Outreach is the free patient newsletter published by the Network at least twice a year. It is a major communication conduit for patients as it provides important information on subjects such as treatment modality, disease management, quality of life issues, effectively dealing with dialysis facilities (including patient empowerment and grievance processes) and health and safety issues. The newsletter is available through the mail, or electronically on the Kidneypatientnews.org website. By the end of 2014, the Renal Outreach subscription total was 2,433. This includes patients, family members and staff members. Each facility in ESRD Network 9’s service area also receives an electronic copy of Renal Outreach; the distribution list includes medical directors, administrators, social workers, dietitians and head nurses.

The Spring/Summer issue featured:

A first person account from James W. Meyers, III, the Indiana patient who won the 2014 Robert Felter Memorial Award for his volunteer contributions in his community. He attended the annual AAKP conference and wrote about his experience and what he learned.

Dialysis Facility Compare information

Article on the health and healing properties of yoga

Article on overcoming depression from the perspective of a patient

Article on advances in ESRD treatment (The Wearable Kidney)

Quality Incentive Program Performance Score Certificate information

Profile of a LAN member who was named “advocate of the month” by the National Kidney Foundation

Information on filing a grievance

Reminders to take phosphorus binders The Fall/Winter issue featured:

Profile of outstanding ESRD patient volunteer

Article on an advance in ESRD management (phone app that tracks nutrition)

Article on flu vaccinations and Medicare part B vaccinations

Medicare part D information

Article on “Supermarket Tours – New Approaches to Kidney Disease Nutrition”

Profile of ESRD patient overcoming adversity

Appeal for patient advocates to join the various Network committees and programs

Reminder to take phosphorus binders

The Robert Felter Memorial Award The Robert Felter Memorial Award was presented to James W. Meyers, III, an active member of the Network 9 nephrology community. The recipient of this annual award is provided with transportation and registration fees for a national conference. Mr. Meyer chose to attend the national meeting of the American Association of Kidney Patients. Following the conference he shared the experience through an article written for the patient newsletter, Renal Outreach. The Robert Felter Memorial Award began in

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2002 and has been presented annually since that time. The award honors the memory of Mr. Felter, a longtime advocate for patients. Nominations for this award are solicited through dialysis facilities, and the winning nominee is selected by a panel of judges.

Patient Engagement Learning and Action Network (LAN) The Patient Engagement Learning and Action Network (LAN) was established in 2013 and continued during 2014. New members were recruited at the beginning of the year to bring in new perspectives as well as to replace members who had resigned from the LAN. This dynamic group of patients and professionals helps the Network respond to patient needs and seeks ways to improve patient-staff relationships. The Patient Engagement LAN represents a cross-section of patient demographics and treatment modalities across the Network. Membership on this committee includes patients designated as Subject Matter Experts, patients’ family members, renal professionals and other community stakeholders. In 2014, the membership of the PE LAN for Network 9 consisted of the following:

Number of Patients: 14 Number of ESRD Professionals: 16 Modalities of the patients:

In-Center: 9 Transplant: 5

The LAN seeks to improve the quality of life for renal patients through the direct engagement of the patients and their families in the patient’s care. This includes decision-making about care and it identifies ways to spread best practices and serves as an advisory group to the Patient Services Department of ESRD Network 9. The LAN identifies and addresses ESRD patient needs and concerns through the development of quality improvement activities (QIAs) and educational campaigns.

Quality Improvement Activity (QIA): Increase the Patient Voice The goal for this 2014 PE LAN QIA was to increase the voice of the patient within the facility by supporting the establishment of the Network Patient Representative Program (NPRP) in dialysis facilities. This program provides an effective structure for patient involvement in the facility. In order to increase the patient voice, the Network looked to the Network Patient Representative Program (NPRP) which was launched in 2013. The NPRP promotes patient-to-patient communication directly at the facility level. The goal of the NPRP is to have a Network Patient Representative (NPR) in each facility who helps disseminate information to patients in the unit. The Network 9 PE LAN believed establishing the NPRP in facilities would add the dynamic of patient-to-patient sharing of information, which could reinforce information presented using a staff-to-patient model. The recruited NPRs would promote patient-to-patient education on the optimal vascular access for dialysis: an arteriovenous fistula (AVF), and the advantages of an AVF. All facilities chosen for the QIA were asked to appoint staff to serve in the role of Facility Staff Coordinator (FSC), and to recruit NPRs. These individuals were key in the distribution of information to the patients in their facilities. This partnership had the additional benefit of promoting communications

34

between the Network and dialysis units, as well as with patients. The NPR worked with the FSC to post and distribute educational information about the advantages of an AVF as well as acting as a patient liaison to Network 9 and serving as a SME to CMS. To keep the NPRs and FSCs invested, the Network initiated a monthly conference call, starting in June 2014. This monthly call, titled Share Call, served to keep the volunteers updated on the latest resources and to share best practices and address concerns. A dedicated Web page for the NPRs and FSCs on KidneyPatientNews.org was developed and featured the resources sent through the year to participants in the program. This QIA was a success and identified the following accomplishments (N = 100 facilities):

82% of the chosen facilities established the NPRP, exceeding the project goal of 5%.

94% of the participants felt the resources developed on the AVF advantage were "very" or “somewhat helpful."

100% of participating facilities posted the AVF poster “Are You Using the Gold Standard?” At year-end, the NPRP within the entire service area of Network 9 had a total of 116 facilities participating (up from 28 facilities at year-end 2013). This reflects both the facilities that were in the QIA and non-QIA facilities that have chosen to participate in the NPRP.

Educational Campaign: Adherence to Phosphorus Binders The focus of this campaign was to increase patient awareness of the importance of taking phosphorus binders as prescribed. To assist the facility dietitians who were pivotal in this campaign, Network 9 developed and distributed new tools and resources to help them address the importance of phosphorus management with their patients. The dietitians reinforced to the patients the importance of their binders each month as they met to discuss their lab reports. The dietitians collected monthly aggregated patient-reported phosphorus binder adherence information. Posters and handouts were developed and distributed to patients by the dietitian and in many cases the NPR, to educate them on phosphorus management. Patients were also reminded to take their binders through additional avenues such as the Renal Outreach patient newsletter. The Network also provided information that allowed patients to voice their desire to the Food and Drug Administration (FDA) to have phosphorus information included on food labels. This educational campaign was a success and identified the following accomplishments (n=69 facilities):

Achieved patient participation rate of reporting binder adherence of 75% (goal was 10%).

84% of the participating facilities recorded an increase in the proportion of patients with phosphorus levels within normal limits.

Individual facilities conducted contests and motivational activities to get patients involved with taking their binders and keeping their phosphorus in control. Examples of these activities included:

35

A Halloween activity highlighting candy corn, a low phosphorus candy. Patients guessed the number of candy corn pieces in a large jar. The winner received a gift basket of kidney-friendly candy and the second-place winner got the jar of candy corn.

Another innovation was that a facility created a special store to help motivate and reward patients in improving their phosphorus labs. This store was set up in the unit's conference room once a month. Patients received "bucks" for phosphorus control as follows: one buck for improvement, two bucks for a perfect phosphorus score, and three bucks for both improved and perfect lab. The facility participating in this activity reported it was a great success.

The Network shared these best practices with other facilities.

Educational Campaign: Transition of Care The goal of this educational campaign was to increase patient access to a transition of care form. To accomplish this, the Network provided resources to patients addressing the importance of keeping their health information current and available especially when they interact with their various health care providers as well as offering a Transition of Care form. The Network developed a "Transition of Care Information Form" for facilities to give to their patients, to encourage them to become involved with their health care through keeping an accurate transition of care form. The Network collected monthly aggregated facility-reported data on the access to a care transitions form. This educational campaign was a success and identified the following accomplishment (n=111 facilities):

91.7% of the participating facilities reported that patients have access to Transitions of Care information (goal was 10%).

Support for ICH CAHPS The Consumer Assessment of Healthcare Providers and Systems In-Center Hemodialysis Survey (ICH CAHPS) annually measures the experiences of people receiving in-center hemodialysis care from Medicare-certified dialysis facilities. The survey measures were endorsed by the National Quality Forum (NQF) in 2007. ESRD Network 9 encourages qualified outpatient dialysis facilities to participate in the ICH CAHPS data collection. The Network notified providers in January 2014 of the instructions for changing their survey vendor if necessary and received contact information for the ICH CAHPS Survey Coordination Team for questions. Also at that time providers were given the website address, ichcahps.org, for official news and information about the ICH CAHPS Survey and information on the QIP. In March 2014, The Network asked independent providers and LDO representatives to inform the Network of when they would be administering the ICH CAHPS.

36

Grievances and Access to Care ESRD Network 9 responds to grievances filed by or on behalf of ESRD patients in its service area. Grievances may involve immediate advocacy which usually include staff related issues of communication and professionalism. With the patient’s consent, these cases result in resolution that involve direct contact with the provider/practitioner. Grievances also may involve quality of care reviews (general and patient-specific) which are related to the clinical quality of patients’ medical care and/or the violation of patient rights. The Network also addresses grievance and non-grievance access to care cases. These cases involve failure to place, involuntary discharge/transfer and patients at risk for discharge. In 2014, ESRD Network 9 responded to 89 grievances. Of these, three (3.4%) involved issues related to access to care, 68 were Immediate Advocacy Contacts and 18 were Patient Specific - Quality of Care – Reviews. The top grievance concerns were staff-related issues (48.7%) and treatment-related issues (21.7%), which have consistently been the primary areas of concern of grievances for the past several years. The Network investigates these concerns further and has found that communication between the patient and staff, and patient safety/health are the top concerns for which patients/family members call the Network. The Network uses the trending information from grievances to develop resources for patients and staff, as well as for educational articles in the patient newsletter, topics for patient meetings and presentations and training programs for staff. In many instances, ESRD Network 9 works with individual facilities to identify and address difficulties in placing or maintaining patients in treatment. These access to care cases may come to the Network’s attention in the form of a patient grievance, or may be initiated by facility staff. An involuntary discharge is a discharge initiated by the treating dialysis facility without the patient’s agreement. An involuntary transfer occurs when the transferring facility temporarily or permanently closes due to a merger, or due to an emergency or disaster situation, or due to other circumstances, and the patient is dissatisfied with the transfer to another facility. A failure to place is defined as a situation in which no outpatient dialysis facility can be located that will accept an ESRD patient for routine dialysis treatment. In 2014, ESRD Network 9 responded to 42 non-grievance access to care cases brought to the Network’s attention by facility staff or hospital staff.

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Table D. Grievances and Non-Grievance Access to Care Cases, Calendar Year 2014

Source of data: Patient Contact Utility. *Includes grievance cases involving access to care. **Includes grievance cases involving access to care as well as non-grievance access to care cases.

Grievances and Non-Grievance Access to Care Cases Referred to State Survey Agencies ESRD Network 9 contacts the State Survey Agency (SA) whenever there is an involuntary discharge, to alert the agency of the situation and as a check that the facility is contacting both agencies. ESRD Network 9 also routinely provides the SAs with a list of all facilities that had grievances (86) and involuntary discharges (28). The list, which is provided every other month, includes the facility CCN and the reasons for the grievances and discharges. There were four cases that were either referred to the SAs by the Network or the information was provided to the patient who wished to contact the agency directly. The SAs then determined if the grievance met the state criteria for a site visit. The SAs conducted site visits based upon complaints at three of the facilities and substantiated two of the grievances. The Network held a conference call with the SA regarding an involuntary discharge and discussed findings and plan of action. The Network also provided contact information to the Office of Civil Rights to patients as appropriate and assisted one patient in its complaint application process.

Recommendations for Sanctions During 2014, no recommendations for sanctions were made by ESRD Network 9.

Recommendations to CMS for Additional Facilities During 2014, no recommendations for additional facilities were made to CMS by ESRD Network 9.

Category Number

Number of Grievance Cases Opened by ESRD Network 9 in Calendar Year 2014* 89

Number (Percent) of Grievance Cases Involving Access to Care 3 (3.4%)

Number of Non-Grievance Access to Care Cases Opened by ESRD Network 9 in Calendar Year 2014

42***

Total Number of Grievance and Non-Grievance Cases Involving Access to Care in Calendar Year 2014

44***

Number of Cases Involving Involuntary Transfers** 3

Number of Cases Involving Involuntary Discharges** 25

Number of Cases Involving Failure to Place** 16

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Emergency Preparedness and Response The Network is a resource for its providers during disasters. The Network routinely contacts dialysis units within areas where disasters have been reported, such as floods, tornadoes, snowstorms and power outages. Network 9 has an emergency back-up agreement in place with Network 6 in the event the Network office would close. During every disaster in 2014, facilities were contacted by Network staff to monitor their open and closed status and to offer Network assistance. The open and closed status of affected facilities was provided to the CMS Regional Office. During 2014 the following weather related disasters and waterway contaminations affected dialysis facilities in Network 9’s service area:

January 6, 2014: Winter storms Hercules and Ion: snowstorm and extreme cold. The Network office closed. Many facilities in Indiana, Ohio, and Kentucky were closed or delayed opening. Network staff worked remotely by email and conference call to monitor the status of facilities and patients. Many transportation issues were identified due to the deep snow.

January 14, 2014: Chemical spill in West Virginia affected the Ohio River. Chemical levels in the water were monitored for safety. No contamination reached the states within Network 9’s service area.

February 4, 2014: Snowstorm and cold again affected open/closed status of several facilities in Indiana and Ohio.

June 24, 2014: Tornadoes in Central Indiana. The Network office sheltered in place in the basement of the office building due to tornadoes in the area. Facilities were contacted and all remained functional. Some facilities activated their disaster plans and removed patients to safe areas until the warning was cleared.

August 4, 2014: High levels of toxins were found in the water in the Toledo, Ohio area. Some dialysis facilities trucked in water until municipal water was declared safe to use. Two facilities closed and transferred patients to facilities that were nearby, but out of the area of toxic water, for dialysis.

The Network staff worked throughout the year to remind facilities of their role in event of an emergency or disaster. The Network routinely sends emergency preparedness information to all facility administrators prior to impending storms. The information provides disaster preparedness resources for patients and staff. Reminders to update facility disaster plans are included. The materials inform the facilities that they must contact the Network office to advise of any disaster-related closings. The Network also provides technical assistance to facility staff regarding their facility disaster plans. Following the January storms, a conference call was held with Regional Area Managers of dialysis providers to discuss what worked and what did not. Information was shared between corporate entities as well as with the Indiana State Department of Health. Transportation problems were a major issue and it was learned that assistance should be sought from the county emergency agencies. Links to the

39

county EMS offices were sent to dialysis facilities in anticipation of the February storm. Several recipients contacted the Network to thank them for the resources. On October 8, 2014, Network staff participated in an emergency preparedness drill led by the KCER Coalition. The drill simulated an outbreak of a novel influenza pandemic. The goal of the exercise was to test Network level emergency response plans, policies and procedures as they would pertain to an influenza pandemic. The Network staff held meetings to assess the situation and made decisions on how to remain functional despite the challenges presented by the hypothetical pandemic. National issues addressed with facilities in Network 9’s service area during 2014 included shortages of normal saline and PD solutions, and the Ebola crisis. Conference calls and webinars were attended by Network staff regarding each of these issues. Facilities experiencing shortages of normal saline and PD fluid contacted the Network and were given assistance. A facility in Ohio was contacted after notification that a dialysis patient was exposed to a patient diagnosed with Ebola. In October, facilities were emailed information on preparing for the possibility of Ebola.

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List of Tables The following tables are included in this ESRD Network 9 Annual Report: ESRD Incidence (formerly Table 1) ESRD Dialysis Prevalence (formerly Table 2) Dialysis Patients Modality and Setting – In Home Report (formerly Table 3) Dialysis Patients Modality and Setting – In Center Report (formerly Table 4) All Renal Transplant Patients Report (formerly Table 5) Renal Transplant Recipient Report (formerly Table 6) Dialysis Death Report (formerly Table 7) Vocational Rehabilitation Report (formerly Table 8)

41

Data Tables ESRD Incidence (formerly Table 1)

Network 9 Created 05/29/2015

ESRD Incidence - One Year Statistics

As of 01/01/2014 - 12/31/2014

Age Group IN KY OH Other Total

00-04 7 1 7 1 16

05-09 1 2 5 0 8

10-14 7 1 6 0 14

15-19 8 7 9 1 25

20-24 21 10 31 1 63

25-29 26 11 53 1 91

30-34 51 28 76 7 162

35-39 71 40 114 10 235

40-44 107 58 144 19 328

45-49 124 81 212 13 430

50-54 176 119 353 22 670

55-59 266 187 512 22 987

60-64 306 223 581 43 1,153

65-69 344 245 662 32 1,283

70-74 310 249 604 35 1,198

75-79 282 192 582 37 1,093

80-84 195 123 435 35 788

>=85 183 77 344 17 621

Total 2,485

1,654

4,730 296 9,165

Gender IN KY OH Other Total

Female 1,015 695 2,028 124 3,862

Male 1,470 959 2,702 172 5,303

Not Specified 0 0 0 0 0

Total 2,485

1,654

4,730 296 9,165

Race IN KY OH Other Total

American Indian/Alaska Native 1 1 0 0 2

Asian 14 9 32 3 58

Black or African American 417 266 1,204 63 1,950

Multiracial 5 1 9 0 15

Native Hawaiian or Other Pacific Islander 10 5 9 0 24

White 2,028 1,366 3,466 229 7,089

Not Specified 10 6 10 1 27

Total 2,485

1,654

4,730 296 9,165

Primary Diagnosis IN KY OH Other Total

Cystic/Hereditary/Congenital Diseases 74 45 154 11 284

42

Diabetes 1,078 763 2,105 108 4,054

Glomerulonephritis 157 88 276 15 536

Hypertension/Large Vessel Disease 724 486 1,178 93 2,481

Interstitial Nephritis/Pyelonephritis 64 42 161 5 272

Miscellaneous Conditions 225 116 535 33 909

Neoplasms/Tumors 51 44 100 5 200

Secondary GN/Vasculitis 44 27 65 10 146

Not Specified 68 43 156 16 283

Total 2,485

1,654

4,730 296 9,165

Source of Information: CROWNWeb Race: The categories are from the CMS-2728 Form. Diagnosis: The categories are from the CMS 2728 Form. This table cannot be compared to the CMS facility survey because the CMS Facility Survey is limited to dialysis patients receiving outpatient services from Medicare approved dialysis facilities. This table includes 194 patients with transplant therapy as an initial treatment. This table includes 82 patients receiving treatment at VA facilities.

43

ESRD Dialysis Prevalence (formerly Table 2) Network 9 Created 05/29/2015

ESRD Dialysis Prevalence - One Year Statistics

As of 01/01/2014 - 12/31/2014

Age Group IN KY OH Oth

er Total

00-04 10 2 10 3 25

05-09 2 3 6 0 11

10-14 8 4 13 0 25

15-19 15 11 38 1 65

20-24 64 37 101 6 208

25-29 116 66 225 13 420

30-34 188 117 335 14 654

35-39 294 179 495 24 992

40-44 455 302 804 39 1,600

45-49 556 354 1,103

58 2,071

50-54 733 482 1,507

73 2,795

55-59 966 660 1,980

89 3,695

60-64 1,110 798 2,160

96 4,164

65-69 1,151 761 2,390

89 4,391

70-74 976 656 1,902

85 3,619

75-79 824 526 1,651

73 3,074

80-84 615 335 1,177

64 2,191

>=85 443 207 939 51 1,640

Total 8,526 5,500 16,836

778 31,640

Gender IN KY OH Oth

er Total

Female 3,695 2,322 7,396

327 13,740

Male 4,831 3,178 9,440

451 17,900

Total 8,526 5,500 16,836

778 31,640

Ethnicity IN KY OH Oth

er Total

Hispanic or Latino 345 73 342 40 800

Not Hispanic or Latino 8,177 5,426 16,482

737 30,822

Not Specified 4 1 12 1 18

Total 8,526 5,500 16,836

778 31,640

Race IN KY OH Oth

er Total

American Indian/Alaska Native 5 3 10 0 18

Asian 60 29 126 4 219

Black or African American 2,398 1,481 6,334

246 10,459

44

More than one race selected 12 5 18 0 35

Native Hawaiian or Other Pacific Islander 26 19 29 3 77

White 6,021 3,962 10,310

524 20,817

Not Specified 4 1 9 1 15

Total 8,526 5,500 16,836

778 31,640

Primary Diagnosis IN KY OH Oth

er Total

Acquired obstructive uropathy 96 33 167 11 307

Acute interstitial nephritis 9 10 26 0 45

AIDS nephropathy 20 10 64 3 97

Amyloidosis 16 12 35 2 65

Analgesic abuse 19 7 25 1 52

Cholesterol emboli, renal emboli 13 5 49 1 68

Chronic interstitial nephritis 44 41 150 4 239

Chronic pyelonephritis, reflux nephropathy 22 21 71 5 119

Complications of other specified transplanted organ

2 0 1 0 3

Complications of transplanted bone marrow

1 1 1 0 3

Complications of transplanted heart 2 2 7 0 11

Complications of transplanted intestine 0 1 0 0 1

Complications of transplanted kidney 212 120 365 14 711

Complications of transplanted liver 10 15 21 1 47

Complications of transplanted lung 2 2 6 1 11

Complications of transplanted organ unspecified

7 5 8 0 20

Congenital nephrotic syndrome 4 5 15 0 24

Congenital obstruction of ureterpelvic junction

8 9 17 0 34

Congenital obstruction of uretrovesical junction

1 0 6 0 7

Cystinosis 0 3 3 0 6

Dense deposit disease, MPGN type 2 6 1 8 0 15

Diabetes with renal manifestations Type 1 353 247 630 27 1,257

Diabetes with renal manifestations Type 2 3,273 2,220 6,851

279 12,623

Drash syndrome, mesangial sclerosis 0 1 1 0 2

Etiology uncertain 389 226 780 36 1,431

Fabry's disease 1 1 6 0 8

Focal Glomerulonephritis, focal sclerosing GN

263 168 602 23 1,056

Glomerulonephritis (GN) (histologically not examined)

197 105 419 15 736

Goodpasture's syndrome 14 5 26 0 45

Gouty nephropathy 2 2 4 1 9

Hemolytic uremic syndrome 6 4 26 0 36

Henoch-Schonlein syndrome 0 4 5 0 9

Hepatorenal syndrome 16 7 22 2 47

Hereditary nephritis, Alport's syndrome 15 9 35 2 61

Hypertension: Unspecified with renal failure

2,315 1,465 4,058

224 8,062

45

IgA nephropathy, Berger's disease (proven by immunofluorescence)

94 47 157 8 306

IgM nephropathy (proven by immunofluorescence)

7 13 9 0 29

Lead nephropathy 0 1 0 0 1

Lupus erythematosus, (SLE nephritis) 81 44 145 6 276

Lymphoma of kidneys 3 0 1 0 4

Medullary cystic disease, including nephronophthisis

3 5 6 1 15

Membranoproliferative GN type 1, diffuse MPGN

28 18 68 2 116

Membranous nephropathy 55 25 91 2 173

Multiple myeloma 31 28 71 3 133

Nephrolithiasis 14 7 26 1 48

Nephropathy caused by other agents 26 22 50 3 101

Nephropathy due to heroin abuse and related drugs

2 2 1 0 5

Other (congenital malformation syndromes)

11 9 16 0 36

Other Congenital obstructive uropathy 19 9 34 3 65

Other disorders of calcium metabolism 1 2 7 0 10

Other immuno proliferative neoplasms (including light chain nephropathy)

13 4 15 0 32

Other proliferative GN 37 18 60 0 115

Other renal disorders 83 65 187 11 346

Other Vasculitis and its derivatives 26 12 33 2 73

Polyarteritis 3 4 9 1 17

Polycystic kidneys, adult type (dominant) 193 141 426 21 781

Polycystic, infantile (recessive) 4 2 7 0 13

Post infectious GN, SBE 6 3 16 0 25

Post partum renal failure 0 0 1 0 1

Primary oxalosis 1 0 2 0 3

Prune belly syndrome 4 1 11 0 16

Radiation nephritis 1 1 4 1 7

Renal artery occlusion 10 6 22 1 39

Renal artery stenosis 39 22 80 6 147

Renal hypoplasia, dysplasia, oligonephronia

21 7 32 2 62

Renal tumor (benign) 0 4 1 0 5

Renal tumor (malignant) 30 18 47 6 101

Renal tumor (unspecified) 5 4 4 1 14

Scleroderma 1 1 9 1 12

Secondary GN, other 14 6 19 3 42

Sickle cell disease/anemia 4 2 11 0 17

Sickle cell trait and other sickle cell (HbS/Hb other)

0 1 1 0 2

Traumatic or surgical loss of kidney(s) 5 8 23 0 36

Tuberous sclerosis 4 1 11 0 16

Tubular necrosis (no recovery) 179 71 353 27 630

Urinary tract tumor (benign) 0 1 2 0 3

Urinary tract tumor (malignant) 1 4 11 0 16

Urinary tract tumor (unspecified) 4 1 5 0 10

46

Urolithiasis 2 0 7 1 10

Wegener's granulomatosis 33 26 42 2 103

With lesion of rapidly progressive GN 19 15 44 0 78

Not Specified 71 52 149 11 283

Total 8,526 5,500 16,836

778 31,640

When a category count = 0, the category may not be displayed on the report.

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Dialysis Patients Modality and Setting – In Home Report (formerly Table 3) Network 9 Created 05/29/2015

Dialysis Patients Modality and Setting - In Home

For Survey Years 2013 and 2014

State: IN

Hemo CAPD CCPD Other Total

Facility CCN 2013 2014 2013 2014 2013 2014 2013 2014 2013 2014

15003F 0 0 0 0 0 0 0 0 0 0

150056 0 0 0 0 0 0 0 0 0 0

152500 3 5 17 20 15 15 0 0 35 40

152501 0 0 3 1 11 16 0 0 14 17

152502 0 0 0 0 0 0 0 0 0 0

152503 1 0 3 2 8 8 0 0 12 10

152504 3 5 4 3 3 7 0 0 10 15

152507 0 0 0 0 0 0 0 0 0 0

152509 1 2 6 8 12 11 0 0 19 21

152510 0 2 4 6 11 13 0 0 15 21

152511 0 0 3 2 6 10 0 0 9 12

152512 0 0 0 0 0 0 0 0 0 0

152514 0 0 0 0 0 0 0 0 0 0

152515 2 4 11 11 14 18 0 0 27 33

152516 0 0 4 2 9 13 0 0 13 15

152517 0 0 0 0 0 0 0 0 0 0

152518 0 0 2 1 12 7 0 0 14 8

152520 0 0 0 0 0 0 0 0 0 0

152521 0 0 1 3 14 15 0 0 15 18

152522 16 9 4 3 16 14 0 0 36 26

152523 0 1 2 3 3 4 0 0 5 8

152524 0 0 0 0 0 0 0 0 0 0

152525 3 3 21 18 12 19 0 0 36 40

152526 3 3 2 4 18 18 0 0 23 25

152527 0 0 2 1 3 2 0 0 5 3

152530 0 0 0 0 0 0 0 0 0 0

152531 0 0 0 0 0 0 0 0 0 0

152532 4 2 28 21 20 28 0 0 52 51

152534 0 0 1 5 0 2 0 0 1 7

152535 0 0 0 0 0 0 0 0 0 0

152536 0 0 0 0 0 0 0 0 0 0

152537 0 0 0 0 0 0 0 0 0 0

152538 0 1 0 0 0 0 0 0 0 1

152539 0 0 0 0 0 0 0 0 0 0

152541 1 4 3 5 20 27 0 0 24 36

152542 0 0 0 0 0 0 0 0 0 0

152543 0 0 0 0 0 0 0 0 0 0

152544 0 0 0 0 0 0 0 0 0 0

152545 0 0 0 0 0 0 0 0 0 0

48

152546 0 0 4 2 14 16 0 0 18 18

152547 0 0 4 3 3 6 0 0 7 9

152549 0 0 0 0 6 6 0 0 6 6

152550 0 0 0 1 5 10 0 0 5 11

152551 0 0 0 0 0 0 0 0 0 0

152552 1 0 0 5 0 3 0 0 1 8

152553 0 0 0 0 0 0 0 0 0 0

152554 0 0 0 0 0 0 0 0 0 0

152556 0 0 3 1 15 17 0 0 18 18

152558 0 0 18 12 4 9 0 0 22 21

152560 0 0 0 0 0 0 0 0 0 0

152561 0 0 0 0 0 0 0 0 0 0

152562 0 0 0 0 0 0 0 0 0 0

152564 0 0 0 0 0 0 0 0 0 0

152565 0 0 0 0 0 0 0 0 0 0

152566 0 0 0 0 0 0 0 0 0 0

152567 0 0 0 0 0 0 0 0 0 0

152568 0 0 0 0 0 0 0 0 0 0

152569 7 5 30 35 23 26 0 0 60 66

152571 0 0 0 0 0 0 0 0 0 0

152565 0 0 0 1 1 3 0 0 1 4

152573 0 0 0 0 0 0 0 0 0 0

152574 0 0 0 0 0 0 0 0 0 0

152575 0 0 0 0 0 0 0 0 0 0

152576 0 0 0 0 0 0 0 0 0 0

152577 0 0 0 0 0 0 0 0 0 0

152579 1 1 6 3 15 27 0 0 22 31

152581 0 0 1 0 19 19 0 0 20 19

152582 0 0 0 0 0 0 0 0 0 0

152583 0 0 0 0 0 0 0 0 0 0

152584 0 0 0 0 0 0 0 0 0 0

152585 0 0 0 0 0 0 0 0 0 0

152586 0 0 0 0 0 0 0 0 0 0

152588 3 0 14 0 15 0 0 0 32 0

152589 0 0 0 0 0 0 0 0 0 0

152590 0 0 0 0 0 0 0 0 0 0

152591 0 0 0 0 0 0 0 0 0 0

152592 0 0 0 0 0 0 0 0 0 0

152593 0 0 0 0 0 0 0 0 0 0

152594 2 2 0 1 8 6 0 0 10 9

152595 5 10 4 8 22 23 0 3 31 44

152596 6 6 6 7 11 9 1 0 24 22

152597 12 16 10 10 33 26 0 0 55 52

152598 0 0 0 0 0 0 0 0 0 0

152599 0 0 0 0 8 13 0 0 8 13

152600 0 0 0 0 0 0 0 0 0 0

152601 5 3 29 11 4 17 1 1 39 32

49

152602 0 0 0 0 0 0 0 0 0 0

152603 0 0 1 0 3 2 0 0 4 2

152604 0 0 0 0 0 0 0 0 0 0

152605 0 0 0 0 0 0 0 0 0 0

152606 0 0 0 0 0 0 0 0 0 0

152607 5 7 7 3 6 7 0 0 18 17

152608 0 0 0 0 0 0 0 0 0 0

152609 0 0 0 0 0 0 0 0 0 0

152610 1 1 2 2 1 1 0 0 4 4

152611 0 0 0 0 0 0 0 0 0 0

152612 7 5 7 5 68 64 0 0 82 74

152613 0 0 0 0 0 0 0 0 0 0

152614 0 0 0 0 0 0 0 0 0 0

152615 5 4 1 1 4 3 0 0 10 8

152616 1 1 4 2 16 6 0 0 21 9

152617 1 1 1 2 2 2 0 0 4 5

152618 0 0 1 0 1 0 0 0 2 0

152619 0 0 0 0 0 0 0 0 0 0

152620 0 0 0 0 3 2 0 0 3 2

152621 0 0 2 0 0 0 0 0 2 0

152622 1 0 0 0 0 0 0 0 1 0

152623 0 0 2 2 5 8 0 0 7 10

152624 0 0 0 0 0 0 0 0 0 0

152625 0 0 0 0 0 0 0 0 0 0

152626 0 0 0 0 7 5 0 0 7 5

152627 0 0 0 0 2 3 0 0 2 3

152628 0 0 0 0 0 0 0 0 0 0

152629 0 0 0 0 0 0 0 0 0 0

152630 3 2 1 1 6 6 0 0 10 9

152631 0 0 0 0 0 0 0 0 0 0

152632 0 0 0 0 0 1 0 0 0 1

152634 0 0 2 3 8 12 0 0 10 15

152635 0 0 0 0 0 0 0 0 0 0

152636 0 0 0 0 0 0 0 0 0 0

152637 16 14 3 4 8 6 0 0 27 24

152638 0 0 1 1 5 8 0 0 6 9

152639 0 0 0 0 0 0 0 0 0 0

152640 0 0 4 4 5 4 0 0 9 8

152641 0 0 0 0 0 0 0 0 0 0

152642 1 0 1 1 6 5 0 0 8 6

152643 0 0 0 0 0 0 0 0 0 0

152644 0 0 0 0 0 0 0 0 0 0

152645 3 4 0 1 2 2 0 0 5 7

152646 0 0 0 0 0 0 0 0 0 0

152647 0 0 0 0 0 0 0 0 0 0

152648 1 1 0 0 7 12 0 0 8 13

152649 6 10 8 2 37 42 0 0 51 54

50

152650 0 0 0 0 0 0 0 0 0 0

152651 0 0 0 0 2 4 0 0 2 4

152652 0 0 0 1 1 2 0 0 1 3

152653 0 0 0 0 0 0 0 0 0 0

152654 2 5 3 18 4 21 0 0 9 44

152655 0 0 1 1 5 16 0 0 6 17

152656 0 0 0 0 0 0 0 0 0 0

152657 0 0 2 10 2 11 0 0 4 21

152658 0 0 0 0 0 0 0 0 0 0

152659 0 0 0 0 0 0 0 0 0 0

152660 0 0 0 0 0 0 0 0 0 0

152661 0 0 0 0 0 0 0 0 0 0

152662 0 0 0 1 0 1 0 0 0 2

152663^ 0 0 0 0 0 1 0 0 0 1

152664^ 0 0 0 0 0 2 0 0 0 2

152665^ 0 0 0 0 0 0 0 0 0 0

153510 0 0 0 0 0 0 0 0 0 0

153515 0 0 0 0 0 0 0 0 0 0

153517 0 0 0 0 0 0 0 0 0 0

153521 57 62 38 38 13 13 0 0 108 113

153522 0 0 1 1 18 22 0 0 19 23

IN Totals 189 201 343 323 660 777 2 4 1,194 1,305

State: KY

Hemo CAPD CCPD Other Total

Facility CCN 2013 2014 2013 2014 2013 2014 2013 2014 2013 2014

180017 0 0 0 0 0 0 0 0 0 0

18005F 0 0 0 0 0 0 0 0 0 0

180067 0 0 0 0 3 4 0 0 3 4

182501 16 15 2 2 9 5 0 0 27 22

182502 0 0 0 1 4 2 0 0 4 3

182503 0 0 0 0 0 0 0 0 0 0

182504 0 0 12 9 39 43 0 0 51 52

182505 0 0 3 3 11 9 0 0 14 12

182507 1 1 2 2 0 3 0 0 3 6

182508 0 0 0 0 0 0 0 0 0 0

182509 0 0 1 3 4 5 0 0 5 8

182512 0 0 0 0 0 0 0 0 0 0

182513 0 0 0 1 0 3 0 0 0 4

182514 0 0 0 0 0 0 0 0 0 0

182516 1 1 1 0 13 7 0 0 15 8

182517 4 3 3 3 13 10 0 0 20 16

182518 0 0 0 0 0 0 0 0 0 0

182519 0 0 1 1 7 10 0 0 8 11

182521 0 0 0 0 0 0 0 0 0 0

182523 0 0 0 0 0 0 0 0 0 0

182524 0 0 1 1 14 14 0 0 15 15

182526 0 0 0 0 0 0 0 0 0 0

51

182527 0 0 0 0 0 0 0 0 0 0

182529 0 0 0 0 0 0 0 0 0 0

182530 0 0 0 0 0 0 0 0 0 0

182532 4 4 3 4 4 3 0 0 11 11

182533 0 0 0 0 0 0 0 0 0 0

182534 0 0 0 0 0 0 0 0 0 0

182535 0 0 0 0 0 0 0 0 0 0

182536 0 0 0 0 0 0 0 0 0 0

182537 0 0 0 0 0 0 0 0 0 0

182538 0 0 1 0 13 9 0 0 14 9

182540 0 0 2 0 16 15 0 0 18 15

182541 0 0 0 0 8 9 0 0 8 9

182542 0 0 0 0 0 0 0 0 0 0

182543 0 0 0 0 0 0 0 0 0 0

182544 0 0 0 0 0 0 0 0 0 0

182547 0 0 9 5 16 8 0 0 25 13

182548 0 0 0 1 2 1 0 0 2 2

182549 1 0 0 0 0 0 0 0 1 0

182550 0 0 0 0 0 2 0 0 0 2

182551 0 0 0 0 0 0 0 0 0 0

182552 0 0 4 4 46 40 0 0 50 44

182553 0 0 0 0 0 0 0 0 0 0

182554 0 0 0 0 0 0 0 0 0 0

182555 0 0 0 0 0 0 0 0 0 0

182556 0 0 0 0 0 0 0 0 0 0

182557 3 0 3 0 42 0 0 0 48 0

182558 0 0 0 0 0 0 0 0 0 0

182559 0 0 0 0 0 0 0 0 0 0

182560 0 0 0 0 0 0 0 0 0 0

182561 0 0 0 0 0 0 0 0 0 0

182562 0 0 0 0 0 0 0 0 0 0

182563 0 0 0 0 0 0 0 0 0 0

182564 0 2 0 0 0 0 0 0 0 2

182565 0 0 2 2 3 2 0 0 5 4

182566 0 0 0 0 1 1 0 0 1 1

182567 0 0 0 0 0 0 0 0 0 0

182568 0 0 0 0 0 0 0 0 0 0

182569 5 1 3 2 51 30 0 0 59 33

182570 0 0 0 0 0 0 0 0 0 0

182571 0 0 0 0 0 0 0 0 0 0

182565 0 0 0 0 0 0 0 0 0 0

182573 0 0 0 0 0 0 0 0 0 0

182574 0 0 0 0 0 0 0 0 0 0

182575 0 0 0 0 0 0 0 0 0 0

182576 0 0 0 0 0 0 0 0 0 0

182577 0 0 0 0 0 0 0 0 0 0

182578 0 0 0 0 0 0 0 0 0 0

52

182580 0 0 0 0 6 5 0 0 6 5

182581 5 4 5 4 9 9 0 0 19 17

182582 0 0 0 0 0 0 0 0 0 0

182583 0 0 0 0 0 0 0 0 0 0

182584 0 0 0 0 0 0 0 0 0 0

182586 2 6 7 3 63 64 0 0 72 73

182587 0 0 0 0 4 3 0 0 4 3

182588 0 0 0 0 0 0 0 0 0 0

182589 2 1 0 3 7 6 0 0 9 10

182590 0 0 0 0 0 0 0 0 0 0

182591 2 1 1 1 13 12 0 0 16 14

182592 0 0 0 0 0 0 0 0 0 0

182593# 0 0 0 0 0 0 0 0 0 0

182594 0 0 1 2 9 8 0 0 10 10

182595 0 0 0 0 0 0 0 0 0 0

182596 0 0 0 0 0 0 0 0 0 0

182597 0 0 0 0 7 4 0 0 7 4

182598 0 0 0 0 9 9 0 0 9 9

182599 0 0 5 5 1 3 0 0 6 8

182600 0 0 0 0 0 0 0 0 0 0

182601 0 0 5 5 3 3 0 0 8 8

182602 1 1 1 1 3 6 0 0 5 8

182603 0 0 0 0 0 0 0 0 0 0

182604 0 0 0 0 0 0 0 0 0 0

182605 0 0 0 0 1 0 0 0 1 0

182606 0 0 0 0 0 0 0 0 0 0

182607 0 0 1 2 3 3 0 0 4 5

182608 0 0 0 0 0 0 0 0 0 0

182609 6 7 0 0 0 0 0 0 6 7

182610 0 0 0 0 0 0 0 0 0 0

182611 0 0 0 0 0 0 0 0 0 0

182612 2 1 2 11 14 14 0 0 18 26

182613 9 7 13 13 11 12 0 0 33 32

182614 0 0 0 0 0 0 0 0 0 0

182615 0 0 1 1 8 13 0 0 9 14

182616 0 0 0 0 0 0 0 0 0 0

182617 1 4 0 0 2 1 0 0 3 5

182618 0 0 0 0 0 0 0 0 0 0

182619 2 3 0 0 14 11 0 0 16 14

182620 0 0 4 5 0 3 0 0 4 8

182621 3 2 1 3 2 6 0 0 6 11

182622 0 0 0 0 0 0 0 0 0 0

182623^ 0 0 0 0 0 0 0 0 0 0

182624 0 0 0 0 0 0 0 0 0 0

182625 0 5 0 0 0 7 0 0 0 12

182626 0 0 0 4 0 14 0 0 0 18

182627^ 0 10 0 1 0 65 0 0 0 76

53

182628^ 0 0 0 0 0 0 0 0 0 0

KY Totals 70 79 100 108 508 516 0 0 678 703

State: OH

Hemo CAPD CCPD Other Total

Facility CCN 2013 2014 2013 2014 2013 2014 2013 2014 2013 2014

360003 0 0 0 0 0 0 0 0 0 0

360009 0 0 4 3 16 19 0 0 20 22

360024 0 0 0 0 0 0 0 0 0 0

36003F 0 0 2 1 0 0 0 0 2 1

360048 0 0 0 0 0 0 0 0 0 0

36004F 0 0 0 0 0 0 0 0 0 0

360051* 0 0 0 0 0 0 0 0 0 0

360064 0 0 0 0 0 0 0 0 0 0

360066 0 0 0 0 0 0 0 0 0 0

360068 0 0 0 0 0 0 0 0 0 0

36007F 0 0 2 0 1 2 0 0 3 2

360084 0 0 0 0 0 0 0 0 0 0

360099 0 0 0 0 0 0 0 0 0 0

360112 0 0 0 0 0 0 0 0 0 0

360137 5 4 1 0 21 20 0 0 27 24

360163 0 0 0 0 0 0 0 0 0 0

360180 0 0 0 0 0 0 0 0 0 0

360229 0 0 0 1 5 9 0 0 5 10

362500 0 0 0 0 0 0 0 0 0 0

362501 0 0 0 0 0 0 0 0 0 0

362502 0 0 0 0 0 0 0 0 0 0

362503 0 0 0 0 0 0 0 0 0 0

362504 10 9 2 3 44 43 0 0 56 55

362505 0 0 0 0 0 0 0 0 0 0

362508 1 2 9 8 14 17 0 0 24 27

362509 4 3 3 0 17 15 0 0 24 18

362512 14 19 10 7 21 20 0 0 45 46

362514 0 0 0 0 0 0 0 0 0 0

362516 0 0 0 0 5 7 0 0 5 7

362517# 0 0 0 0 0 0 0 0 0 0

362518 1 2 1 1 10 13 0 0 12 16

362519 0 0 0 0 0 0 0 0 0 0

362520 0 0 3 5 4 4 0 0 7 9

362521 0 0 0 0 0 0 0 0 0 0

362522 0 0 0 0 0 0 0 0 0 0

362523 0 0 0 0 0 0 0 0 0 0

362524 0 0 0 0 0 0 0 0 0 0

362526 0 0 4 2 18 18 0 0 22 20

362528 0 0 0 0 0 0 0 0 0 0

362529 0 0 1 3 11 12 0 0 12 15

362530 0 0 0 0 0 0 0 0 0 0

362531 3 3 0 2 7 8 0 0 10 13

54

362534 0 0 2 1 1 0 0 0 3 1

362535# 0 0 0 0 0 0 0 0 0 0

362537 0 0 0 0 0 0 0 0 0 0

362539 0 0 0 0 0 0 0 0 0 0

362541 2 6 7 9 22 22 0 0 31 37

362542 0 0 13 8 34 35 0 0 47 43

362543 0 0 10 10 23 21 0 0 33 31

362545 0 0 0 0 0 0 0 0 0 0

362547 3 1 0 0 9 9 0 0 12 10

362549 2 1 6 4 4 8 0 0 12 13

362551 0 0 1 1 6 8 0 0 7 9

362552 0 0 0 0 0 0 0 0 0 0

362553 0 1 0 0 0 0 0 0 0 1

362554 0 0 0 0 8 10 0 0 8 10

362556 0 0 5 7 7 9 0 0 12 16

362557 0 0 0 0 0 0 0 0 0 0

362558 0 0 0 0 0 0 0 0 0 0

362559 3 0 7 9 14 17 0 0 24 26

362560 19 3 0 0 0 0 0 0 19 3

362561 0 0 6 2 1 3 0 0 7 5

362562 0 0 4 4 5 5 0 0 9 9

362563 0 0 0 0 0 0 0 0 0 0

362564 19 0 0 0 0 0 0 0 19 0

362566 0 0 0 0 0 0 0 0 0 0

362567 0 0 0 0 0 0 0 0 0 0

362568 0 0 0 0 0 0 0 0 0 0

362569 0 0 0 0 0 0 0 0 0 0

362570 8 17 8 19 31 36 0 0 47 72

362571 0 0 0 0 0 0 0 0 0 0

362565 0 0 0 0 3 1 0 0 3 1

362575 0 0 1 1 3 2 0 0 4 3

362576 6 4 5 4 15 10 0 0 26 18

362577 0 1 0 0 0 0 0 0 0 1

362578 4 7 11 5 8 18 0 0 23 30

362579 0 0 9 8 1 5 0 0 10 13

362580 0 0 0 0 0 1 0 0 0 1

362581 0 0 0 0 0 0 0 0 0 0

362582 0 0 0 0 0 0 0 0 0 0

362583 0 0 0 0 0 0 0 0 0 0

362584 0 0 0 0 0 0 0 0 0 0

362585 0 0 0 0 0 0 0 0 0 0

362587 2 1 1 0 1 4 0 0 4 5

362589 0 0 0 0 0 0 0 0 0 0

362590 0 0 0 0 0 0 0 0 0 0

362591 0 0 0 0 0 0 0 0 0 0

362592 0 0 8 11 14 15 0 0 22 26

362593 95 0 0 0 0 0 0 0 95 0

55

362594 0 0 1 1 14 13 0 0 15 14

362595 0 0 0 0 0 0 0 0 0 0

362596# 0 0 0 0 0 0 0 0 0 0

362597 0 0 1 1 3 7 0 0 4 8

362598 6 6 7 7 31 38 0 0 44 51

362599 0 0 0 0 0 0 0 0 0 0

362600 24 17 10 12 28 36 0 0 62 65

362602 0 0 0 0 0 0 0 0 0 0

362603 63 0 0 0 0 0 0 0 63 0

362604 0 0 0 0 0 0 0 0 0 0

362607 0 0 0 0 0 0 0 0 0 0

362608 0 0 4 0 15 12 0 0 19 12

362609 0 0 3 3 13 12 0 0 16 15

362610 0 0 0 0 4 0 0 0 4 0

362611 0 0 0 0 0 0 0 0 0 0

362612 0 0 0 0 0 0 0 0 0 0

362613 9 8 2 2 37 44 0 0 48 54

362614 3 2 0 0 3 4 0 0 6 6

362616 0 0 0 0 0 0 0 0 0 0

362617 0 0 0 0 0 0 0 0 0 0

362618 0 0 0 0 0 0 0 0 0 0

362619 0 0 0 0 0 0 0 0 0 0

362620 0 0 0 0 0 0 0 0 0 0

362621 0 0 0 0 0 0 0 0 0 0

362622 0 0 1 2 1 1 0 0 2 3

362623 0 0 0 0 0 0 0 0 0 0

362624 0 0 0 0 0 0 0 0 0 0

362625 6 6 8 2 9 9 0 0 23 17

362626 0 0 0 0 0 0 0 0 0 0

362627 2 2 4 3 4 4 0 0 10 9

362628 0 0 0 0 0 0 0 0 0 0

362629 0 0 0 0 0 0 0 0 0 0

362630 1 1 0 0 13 7 0 0 14 8

362631 0 0 0 0 0 0 0 0 0 0

362632 0 0 0 0 0 0 0 0 0 0

362633 0 0 0 0 0 0 0 0 0 0

362634 0 0 8 14 22 22 0 0 30 36

362635 0 0 0 0 0 0 0 0 0 0

362636 0 0 0 0 0 0 0 0 0 0

362637 0 0 0 0 0 0 0 0 0 0

362638 0 0 0 0 0 0 0 0 0 0

362639 0 0 0 0 0 0 0 0 0 0

362640 0 0 0 0 0 0 0 0 0 0

362641 0 0 0 0 0 0 0 0 0 0

362642 0 0 1 0 1 1 0 0 2 1

362643 0 0 2 1 7 9 1 0 10 10

362644 0 0 0 0 8 8 0 0 8 8

56

362645 8 8 0 2 1 3 0 0 9 13

362646 1 1 1 1 8 4 0 0 10 6

362647 0 0 0 0 0 0 0 0 0 0

362648 0 0 7 9 6 4 0 0 13 13

362649 1 1 7 6 4 4 0 0 12 11

362650 0 0 0 0 0 0 0 0 0 0

362651 0 0 0 0 0 0 0 0 0 0

362652 0 0 0 0 0 0 0 0 0 0

362653 0 0 1 0 0 2 0 0 1 2

362654 0 0 0 0 0 0 0 0 0 0

362655 0 0 3 0 3 3 0 0 6 3

362656 2 1 15 11 41 33 0 0 58 45

362657 1 2 10 7 10 10 0 0 21 19

362659 0 0 0 0 0 0 0 0 0 0

362660 0 0 2 2 4 8 0 0 6 10

362661 0 0 0 0 0 0 0 0 0 0

362662 0 0 0 0 7 5 0 0 7 5

362663 0 0 0 0 0 0 0 0 0 0

362664 0 0 0 0 0 0 0 0 0 0

362665 2 3 1 2 6 9 0 0 9 14

362666 0 0 0 0 0 0 0 0 0 0

362667 0 0 0 0 0 0 0 0 0 0

362668 0 0 0 0 0 0 0 0 0 0

362669 0 0 1 1 12 8 0 0 13 9

362670 0 1 1 1 0 0 0 0 1 2

362671 1 0 0 0 1 6 0 0 2 6

362672 0 0 0 0 0 0 0 0 0 0

362674 0 0 0 0 0 0 0 0 0 0

362675 0 0 0 0 2 2 0 0 2 2

362677 1 1 1 1 6 6 0 0 8 8

362678 0 0 0 0 0 0 0 0 0 0

362679 0 0 3 1 17 15 0 0 20 16

362680 0 0 0 0 0 0 0 0 0 0

362681 0 0 0 0 0 0 0 0 0 0

362682 0 0 2 0 4 4 0 0 6 4

362683 0 0 0 0 0 0 0 0 0 0

362684 5 9 0 0 0 0 0 0 5 9

362685 0 0 1 0 12 10 0 0 13 10

362686 0 0 2 4 1 1 0 0 3 5

362687 20 23 10 5 50 53 0 0 80 81

362688 0 0 0 0 0 0 0 0 0 0

362689 0 0 1 5 10 10 0 0 11 15

362690 7 8 2 2 1 5 0 0 10 15

362691 0 2 5 3 7 9 0 0 12 14

362692 36 0 0 0 0 0 0 0 36 0

362693 0 0 5 0 0 3 0 0 5 3

362694 0 0 0 0 3 2 0 0 3 2

57

362695 0 0 0 0 0 0 0 0 0 0

362696 0 0 0 0 0 0 0 0 0 0

362697 0 0 0 0 0 0 0 0 0 0

362698 0 0 0 0 0 0 0 0 0 0

362699 3 9 0 0 22 17 0 0 25 26

362700 1 4 0 0 0 0 1 0 2 4

362701 0 0 0 0 0 0 0 0 0 0

362702 0 0 10 6 27 17 0 0 37 23

362703 0 0 0 0 3 3 0 0 3 3

362704 0 0 1 2 9 10 0 0 10 12

362705 0 0 5 5 14 13 0 0 19 18

362706 0 0 2 3 9 9 0 0 11 12

362707 0 0 0 0 0 0 0 0 0 0

362708 0 0 0 0 0 0 0 0 0 0

362709 0 0 0 0 0 0 0 0 0 0

362710 0 0 0 0 0 0 0 0 0 0

362711^# 2 0 0 0 0 0 0 0 2 0

362712 0 0 0 0 0 0 0 0 0 0

362713 0 0 0 0 13 16 0 0 13 16

362715 0 0 0 0 0 0 0 0 0 0

362716 0 0 0 0 0 0 0 0 0 0

362717 0 0 0 0 0 0 0 0 0 0

362718 0 0 2 0 9 0 0 0 11 0

362719 0 0 0 0 0 0 0 0 0 0

362720 0 0 0 0 0 0 0 0 0 0

362721 18 23 3 2 16 22 0 0 37 47

362723 0 0 0 0 2 1 0 0 2 1

362724 0 0 0 0 0 0 0 0 0 0

362725 0 0 0 0 0 0 0 0 0 0

362727 9 8 0 0 0 0 0 0 9 8

362728 0 0 0 0 0 0 0 0 0 0

362729 0 0 0 0 5 2 0 0 5 2

362730 1 1 1 0 2 1 0 0 4 2

362731 0 2 2 1 2 7 3 3 7 13

362732 0 0 2 1 3 2 0 0 5 3

362733 2 2 8 4 1 6 0 0 11 12

362734 0 0 0 0 0 0 0 0 0 0

362735 0 0 0 0 0 0 0 0 0 0

362736 1 0 0 0 0 0 0 0 1 0

362737 0 0 5 4 10 11 0 0 15 15

362738 0 0 2 1 2 1 0 0 4 2

362739 0 0 0 0 0 0 0 0 0 0

362740 0 0 0 0 0 0 0 0 0 0

362741 0 0 1 2 4 3 0 0 5 5

362742 0 0 0 0 0 0 0 0 0 0

362743 0 0 0 0 0 0 0 0 0 0

362744 0 0 6 1 6 13 0 0 12 14

58

362745 0 0 0 0 0 0 0 0 0 0

362746 2 1 7 6 11 17 0 0 20 24

362747 0 0 7 7 14 12 0 0 21 19

362748 0 0 0 0 0 0 0 0 0 0

362749 0 0 0 0 0 0 0 0 0 0

362750 1 0 1 1 5 1 0 0 7 2

362751 1 1 0 0 0 0 0 0 1 1

362752 0 0 0 2 2 1 0 0 2 3

362753 7 5 0 0 0 0 0 0 7 5

362754 0 0 0 0 0 0 0 0 0 0

362755 0 0 0 0 0 0 0 0 0 0

362756 0 0 0 0 0 0 0 0 0 0

362757 0 0 0 0 0 0 0 0 0 0

362758 87 0 0 0 0 0 0 0 87 0

362759 0 0 1 5 8 5 0 0 9 10

362760 0 0 0 0 0 0 0 0 0 0

362761 0 0 0 0 1 2 0 0 1 2

362762 0 0 0 0 0 0 0 0 0 0

362763 2 4 0 0 5 10 0 0 7 14

362764 0 0 0 0 0 0 0 0 0 0

362765 0 0 2 3 13 16 0 0 15 19

362766 1 4 1 0 2 3 0 0 4 7

362767 2 1 14 8 24 19 0 0 40 28

362768 0 1 0 1 1 1 0 0 1 3

362769 0 0 0 0 0 0 0 0 0 0

362770 0 0 0 0 0 0 0 0 0 0

362771 1 0 0 0 1 0 0 0 2 0

362772 0 0 0 0 0 0 0 0 0 0

362773 0 0 0 0 0 0 0 0 0 0

362774 0 0 0 0 0 0 0 0 0 0

362775 0 0 2 1 10 9 0 0 12 10

362776 0 0 0 0 0 0 0 0 0 0

362777 0 0 0 1 1 2 0 0 1 3

362778 0 0 0 0 0 0 0 0 0 0

362779 0 0 1 1 7 6 0 0 8 7

362780 0 0 0 0 0 0 0 0 0 0

362781 0 0 0 0 0 0 0 0 0 0

362782 0 0 0 0 0 0 0 0 0 0

362783 0 0 3 3 0 4 0 0 3 7

362784 0 0 0 0 0 0 0 0 0 0

362785 0 0 0 0 0 2 0 0 0 2

362786 0 0 1 0 2 1 0 0 3 1

362787 0 0 0 2 8 9 0 0 8 11

362788 1 1 0 0 0 0 0 0 1 1

362789 1 0 0 0 0 0 0 0 1 0

362790 0 0 4 3 3 6 0 0 7 9

362791 1 0 0 0 4 4 0 0 5 4

59

362792 0 0 0 0 0 0 0 0 0 0

362793 0 0 0 0 0 0 0 0 0 0

362794 1 0 1 0 5 5 0 0 7 5

362795 1 0 0 0 0 0 0 0 1 0

362796 0 0 0 0 0 0 0 0 0 0

362797 0 0 1 2 0 2 0 0 1 4

362798 0 0 0 0 0 0 0 0 0 0

362799 0 0 0 0 0 2 0 0 0 2

362800 0 0 0 2 0 5 0 0 0 7

362801 0 3 0 1 0 9 0 0 0 13

362802 0 0 0 0 0 0 0 0 0 0

362803 0 0 0 0 0 0 0 0 0 0

362804 0 2 0 0 0 0 0 0 0 2

362805 0 0 0 2 0 3 0 0 0 5

362806 0 0 0 0 0 0 0 0 0 0

362807 0 0 0 0 0 0 0 0 0 0

362808 0 0 0 0 0 0 0 0 0 0

362809 0 4 0 0 0 6 0 0 0 10

362810 0 0 0 1 0 2 0 0 0 3

362811 0 0 0 0 0 0 0 0 0 0

362812 0 0 0 0 0 0 0 0 0 0

362813 0 0 0 0 0 0 0 0 0 0

362814^ 0 21 0 5 0 5 0 0 0 31

362815^ 0 0 0 0 0 1 0 0 0 1

362816^ 0 1 0 0 0 0 0 0 0 1

362817^ 0 0 0 0 0 0 0 0 0 0

362818^ 0 0 0 0 0 0 0 0 0 0

362819^ 0 0 0 0 0 0 0 0 0 0

362820^ 0 0 0 0 0 0 0 0 0 0

362821^ 0 0 0 0 0 0 0 0 0 0

362822^ 0 0 0 0 0 0 0 0 0 0

362823^# 0 0 0 0 0 0 0 0 0 0

362824^# 0 0 0 0 0 0 0 0 0 0

362825^ 0 0 0 0 0 0 0 0 0 0

363300 0 0 0 0 6 8 0 0 6 8

363303 0 0 0 0 8 7 0 0 8 7

363304 0 0 0 0 3 6 0 0 3 6

363509 4 8 20 17 8 8 0 0 32 33

363510# 0 0 0 0 0 0 0 0 0 0

363511 0 0 0 0 0 0 0 0 0 0

364000 0 0 0 0 0 0 0 0 0 0

368839^ 0 2 0 0 0 0 0 0 0 2

368842^ 0 3 0 1 0 0 0 0 0 4

368848^ 0 0 0 0 0 0 0 0 0 0

OH Totals 550 297 395 357 1,144 1,245 5 3 2,094 1,902

State: Unknown

60

Hemo CAPD CCPD Other Total

Facility CCN 2013 2014 2013 2014 2013 2014 2013 2014 2013 2014

153510* 0 0 0 0 0 0 0 0 0 0

360064* 0 0 0 0 0 0 0 0 0 0

Unknown Totals 0 0 0 0 0 0 0 0 0 0

Network

Hemo CAPD CCPD Other Total

2013 2014 2013 2014 2013 2014 2013 2014 2013 2014

Network Totals 809 577 838 788 2,312 2,538 7 7 3,966 3,910

Source of Information: Facility Survey (CMS 2744) and CROWNWeb Date of Preparation: May 2015 This table includes 5 Veterans Affairs Facility patients for 2013 and 3 Veterans Affairs Facility patients for 2014 ^ Facility not operational in 2013 # Facility not operational in 2014 * Facility does not have a generated 2744 in 2014

61

Dialysis Patients Modality and Setting – In Center Report (formerly Table 4) Network 9 Created 05/29/2015

Dialysis Patients Modality and Setting - In Center

For Survey Years 2013 and 2014

State: IN

Hemo PD Total Total In-Center & Home1

Facility CCN 2013 2014 2013

2014 2013 2014 2013 2014

15003F 76 68 0 0 76 68 76 68

150056 0 0 0 0 0 0 0 0

152500 151 141 0 0 151 141 186 181

152501 107 117 0 0 107 117 121 134

152502 140 137 0 0 140 137 140 137

152503 56 62 0 0 56 62 68 72

152504 89 100 1 1 90 101 100 116

152507 33 32 0 0 33 32 33 32

152509 114 106 0 0 114 106 133 127

152510 99 114 0 0 99 114 114 135

152511 42 41 0 0 42 41 51 53

152512 93 83 0 0 93 83 93 83

152514 18 19 0 0 18 19 18 19

152515 44 68 0 0 44 68 71 101

152516 79 89 0 0 79 89 92 104

152517 40 49 0 0 40 49 40 49

152518 57 53 0 0 57 53 71 61

152520 145 127 0 0 145 127 145 127

152521 190 198 0 0 190 198 205 216

152522 121 119 0 0 121 119 157 145

152523 46 56 0 0 46 56 51 64

152524 69 72 0 0 69 72 69 72

152525 87 85 1 2 88 87 124 127

152526 84 81 0 0 84 81 107 106

152527 35 36 0 0 35 36 40 39

152530 108 119 0 0 108 119 108 119

152531 37 32 0 0 37 32 37 32

152532 0 0 0 0 0 0 52 51

152534 44 40 0 0 44 40 45 47

152535 13 12 0 0 13 12 13 12

152536 76 86 0 0 76 86 76 86

152537 36 52 0 0 36 52 36 52

152538 27 23 0 0 27 23 27 24

152539 31 25 0 0 31 25 31 25

152541 79 90 0 0 79 90 103 126

152542 114 99 0 0 114 99 114 99

152543 103 107 0 0 103 107 103 107

152544 0 0 0 0 0 0 0 0

62

152545 18 20 0 0 18 20 18 20

152546 50 54 0 0 50 54 68 72

152547 160 155 0 0 160 155 167 164

152549 120 118 0 0 120 118 126 124

152550 34 32 0 0 34 32 39 43

152551 17 21 0 0 17 21 17 21

152552 61 56 0 0 61 56 62 64

152553 30 38 0 0 30 38 30 38

152554 65 67 0 0 65 67 65 67

152556 47 58 0 0 47 58 65 76

152558 58 65 0 0 58 65 80 86

152560 65 68 0 0 65 68 65 68

152561 56 61 0 0 56 61 56 61

152562 43 46 0 0 43 46 43 46

152564 80 80 0 0 80 80 80 80

152565 56 52 0 0 56 52 56 52

152566 47 57 0 0 47 57 47 57

152567 40 39 0 0 40 39 40 39

152568 47 46 0 0 47 46 47 46

152569 83 77 0 0 83 77 143 143

152571 122 125 0 0 122 125 122 125

152565 63 61 0 0 63 61 64 65

152573 22 22 0 0 22 22 22 22

152574 21 20 0 0 21 20 21 20

152575 19 17 0 0 19 17 19 17

152576 71 71 0 0 71 71 71 71

152577 38 37 0 0 38 37 38 37

152579 49 55 0 0 49 55 71 86

152581 56 66 0 0 56 66 76 85

152582 20 23 0 0 20 23 20 23

152583 23 18 0 0 23 18 23 18

152584 36 40 0 0 36 40 36 40

152585 98 104 0 0 98 104 98 104

152586 34 43 0 0 34 43 34 43

152588 0 0 0 0 0 0 32 0

152589 25 25 0 0 25 25 25 25

152590 30 32 0 0 30 32 30 32

152591 85 86 0 0 85 86 85 86

152592 93 85 0 0 93 85 93 85

152593 95 105 0 0 95 105 95 105

152594 54 59 0 0 54 59 64 68

152595 54 44 0 0 54 44 85 88

152596 97 93 0 0 97 93 121 115

152597 0 0 0 0 0 0 55 52

152598 37 42 0 0 37 42 37 42

152599 68 65 0 0 68 65 76 78

63

152600 26 28 0 0 26 28 26 28

152601 78 69 2 0 80 69 119 101

152602 21 26 0 0 21 26 21 26

152603 26 29 0 0 26 29 30 31

152604 20 22 0 0 20 22 20 22

152605 25 26 0 0 25 26 25 26

152606 34 31 0 0 34 31 34 31

152607 74 87 0 0 74 87 92 104

152608 23 26 0 0 23 26 23 26

152609 44 43 0 0 44 43 44 43

152610 27 33 0 0 27 33 31 37

152611 36 36 0 0 36 36 36 36

152612 0 0 0 0 0 0 82 74

152613 20 18 0 0 20 18 20 18

152614 31 31 0 0 31 31 31 31

152615 6 8 0 0 6 8 16 16

152616 47 40 1 1 48 41 69 50

152617 23 28 0 0 23 28 27 33

152618 26 27 0 0 26 27 28 27

152619 26 29 0 0 26 29 26 29

152620 20 19 0 0 20 19 23 21

152621 11 11 0 0 11 11 13 11

152622 31 34 0 0 31 34 32 34

152623 59 66 0 0 59 66 66 76

152624 7 11 0 0 7 11 7 11

152625 37 43 0 0 37 43 37 43

152626 25 25 0 0 25 25 32 30

152627 30 29 0 0 30 29 32 32

152628 14 14 0 0 14 14 14 14

152629 52 53 0 0 52 53 52 53

152630 45 47 0 0 45 47 55 56

152631 45 55 0 0 45 55 45 55

152632 38 46 0 0 38 46 38 47

152634 39 50 0 0 39 50 49 65

152635 51 55 0 0 51 55 51 55

152636 19 20 0 0 19 20 19 20

152637 57 55 0 0 57 55 84 79

152638 29 26 0 0 29 26 35 35

152639 9 0 0 0 9 0 9 0

152640 17 24 0 0 17 24 26 32

152641 38 35 0 0 38 35 38 35

152642 38 39 0 0 38 39 46 45

152643 38 43 0 0 38 43 38 43

152644 31 44 0 0 31 44 31 44

152645 43 54 0 0 43 54 48 61

152646 22 24 0 0 22 24 22 24

64

152647 93 100 0 0 93 100 93 100

152648 46 47 0 0 46 47 54 60

152649 0 0 0 0 0 0 51 54

152650 15 22 0 0 15 22 15 22

152651 37 42 0 0 37 42 39 46

152652 15 23 0 0 15 23 16 26

152653 98 97 0 0 98 97 98 97

152654 22 30 0 0 22 30 31 74

152655 28 36 0 0 28 36 34 53

152656 4 14 0 0 4 14 4 14

152657 21 47 0 2 21 49 25 70

152658 3 29 0 0 3 29 3 29

152659 3 15 0 0 3 15 3 15

152660 0 45 0 0 0 45 0 45

152661 0 1 0 0 0 1 0 1

152662 0 0 0 0 0 0 0 2

152663^ 0 2 0 0 0 2 0 3

152664^ 0 8 0 0 0 8 0 10

152665^ 0 2 0 0 0 2 0 2

153510 134 138 0 0 134 138 134 138

153515 63 62 0 0 63 62 63 62

153517 0 0 0 0 0 0 0 0

153521 0 0 0 0 0 0 108 113

153522 6 6 0 0 6 6 25 29

IN Totals 7,216 7,611 5 6 7,221 7,617 8,415 8,922

State: KY

Hemo PD Total Total In-Center & Home1

Facility CCN 2013 2014 2013

2014 2013 2014 2013 2014

180017 59 59 0 0 59 59 59 59

18005F 25 33 0 0 25 33 25 33

180067 2 2 0 0 2 2 5 6

182501 186 111 0 0 186 111 213 133

182502 33 28 0 0 33 28 37 31

182503 63 62 0 0 63 62 63 62

182504 40 32 0 0 40 32 91 84

182505 91 99 0 0 91 99 105 111

182507 37 42 0 0 37 42 40 48

182508 55 71 0 0 55 71 55 71

182509 46 43 0 0 46 43 51 51

182512 44 44 0 0 44 44 44 44

182513 53 70 0 0 53 70 53 74

182514 57 60 0 0 57 60 57 60

182516 79 86 0 0 79 86 94 94

182517 74 90 0 0 74 90 94 106

182518 45 44 0 0 45 44 45 44

182519 48 62 0 0 48 62 56 73

65

182521 86 78 0 0 86 78 86 78

182523 103 108 0 0 103 108 103 108

182524 23 31 0 0 23 31 38 46

182526 41 44 0 0 41 44 41 44

182527 57 53 0 0 57 53 57 53

182529 62 56 0 0 62 56 62 56

182530 38 47 0 0 38 47 38 47

182532 77 76 0 0 77 76 88 87

182533 33 35 0 0 33 35 33 35

182534 90 86 0 0 90 86 90 86

182535 58 66 0 0 58 66 58 66

182536 56 54 0 0 56 54 56 54

182537 98 72 0 0 98 72 98 72

182538 39 37 0 0 39 37 53 46

182540 35 35 0 0 35 35 53 50

182541 29 33 0 0 29 33 37 42

182542 44 43 0 0 44 43 44 43

182543 92 91 0 0 92 91 92 91

182544 65 72 0 0 65 72 65 72

182547 84 88 0 0 84 88 109 101

182548 25 31 0 0 25 31 27 33

182549 47 50 0 0 47 50 48 50

182550 48 52 0 0 48 52 48 54

182551 16 15 0 0 16 15 16 15

182552 43 57 1 0 44 57 94 101

182553 35 46 0 0 35 46 35 46

182554 47 44 0 0 47 44 47 44

182555 44 53 0 0 44 53 44 53

182556 72 75 0 0 72 75 72 75

182557 0 0 0 0 0 0 48 0

182558 52 64 0 0 52 64 52 64

182559 44 46 0 0 44 46 44 46

182560 49 41 0 0 49 41 49 41

182561 26 23 0 0 26 23 26 23

182562 28 25 0 0 28 25 28 25

182563 51 47 0 0 51 47 51 47

182564 15 12 0 0 15 12 15 14

182565 24 27 1 1 25 28 30 32

182566 22 27 0 0 22 27 23 28

182567 71 55 0 0 71 55 71 55

182568 16 17 0 0 16 17 16 17

182569 0 0 0 0 0 0 59 33

182570 78 64 0 0 78 64 78 64

182571 19 0 0 0 19 0 19 0

182565 24 21 0 0 24 21 24 21

182573 22 28 0 0 22 28 22 28

66

182574 26 27 0 0 26 27 26 27

182575 21 24 0 0 21 24 21 24

182576 23 27 0 0 23 27 23 27

182577 21 23 0 0 21 23 21 23

182578 25 21 0 0 25 21 25 21

182580 35 40 0 0 35 40 41 45

182581 96 93 0 0 96 93 115 110

182582 79 72 0 0 79 72 79 72

182583 22 20 0 0 22 20 22 20

182584 22 26 0 0 22 26 22 26

182586 0 0 0 0 0 0 72 73

182587 41 61 0 0 41 61 45 64

182588 24 25 0 0 24 25 24 25

182589 40 38 0 0 40 38 49 48

182590 42 53 0 0 42 53 42 53

182591 48 35 0 0 48 35 64 49

182592 45 43 0 0 45 43 45 43

182593# 0 0 0 0 0 0 0 0

182594 36 28 0 0 36 28 46 38

182595 34 34 0 0 34 34 34 34

182596 46 45 0 0 46 45 46 45

182597 65 72 0 0 65 72 72 76

182598 42 34 0 0 42 34 51 43

182599 31 46 0 0 31 46 37 54

182600 26 23 0 0 26 23 26 23

182601 25 35 0 0 25 35 33 43

182602 34 35 0 0 34 35 39 43

182603 29 32 0 0 29 32 29 32

182604 35 39 0 0 35 39 35 39

182605 17 26 0 0 17 26 18 26

182606 17 21 0 0 17 21 17 21

182607 20 23 0 0 20 23 24 28

182608 22 23 0 0 22 23 22 23

182609 45 52 0 0 45 52 51 59

182610 36 40 0 0 36 40 36 40

182611 46 45 0 0 46 45 46 45

182612 1 42 0 0 1 42 19 68

182613 0 0 0 0 0 0 33 32

182614 25 23 0 0 25 23 25 23

182615 44 50 0 0 44 50 53 64

182616 11 12 0 0 11 12 11 12

182617 0 0 0 0 0 0 3 5

182618 50 51 0 0 50 51 50 51

182619 29 36 0 0 29 36 45 50

182620 23 36 0 0 23 36 27 44

182621 43 53 0 0 43 53 49 64

67

182622 0 12 0 0 0 12 0 12

182623^ 0 51 0 0 0 51 0 51

182624 0 41 0 0 0 41 0 41

182625 0 36 0 0 0 36 0 48

182626 0 0 0 0 0 0 0 18

182627^ 0 0 0 0 0 0 0 76

182628^ 0 0 0 0 0 0 0 0

KY Totals 4,607 4,887 2 1 4,609 4,888 5,287 5,591

State: OH

Hemo PD Total Total In-Center & Home1

Facility CCN 2013 2014 2013

2014 2013 2014 2013 2014

360003 0 0 0 0 0 0 0 0

360009 59 58 0 0 59 58 79 80

360024 117 114 0 0 117 114 117 114

36003F 21 25 0 0 21 25 23 26

360048 5 7 0 0 5 7 5 7

36004F 2 79 0 0 2 79 2 79

360051* 0 0 0 0 0 0 0 0

360064 0 0 0 0 0 0 0 0

360066 0 0 0 0 0 0 0 0

360068 11 11 0 0 11 11 11 11

36007F 41 40 0 0 41 40 44 42

360084 7 3 0 0 7 3 7 3

360099 30 27 0 0 30 27 30 27

360112 16 14 0 0 16 14 16 14

360137 77 52 0 0 77 52 104 76

360163 61 0 0 0 61 0 61 0

360180 1 3 0 0 1 3 1 3

360229 7 5 0 0 7 5 12 15

362500 322 308 0 0 322 308 322 308

362501 75 73 0 0 75 73 75 73

362502 119 115 0 0 119 115 119 115

362503 94 97 0 0 94 97 94 97

362504 107 108 0 0 107 108 163 163

362505 117 108 0 0 117 108 117 108

362508 64 70 0 0 64 70 88 97

362509 101 100 1 0 102 100 126 118

362512 158 125 0 0 158 125 203 171

362514 19 18 0 0 19 18 19 18

362516 62 54 0 0 62 54 67 61

362517# 0 0 0 0 0 0 0 0

362518 43 39 0 0 43 39 55 55

362519 61 67 0 0 61 67 61 67

362520 61 65 0 0 61 65 68 74

362521 93 77 0 0 93 77 93 77

362522 47 43 0 0 47 43 47 43

68

362523 77 72 0 0 77 72 77 72

362524 97 85 0 0 97 85 97 85

362526 0 0 0 0 0 0 22 20

362528 90 79 0 0 90 79 90 79

362529 0 0 0 0 0 0 12 15

362530 64 61 0 0 64 61 64 61

362531 71 70 0 0 71 70 81 83

362534 18 23 0 0 18 23 21 24

362535# 0 0 0 0 0 0 0 0

362537 70 71 0 0 70 71 70 71

362539 63 65 0 0 63 65 63 65

362541 0 0 0 0 0 0 31 37

362542 0 0 0 0 0 0 47 43

362543 81 76 0 0 81 76 114 107

362545 38 37 0 0 38 37 38 37

362547 69 74 0 0 69 74 81 84

362549 110 109 0 0 110 109 122 122

362551 33 34 0 0 33 34 40 43

362552 71 76 0 0 71 76 71 76

362553 190 221 0 0 190 221 190 222

362554 68 60 1 0 69 60 77 70

362556 0 0 0 0 0 0 12 16

362557 22 24 0 0 22 24 22 24

362558 102 107 0 0 102 107 102 107

362559 102 94 0 0 102 94 126 120

362560 87 83 0 0 87 83 106 86

362561 55 59 0 0 55 59 62 64

362562 55 57 1 0 56 57 65 66

362563 32 31 0 0 32 31 32 31

362564 2 15 0 0 2 15 21 15

362566 39 36 0 0 39 36 39 36

362567 102 89 0 0 102 89 102 89

362568 119 117 0 0 119 117 119 117

362569 238 234 0 0 238 234 238 234

362570 0 0 0 0 0 0 47 72

362571 26 29 0 0 26 29 26 29

362565 61 61 0 0 61 61 64 62

362575 44 40 0 0 44 40 48 43

362576 83 94 0 0 83 94 109 112

362577 204 230 0 0 204 230 204 231

362578 0 0 0 0 0 0 23 30

362579 59 59 0 0 59 59 69 72

362580 41 43 0 0 41 43 41 44

362581 38 41 0 0 38 41 38 41

362582 165 162 0 0 165 162 165 162

362583 57 41 0 0 57 41 57 41

69

362584 64 61 0 0 64 61 64 61

362585 81 72 0 0 81 72 81 72

362587 45 41 0 0 45 41 49 46

362589 51 56 0 0 51 56 51 56

362590 68 68 0 0 68 68 68 68

362591 109 110 0 0 109 110 109 110

362592 77 69 0 0 77 69 99 95

362593 0 90 0 0 0 90 95 90

362594 47 48 0 0 47 48 62 62

362595 247 242 0 0 247 242 247 242

362596# 0 0 0 0 0 0 0 0

362597 42 42 0 0 42 42 46 50

362598 112 105 0 0 112 105 156 156

362599 42 42 0 0 42 42 42 42

362600 96 91 0 0 96 91 158 156

362602 56 62 0 0 56 62 56 62

362603 0 57 0 0 0 57 63 57

362604 105 110 0 0 105 110 105 110

362607 119 116 0 0 119 116 119 116

362608 0 0 0 0 0 0 19 12

362609 41 34 0 0 41 34 57 49

362610 22 31 0 0 22 31 26 31

362611 129 128 0 0 129 128 129 128

362612 62 62 0 0 62 62 62 62

362613 57 59 0 0 57 59 105 113

362614 27 33 0 0 27 33 33 39

362616 38 39 0 0 38 39 38 39

362617 42 51 0 0 42 51 42 51

362618 57 66 0 0 57 66 57 66

362619 108 101 0 0 108 101 108 101

362620 59 60 0 0 59 60 59 60

362621 55 54 0 0 55 54 55 54

362622 42 36 0 0 42 36 44 39

362623 67 73 0 0 67 73 67 73

362624 79 77 0 0 79 77 79 77

362625 55 56 0 0 55 56 78 73

362626 25 0 0 0 25 0 25 0

362627 119 116 0 0 119 116 129 125

362628 77 73 0 0 77 73 77 73

362629 62 46 0 0 62 46 62 46

362630 42 38 0 0 42 38 56 46

362631 60 52 0 0 60 52 60 52

362632 28 39 0 0 28 39 28 39

362633 56 57 0 0 56 57 56 57

362634 0 0 1 0 1 0 31 36

362635 45 38 0 0 45 38 45 38

70

362636 76 76 0 0 76 76 76 76

362637 57 60 0 0 57 60 57 60

362638 19 22 0 0 19 22 19 22

362639 21 19 0 0 21 19 21 19

362640 55 56 0 0 55 56 55 56

362641 78 72 0 0 78 72 78 72

362642 19 22 0 0 19 22 21 23

362643 83 77 0 0 83 77 93 87

362644 47 54 0 0 47 54 55 62

362645 47 45 1 0 48 45 57 58

362646 43 49 0 0 43 49 53 55

362647 60 61 0 0 60 61 60 61

362648 77 67 0 0 77 67 90 80

362649 74 78 0 0 74 78 86 89

362650 52 52 0 0 52 52 52 52

362651 63 67 0 0 63 67 63 67

362652 38 40 0 0 38 40 38 40

362653 115 121 0 0 115 121 116 123

362654 34 32 0 0 34 32 34 32

362655 36 34 1 0 37 34 43 37

362656 89 82 0 0 89 82 147 127

362657 108 119 0 0 108 119 129 138

362659 26 35 0 0 26 35 26 35

362660 0 0 0 0 0 0 6 10

362661 68 74 0 0 68 74 68 74

362662 23 24 0 0 23 24 30 29

362663 7 0 0 0 7 0 7 0

362664 55 50 0 0 55 50 55 50

362665 32 37 0 0 32 37 41 51

362666 61 61 0 0 61 61 61 61

362667 16 14 0 0 16 14 16 14

362668 75 71 0 0 75 71 75 71

362669 77 75 1 2 78 77 91 86

362670 37 33 0 0 37 33 38 35

362671 29 31 0 0 29 31 31 37

362672 31 29 0 0 31 29 31 29

362674 24 22 0 0 24 22 24 22

362675 35 29 0 0 35 29 37 31

362677 72 56 1 0 73 56 81 64

362678 94 86 0 0 94 86 94 86

362679 80 94 0 0 80 94 100 110

362680 61 72 0 0 61 72 61 72

362681 46 47 0 0 46 47 46 47

362682 20 22 0 0 20 22 26 26

362683 35 34 0 0 35 34 35 34

362684 34 32 0 0 34 32 39 41

71

362685 36 38 0 0 36 38 49 48

362686 61 64 0 0 61 64 64 69

362687 0 0 0 0 0 0 80 81

362688 76 80 0 0 76 80 76 80

362689 0 0 0 0 0 0 11 15

362690 63 58 0 0 63 58 73 73

362691 92 104 0 0 92 104 104 118

362692 7 53 0 0 7 53 43 53

362693 32 28 0 0 32 28 37 31

362694 27 31 0 0 27 31 30 33

362695 11 0 0 0 11 0 11 0

362696 74 70 0 0 74 70 74 70

362697 39 36 0 0 39 36 39 36

362698 33 41 0 0 33 41 33 41

362699 65 79 0 0 65 79 90 105

362700 32 38 0 0 32 38 34 42

362701 16 13 0 0 16 13 16 13

362702 0 0 0 0 0 0 37 23

362703 15 16 0 0 15 16 18 19

362704 70 81 0 0 70 81 80 93

362705 47 54 0 0 47 54 66 72

362706 50 56 0 0 50 56 61 68

362707 27 27 0 0 27 27 27 27

362708 77 78 0 0 77 78 77 78

362709 11 15 0 0 11 15 11 15

362710 42 46 0 0 42 46 42 46

362711^# 0 0 0 0 0 0 2 0

362712 20 24 0 0 20 24 20 24

362713 25 21 0 0 25 21 38 37

362715 39 45 0 0 39 45 39 45

362716 30 28 0 0 30 28 30 28

362717 99 103 0 0 99 103 99 103

362718 0 0 0 0 0 0 11 0

362719 69 72 0 0 69 72 69 72

362720 19 21 0 0 19 21 19 21

362721 0 0 0 0 0 0 37 47

362723 28 22 0 0 28 22 30 23

362724 26 30 0 0 26 30 26 30

362725 44 51 0 0 44 51 44 51

362727 0 0 0 0 0 0 9 8

362728 33 24 0 0 33 24 33 24

362729 30 25 0 0 30 25 35 27

362730 17 18 0 0 17 18 21 20

362731 14 21 0 0 14 21 21 34

362732 25 23 0 0 25 23 30 26

362733 66 76 1 0 67 76 78 88

72

362734 79 80 0 0 79 80 79 80

362735 24 29 0 0 24 29 24 29

362736 62 58 0 0 62 58 63 58

362737 38 29 0 0 38 29 53 44

362738 20 19 0 0 20 19 24 21

362739 47 47 0 0 47 47 47 47

362740 30 27 0 0 30 27 30 27

362741 31 34 0 0 31 34 36 39

362742 64 69 0 0 64 69 64 69

362743 22 23 0 0 22 23 22 23

362744 67 71 0 0 67 71 79 85

362745 43 39 0 0 43 39 43 39

362746 89 88 0 0 89 88 109 112

362747 113 106 0 0 113 106 134 125

362748 37 41 0 0 37 41 37 41

362749 13 30 0 0 13 30 13 30

362750 14 19 0 0 14 19 21 21

362751 38 47 0 0 38 47 39 48

362752 120 103 0 0 120 103 122 106

362753 0 0 0 0 0 0 7 5

362754 67 68 0 0 67 68 67 68

362755 22 0 0 0 22 0 22 0

362756 50 50 0 0 50 50 50 50

362757 51 47 0 0 51 47 51 47

362758 1 77 0 0 1 77 88 77

362759 53 42 0 0 53 42 62 52

362760 13 0 0 0 13 0 13 0

362761 101 99 0 0 101 99 102 101

362762 29 24 0 0 29 24 29 24

362763 24 20 0 0 24 20 31 34

362764 13 0 0 0 13 0 13 0

362765 56 58 0 0 56 58 71 77

362766 26 35 0 0 26 35 30 42

362767 0 0 0 0 0 0 40 28

362768 10 10 0 0 10 10 11 13

362769 14 13 0 0 14 13 14 13

362770 58 56 0 0 58 56 58 56

362771 0 0 0 0 0 0 2 0

362772 48 61 0 0 48 61 48 61

362773 58 58 0 0 58 58 58 58

362774 2 1 0 0 2 1 2 1

362775 48 39 0 0 48 39 60 49

362776 15 38 0 0 15 38 15 38

362777 24 35 0 0 24 35 25 38

362778 55 64 0 0 55 64 55 64

362779 55 49 0 0 55 49 63 56

73

362780 49 57 0 0 49 57 49 57

362781 28 26 0 0 28 26 28 26

362782 28 35 0 0 28 35 28 35

362783 59 73 0 0 59 73 62 80

362784 47 56 0 0 47 56 47 56

362785 42 36 0 0 42 36 42 38

362786 32 41 0 0 32 41 35 42

362787 0 0 0 0 0 0 8 11

362788 17 21 0 0 17 21 18 22

362789 26 29 0 0 26 29 27 29

362790 52 50 0 0 52 50 59 59

362791 24 42 0 0 24 42 29 46

362792 85 75 0 0 85 75 85 75

362793 0 16 0 0 0 16 0 16

362794 0 0 0 0 0 0 7 5

362795 48 58 0 0 48 58 49 58

362796 81 76 0 0 81 76 81 76

362797 6 11 0 0 6 11 7 15

362798 28 37 0 0 28 37 28 37

362799 12 16 0 0 12 16 12 18

362800 0 0 0 0 0 0 0 7

362801 0 0 0 0 0 0 0 13

362802 1 8 0 0 1 8 1 8

362803 0 42 0 0 0 42 0 42

362804 1 8 0 0 1 8 1 10

362805 3 16 0 0 3 16 3 21

362806 0 27 0 0 0 27 0 27

362807 4 19 0 0 4 19 4 19

362808 1 14 0 0 1 14 1 14

362809 0 14 0 0 0 14 0 24

362810 0 48 0 0 0 48 0 51

362811 0 69 0 0 0 69 0 69

362812 0 12 0 0 0 12 0 12

362813 0 39 0 0 0 39 0 39

362814^ 0 0 0 0 0 0 0 31

362815^ 0 18 0 0 0 18 0 19

362816^ 0 13 0 0 0 13 0 14

362817^ 0 4 0 0 0 4 0 4

362818^ 0 14 0 0 0 14 0 14

362819^ 0 7 0 0 0 7 0 7

362820^ 0 7 0 0 0 7 0 7

362821^ 0 4 0 0 0 4 0 4

362822^ 0 65 0 0 0 65 0 65

362823^# 0 0 0 0 0 0 0 0

362824^# 0 0 0 0 0 0 0 0

362825^ 0 0 0 0 0 0 0 0

74

363300 8 7 0 0 8 7 14 15

363303 1 1 0 0 1 1 9 8

363304 15 10 0 0 15 10 18 16

363509 130 140 0 0 130 140 162 173

363510# 0 0 0 0 0 0 0 0

363511 34 31 0 0 34 31 34 31

364000 11 9 0 0 11 9 11 9

368839^ 0 2 0 0 0 2 0 4

368842^ 0 3 0 0 0 3 0 7

368848^ 0 1 0 0 0 1 0 1

OH Totals 14,389 15,118 9 2 14,398 15,120 16,492 17,022

State: Unknown

Hemo PD Total Total In-Center & Home1

Facility CCN 2013 2014 2013

2014 2013 2014 2013 2014

153510* 0 0 0 0 0 0 0 0

360064* 0 0 0 0 0 0 0 0

Unknown Totals 0 0 0 0 0 0 0 0

Network

Hemo PD Total Total In-Center & Home1

2013 2014 20

13 2014 2013 2014 2013 2014

Network Totals 26,212 27,616 16 9 26,228 27,625 30,194 31,535

Source of Information: Facility Survey (CMS 2744) and CROWNWeb Date of Preparation: May 2015 1 The last column of the report displays the total from Table #3 plus total from Table #4 This table includes 163 Veterans Affairs Facility patients for 2013 and 240 Veterans Affairs Facility patients for 2014 ^ Facility not operational in 2013 # Facility not operational in 2014 * Facility does not have a generated 2744 in 2014

75

All Renal Transplant Patients Report (formerly Table 5) Network 9 Created 05/29/2015

Renal Transplant by Transplant Center

As of: 01/01/2014 - 12/31/2014

Total Transplants

Performed Patients Awaiting Transplant

Transplant Center 2013 2014 2013 2014

150017 34 30 136 228

150056 223 213 1,020 966

150084 43 50 156 52

IN Total 300 293 1,312 1,246

180040 72 61 121 205

180067 89 90 393 415

180088 4 4 2 4

KY Total 165 155 516 624

360003 81 99 270 214

360048 84 84 191 213

360051 21 0 0 0

360085 185 225 631 467

360137 83 88 649 672

360163 50 48 50 48

360180 184 139 693 0

360229 11 4 6 9

363300 34 12 27 14

OH Total 733 699 2,517 1,637

76

Renal Transplant Recipient Report (formerly Table 6) Network 9 Created 05/29/2015

Renal Transplant Recipients

As of 01/01/2014 - 12/31/2014

Age Group

Transplant Type

Total Decease

d

Living Relate

d Living

Unrelated Unknow

n 00-04 0 5 2 0 7

05-09 6 2 0 0 8

10-14 7 4 0 0 11

15-19 20 2 0 0 22

20-24 12 11 6 0 29

25-29 21 17 5 0 43

30-34 31 16 12 0 59

35-39 63 16 21 0 100

40-44 59 18 16 0 93

45-49 75 12 26 0 113

50-54 81 17 28 0 126

55-59 91 28 23 0 142

60-64 124 30 27 0 181

65-69 91 18 12 0 121

70-74 49 11 4 0 64

75-79 14 2 3 0 19

80-84 1 0 0 0 1

>=85 0 0 0 0 0

Total 745 209 185 0 1,139

Gender

Transplant Type

Total

Deceased

Living Relate

d

Living Unrelated

Unknown

Female 289 74 60 0 423

Male 456 135 125 0 716

Total 745 209 185 0 1,139

Race

Transplant Type

Total

Deceased

Living Relate

d

Living Unrelated

Unknown

American Indian/Alaska Native 1 0 0 0 1

Asian 11 0 2 0 13

Black or African American 217 22 14 0 253

Multiracial 3 1 1 0 5

Native Hawaiian or Other Pacific Islander 4 1 0 0 5

White 509 185 168 0 862

Not Specified 0 0 0 0 0

Total 745 209 185 0 1,139

Primary Diagnosis

Transplant Type

Total

Deceased

Living Relate

d

Living Unrelated

Unknown

77

Accessory kidney 0 0 0 0 0

Acquired obstructive uropathy 5 2 0 0 7

Acute interstitial nephritis 0 1 0 0 1

Acute kidney failure with acute cortical necrosis 0 0 0 0 0

Acute nephritic syndrome with dense deposit disease 0 0 0 0 0

Acute nephritic syndrome with diffuse crescentic glomerulonephritis

0 0 0 0 0

Acute nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis

0 0 0 0 0

Acute nephritic syndrome with diffuse membranous glomerulonephritis

0 0 0 0 0

Acute nephritic syndrome with diffuse mesangial proliferative glomerulonephritis

0 0 0 0 0

Acute nephritic syndrome with diffuse mesangiocapillary glomerulonephritis

0 0 0 0 0

Acute nephritic syndrome with focal and segmental glomerular lesions

0 0 0 0 0

Acute nephritic syndrome with minor glomerular abnormality 0 0 0 0 0

Acute nephritic syndrome with other morphologic changes 0 0 0 0 0

AIDS nephropathy 1 0 0 0 1

Allergic purpura 0 0 0 0 0

Alport syndrome 0 0 0 0 0

Amyloidosis 0 1 0 0 1

Amyloidosis, unspecified 0 0 0 0 0

Analgesic abuse 0 0 0 0 0

Analgesic nephropathy 0 0 0 0 0

Atherosclerosis of renal artery 0 0 0 0 0

Balkan nephropathy 0 0 0 0 0

Barth syndrome 0 0 0 0 0

Benign neoplasm of left kidney 0 0 0 0 0

Benign neoplasm of right kidney 0 0 0 0 0

Benign neoplasm of unspecified kidney 0 0 0 0 0

Benign neoplasm of urinary organ, unspecified 0 0 0 0 0

Blastic NK-cell lymphoma 0 0 0 0 0

Bone graft failure 0 0 0 0 0

Bone graft infection 0 0 0 0 0

Bone graft rejection 0 0 0 0 0

Bone marrow transplant failure 0 0 0 0 0

Bone marrow transplant infection 0 0 0 0 0

Bone marrow transplant rejection 0 0 0 0 0

Calculus of kidney 0 0 0 0 0

Calculus of kidney with calculus of ureter 0 0 0 0 0

Calculus of urinary tract in diseases classified elsewhere 0 0 0 0 0

Cardiac allograft vasculopathy 0 0 0 0 0

Cholesterol emboli, renal emboli 1 0 0 0 1

Chronic interstitial nephritis 12 2 2 0 16

Chronic nephritic syndrome with diffuse membranous glomerulonephritis

0 0 0 0 0

Chronic nephritic syndrome with diffuse mesangial proliferative glomerulonephritis

0 0 0 0 0

Chronic nephritic syndrome with focal and segmental glomerular lesions

0 0 0 0 0

78

Chronic nephritic syndrome with unspecified morphologic changes

0 0 0 0 0

Chronic pyelonephritis, reflux nephropathy 9 3 0 0 12

Complications of other specified transplanted organ 0 0 0 0 0

Complications of transplanted bone marrow 0 0 0 0 0

Complications of transplanted heart 2 0 0 0 2

Complications of transplanted intestine 0 0 0 0 0

Complications of transplanted kidney 37 8 4 0 49

Complications of transplanted liver 5 0 0 0 5

Complications of transplanted lung 0 0 1 0 1

Complications of transplanted organ unspecified 0 1 0 0 1

Complications of transplanted pancreas 0 0 0 0 0

Congenital hernia of bladder 0 0 0 0 0

Congenital hydronephrosis 0 0 0 0 0

Congenital malformation of kidney, unspecified 0 0 0 0 0

Congenital malformation syndromes involving early overgrowth 0 0 0 0 0

Congenital malformation syndromes predominantly involving limbs

0 0 0 0 0

Congenital megaureter 0 0 0 0 0

Congenital nephrotic syndrome 0 2 0 0 2

Congenital obstruction of ureterpelvic junction 2 1 0 0 3

Congenital obstruction of uretrovesical junction 1 1 0 0 2

Congenital occlusion of ureter, unspecified 0 0 0 0 0

Congenital occlusion of ureteropelvic junction 0 0 0 0 0

Congenital occlusion of ureterovesical orifice 0 0 0 0 0

CR(E)ST syndrome 0 0 0 0 0

Cutaneous T-cell lymphoma, unspecified, extranodal and solid organ sites

0 0 0 0 0

Cutaneous T-cell lymphoma, unspecified, unspecified site 0 0 0 0 0

Cystic dilatation of collecting ducts 0 0 0 0 0

Cystinosis 2 0 0 0 2

Cystinuria 0 0 0 0 0

Defects in glycoprotein degradation 0 0 0 0 0

Defects in post-translational modification of lysosomal enzymes 0 0 0 0 0

Dense deposit disease, MPGN type 2 1 0 0 0 1

Diabetes with renal manifestations Type 1 65 11 12 0 88

Diabetes with renal manifestations Type 2 162 21 24 0 207

Diffuse follicle center lymphoma, extranodal and solid organ sites

0 0 0 0 0

Diffuse follicle center lymphoma, unspecified site 0 0 0 0 0

Disorder of glycoprotein metabolism, unspecified 0 0 0 0 0

Disorders of amino-acid transport, unspecified 0 0 0 0 0

Disorders of pyruvate metabolism and gluconeogenesis 0 0 0 0 0

Drash syndrome, mesangial sclerosis 0 2 0 0 2

Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease

0 0 0 0 0

Drug or chemical induced diabetes mellitus with diabetic nephropathy

0 0 0 0 0

Drug or chemical induced diabetes mellitus with other diabetic kidney complication

0 0 0 0 0

Drug-induced systemic lupus erythematosus 0 0 0 0 0

79

Ectopic kidney 0 0 0 0 0

Endocarditis in systemic lupus erythematosus 0 0 0 0 0

Etiology uncertain 30 9 9 0 48

Fabry (-Anderson) disease 0 0 0 0 0

Fabry's disease 2 0 0 0 2

Focal Glomerulonephritis, focal sclerosing GN 43 14 12 0 69

Gaucher disease 0 0 0 0 0

Gestational edema with proteinuria, unspecified trimester 0 0 0 0 0

Gestational proteinuria, unspecified trimester 0 0 0 0 0

Glomerular disease in systemic lupus erythematosus 0 0 0 0 0

Glomerular disorders in diseases classified elsewhere 0 0 0 0 0

Glomerulonephritis (GN) (histologically not examined) 30 7 11 0 48

Goodpasture's syndrome 1 1 0 0 2

Gout due to renal impairment, left ankle and foot 0 0 0 0 0

Gout due to renal impairment, left elbow 0 0 0 0 0

Gout due to renal impairment, left hand 0 0 0 0 0

Gout due to renal impairment, left hip 0 0 0 0 0

Gout due to renal impairment, left knee 0 0 0 0 0

Gout due to renal impairment, left shoulder 0 0 0 0 0

Gout due to renal impairment, left wrist 0 0 0 0 0

Gout due to renal impairment, multiple sites 0 0 0 0 0

Gout due to renal impairment, right ankle and foot 0 0 0 0 0

Gout due to renal impairment, right elbow 0 0 0 0 0

Gout due to renal impairment, right hand 0 0 0 0 0

Gout due to renal impairment, right hip 0 0 0 0 0

Gout due to renal impairment, right knee 0 0 0 0 0

Gout due to renal impairment, right shoulder 0 0 0 0 0

Gout due to renal impairment, right wrist 0 0 0 0 0

Gout due to renal impairment, unspecified ankle and foot 0 0 0 0 0

Gout due to renal impairment, unspecified elbow 0 0 0 0 0

Gout due to renal impairment, unspecified hand 0 0 0 0 0

Gout due to renal impairment, unspecified hip 0 0 0 0 0

Gout due to renal impairment, unspecified knee 0 0 0 0 0

Gout due to renal impairment, unspecified shoulder 0 0 0 0 0

Gout due to renal impairment, unspecified site 0 0 0 0 0

Gout due to renal impairment, unspecified wrist 0 0 0 0 0

Gout due to renal impairment, vertebrae 0 0 0 0 0

Gouty nephropathy 0 0 0 0 0

Hartnup's disease 0 0 0 0 0

Heart transplant failure 0 0 0 0 0

Heart transplant infection 0 0 0 0 0

Heart transplant rejection 0 0 0 0 0

Heart-lung transplant failure 0 0 0 0 0

Heart-lung transplant infection 0 0 0 0 0

Heart-lung transplant rejection 0 0 0 0 0

Hemolytic uremic syndrome 3 0 0 0 3

80

Hemolytic-uremic syndrome 0 0 0 0 0

Henoch-Schonlein syndrome 0 2 0 0 2

Hepatorenal syndrome 15 0 0 0 15

Hereditary nephritis, Alport's syndrome 2 3 4 0 9

Hereditary nephropathy, not elsewhere classified with dense deposit disease

0 0 0 0 0

Hereditary nephropathy, not elsewhere classified with diffuse crescentic glomerulonephritis

0 0 0 0 0

Hereditary nephropathy, not elsewhere classified with diffuse membranous glomerulonephritis

0 0 0 0 0

Hereditary nephropathy, not elsewhere classified with focal and segmental glomerular lesions

0 0 0 0 0

Hereditary nephropathy, not elsewhere classified with minor glomerular abnormality

0 0 0 0 0

Hereditary nephropathy, not elsewhere classified with other morphologic lesions

0 0 0 0 0

Hereditary nephropathy, not elsewhere classified with unspecified morphologic lesions

0 0 0 0 0

Human immunodeficiency virus [HIV] disease 0 0 0 0 0

Hyperoxaluria 0 0 0 0 0

Hyperplastic and giant kidney 0 0 0 0 0

Hypersensitivity angiitis 0 0 0 0 0

Hypertension: Unspecified with renal failure 142 45 30 0 217

Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease

0 0 0 0 0

IgA nephropathy, Berger's disease (proven by immunofluorescence)

15 13 6 0 34

IgM nephropathy (proven by immunofluorescence) 1 0 2 0 3

Ill-defined and unknown cause of mortality 0 0 0 0 0

Illness, unspecified 0 0 0 0 0

Intestine transplant failure 0 0 0 0 0

Intestine transplant infection 0 0 0 0 0

Intestine transplant rejection 0 0 0 0 0

Ischemia and infarction of kidney 0 0 0 0 0

Isolated proteinuria with dense deposit disease 0 0 0 0 0

Isolated proteinuria with diffuse crescentic glomerulonephritis 0 0 0 0 0

Isolated proteinuria with diffuse membranous glomerulonephritis

0 0 0 0 0

Isolated proteinuria with focal and segmental glomerular lesions

0 0 0 0 0

Isolated proteinuria with minor glomerular abnormality 0 0 0 0 0

Isolated proteinuria with other morphologic lesion 0 0 0 0 0

Isolated proteinuria with unspecified morphologic lesion 0 0 0 0 0

Juvenile polyarteritis 0 0 0 0 0

Kidney transplant failure 0 0 0 0 0

Kidney transplant infection 0 0 0 0 0

Kidney transplant rejection 0 0 0 0 0

Lead nephropathy 0 1 0 0 1

Lead-induced chronic gout, left ankle and foot, with tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, left ankle and foot, without tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, left elbow, with tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, left elbow, without tophus (tophi) 0 0 0 0 0

81

Lead-induced chronic gout, left hand, with tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, left hand, without tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, left hip, with tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, left hip, without tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, left knee, with tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, left knee, without tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, left shoulder, with tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, left shoulder, without tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, left wrist, with tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, left wrist, without tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, multiple sites, with tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, multiple sites, without tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, right ankle and foot, with tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, right ankle and foot, without tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, right elbow, with tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, right elbow, without tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, right hand, with tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, right hand, without tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, right hip, with tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, right hip, without tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, right knee, with tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, right knee, without tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, right shoulder, with tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, right shoulder, without tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, right wrist, with tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, right wrist, without tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, unspecified ankle and foot, with tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, unspecified ankle and foot, without tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, unspecified elbow, with tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, unspecified elbow, without tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, unspecified hand, with tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, unspecified hand, without tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, unspecified hip, with tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, unspecified hip, without tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, unspecified knee, with tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, unspecified knee, without tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, unspecified shoulder, with tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, unspecified shoulder, without tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, unspecified site, with tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, unspecified site, without tophus (tophi)

0 0 0 0 0

82

Lead-induced chronic gout, unspecified wrist, with tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, unspecified wrist, without tophus (tophi)

0 0 0 0 0

Lead-induced chronic gout, vertebrae, with tophus (tophi) 0 0 0 0 0

Lead-induced chronic gout, vertebrae, without tophus (tophi) 0 0 0 0 0

Liver transplant failure 0 0 0 0 0

Liver transplant infection 0 0 0 0 0

Liver transplant rejection 0 0 0 0 0

Lobulated, fused and horseshoe kidney 0 0 0 0 0

Lung involvement in systemic lupus erythematosus 0 0 0 0 0

Lung transplant failure 0 0 0 0 0

Lung transplant infection 0 0 0 0 0

Lung transplant rejection 0 0 0 0 0

Lupus erythematosus, (SLE nephritis) 16 3 4 0 23

Lymphoma of kidneys 0 0 0 0 0

Malignant neoplasm of left kidney, except renal pelvis 0 0 0 0 0

Malignant neoplasm of right kidney, except renal pelvis 0 0 0 0 0

Malignant neoplasm of unspecified kidney, except renal pelvis 0 0 0 0 0

Malignant neoplasm of urinary organ, unspecified 0 0 0 0 0

Mature T/NK-cell lymphomas, unspecified, extranodal and solid organ sites

0 0 0 0 0

Mature T/NK-cell lymphomas, unspecified, unspecified site 0 0 0 0 0

Mediastinal (thymic) large B-cell lymphoma, extranodal and solid organ sites

0 0 0 0 0

Mediastinal (thymic) large B-cell lymphoma, unspecified site 0 0 0 0 0

Medullary cystic disease, including nephronophthisis 2 0 1 0 3

Medullary cystic kidney 0 0 0 0 0

Megaloureter 0 0 0 0 0

Membranoproliferative GN type 1, diffuse MPGN 5 2 1 0 8

Membranous nephropathy 7 2 6 0 15

Microscopic polyangiitis 0 0 0 0 0

Multiple myeloma 3 0 0 0 3

Multiple myeloma not having achieved remission 0 0 0 0 0

Nephrolithiasis 5 1 0 0 6

Nephropathy caused by other agents 3 1 1 0 5

Nephropathy due to heroin abuse and related drugs 0 0 0 0 0

Nephropathy induced by heavy metals 0 0 0 0 0

Nephropathy induced by other drugs, medicaments and biological substances

0 0 0 0 0

Nephropathy induced by unspecified drug, medicament or biological substance

0 0 0 0 0

Niemann-Pick disease type A 0 0 0 0 0

Niemann-Pick disease type B 0 0 0 0 0

Niemann-Pick disease type C 0 0 0 0 0

Niemann-Pick disease type D 0 0 0 0 0

Niemann-Pick disease, unspecified 0 0 0 0 0

Non-Hodgkin lymphoma, unspecified, extranodal and solid organ sites

0 0 0 0 0

Non-Hodgkin lymphoma, unspecified, unspecified site 0 0 0 0 0

Other (congenital malformation syndromes) 5 2 2 0 9

83

Other complication of kidney transplant 0 0 0 0 0

Other complications of bone graft 0 0 0 0 0

Other complications of bone marrow transplant 0 0 0 0 0

Other complications of corneal transplant 0 0 0 0 0

Other complications of heart transplant 0 0 0 0 0

Other complications of heart-lung transplant 0 0 0 0 0

Other complications of intestine transplant 0 0 0 0 0

Other complications of liver transplant 0 0 0 0 0

Other complications of lung transplant 0 0 0 0 0

Other complications of other transplanted tissue 0 0 0 0 0

Other complications of unspecified transplanted organ and tissue

0 0 0 0 0

Other conditions related to polyarteritis nodosa 0 0 0 0 0

Other congenital malformation syndromes with other skeletal changes

0 0 0 0 0

Other Congenital obstructive uropathy 2 4 0 0 6

Other disorders of amino-acid transport 0 0 0 0 0

Other disorders of calcium metabolism 1 0 0 0 1

Other disorders of glycoprotein metabolism 0 0 0 0 0

Other forms of systemic lupus erythematosus 0 0 0 0 0

Other immuno proliferative neoplasms (including light chain nephropathy)

0 0 0 0 0

Other mature T/NK-cell lymphomas, extranodal and solid organ sites

0 0 0 0 0

Other mature T/NK-cell lymphomas, unspecified site 0 0 0 0 0

Other Niemann-Pick disease 0 0 0 0 0

Other organ or system involvement in systemic lupus erythematosus

0 0 0 0 0

Other polycystic kidney, infantile type 0 0 0 0 0

Other proliferative GN 3 2 2 0 7

Other renal disorders 12 7 7 0 26

Other sickle-cell disorders with acute chest syndrome 0 0 0 0 0

Other sickle-cell disorders with crisis, unspecified 0 0 0 0 0

Other sickle-cell disorders with splenic sequestration 0 0 0 0 0

Other specified congenital malformation syndromes, not elsewhere classified

0 0 0 0 0

Other specified congenital malformations 0 0 0 0 0

Other specified congenital malformations of kidney 0 0 0 0 0

Other specified diabetes mellitus with diabetic chronic kidney disease

0 0 0 0 0

Other specified diabetes mellitus with diabetic nephropathy 0 0 0 0 0

Other specified diabetes mellitus with other diabetic kidney complication

0 0 0 0 0

Other specified disorders of carbohydrate metabolism 0 0 0 0 0

Other specified disorders of kidney and ureter 0 0 0 0 0

Other specified renal tubulo-interstitial diseases 0 0 0 0 0

Other specified types of non-Hodgkin lymphoma, extranodal and solid organ sites

0 0 0 0 0

Other specified types of non-Hodgkin lymphoma, unspecified site

0 0 0 0 0

Other systemic sclerosis 0 0 0 0 0

Other transplanted tissue failure 0 0 0 0 0

84

Other transplanted tissue infection 0 0 0 0 0

Other transplanted tissue rejection 0 0 0 0 0

Other Vasculitis and its derivatives 1 2 3 0 6

Pericarditis in systemic lupus erythematosus 0 0 0 0 0

Poisoning by unspecified nonopioid analgesic, antipyretic and antirheumatic, accidental (unintentional), initial encounter

0 0 0 0 0

Poisoning by unspecified nonopioid analgesic, antipyretic and antirheumatic, assault, initial encounter

0 0 0 0 0

Poisoning by unspecified nonopioid analgesic, antipyretic and antirheumatic, intentional self-harm, initial encounter

0 0 0 0 0

Poisoning by unspecified nonopioid analgesic, antipyretic and antirheumatic, undetermined, initial encounter

0 0 0 0 0

Polyarteritis 0 0 0 0 0

Polyarteritis nodosa 0 0 0 0 0

Polyarteritis with lung involvement [Churg-Strauss] 0 0 0 0 0

Polycystic kidney, adult type 0 0 0 0 0

Polycystic kidneys, adult type (dominant) 46 15 31 0 92

Polycystic, infantile (recessive) 2 2 0 0 4

Post infectious GN, SBE 0 0 0 0 0

Post partum renal failure 0 0 0 0 0

Potter's syndrome 0 0 0 0 0

Pregnancy related renal disease, unspecified trimester 0 0 0 0 0

Primary oxalosis 0 0 0 0 0

Progressive systemic sclerosis 0 0 0 0 0

Prune belly syndrome 2 0 1 0 3

Pseudohypoparathyroidism 0 0 0 0 0

Radiation nephritis 0 1 0 0 1

Renal agenesis, bilateral 0 0 0 0 0

Renal agenesis, unilateral 0 0 0 0 0

Renal agenesis, unspecified 0 0 0 0 0

Renal artery occlusion 0 0 0 0 0

Renal artery stenosis 1 0 0 0 1

Renal hypoplasia, bilateral 0 0 0 0 0

Renal hypoplasia, dysplasia, oligonephronia 11 4 2 0 17

Renal hypoplasia, unilateral 0 0 0 0 0

Renal hypoplasia, unspecified 0 0 0 0 0

Renal tubulo-interstitial disease, unspecified 0 0 0 0 0

Renal tubulo-interstitial disorders in diseases classified elsewhere

0 0 0 0 0

Renal tumor (benign) 0 0 1 0 1

Renal tumor (malignant) 0 1 1 0 2

Renal tumor (unspecified) 1 0 1 0 2

Scleroderma 0 0 0 0 0

Secondary GN, other 4 1 0 0 5

Sicca syndrome with tubulo-interstitial nephropathy 0 0 0 0 0

Sickle cell disease/anemia 0 0 0 0 0

Sickle cell trait and other sickle cell (HbS/Hb other) 0 0 0 0 0

Sickle-cell disease without crisis 0 0 0 0 0

Smith-Lemli-Opitz syndrome 0 0 0 0 0

85

Sphingolipidosis, unspecified 0 0 0 0 0

Systemic lupus erythematosus, organ or system involvement unspecified

0 0 0 0 0

Systemic lupus erythematosus, unspecified 0 0 0 0 0

Systemic sclerosis induced by drug and chemical 0 0 0 0 0

Systemic sclerosis with lung involvement 0 0 0 0 0

Systemic sclerosis with myopathy 0 0 0 0 0

Systemic sclerosis with polyneuropathy 0 0 0 0 0

Systemic sclerosis, unspecified 0 0 0 0 0

Toxic effect of lead and its compounds, accidental (unintentional), initial encounter

0 0 0 0 0

Toxic effect of lead and its compounds, assault, initial encounter

0 0 0 0 0

Toxic effect of lead and its compounds, intentional self-harm, initial encounter

0 0 0 0 0

Toxic effect of lead and its compounds, undetermined, initial encounter

0 0 0 0 0

Toxic nephropathy, not elsewhere classified 0 0 0 0 0

Traumatic or surgical loss of kidney(s) 0 1 0 0 1

Trimethylaminuria 0 0 0 0 0

Tuberous sclerosis 2 0 0 0 2

Tubular necrosis (no recovery) 7 0 1 0 8

Tubulo-interstitial nephropathy in systemic lupus erythematosus

0 0 0 0 0

Type 1 diabetes mellitus with diabetic chronic kidney disease 0 0 0 0 0

Type 1 diabetes mellitus with diabetic nephropathy 0 0 0 0 0

Type 1 diabetes mellitus with other diabetic kidney complication

0 0 0 0 0

Type 2 diabetes mellitus with diabetic chronic kidney disease 0 0 0 0 0

Type 2 diabetes mellitus with diabetic nephropathy 0 0 0 0 0

Type 2 diabetes mellitus with other diabetic kidney complication

0 0 0 0 0

Unspecified B-cell lymphoma, extranodal and solid organ sites 0 0 0 0 0

Unspecified B-cell lymphoma, unspecified site 0 0 0 0 0

Unspecified complication of bone graft 0 0 0 0 0

Unspecified complication of bone marrow transplant 0 0 0 0 0

Unspecified complication of corneal transplant 0 0 0 0 0

Unspecified complication of heart transplant 0 0 0 0 0

Unspecified complication of heart-lung transplant 0 0 0 0 0

Unspecified complication of intestine transplant 0 0 0 0 0

Unspecified complication of kidney transplant 0 0 0 0 0

Unspecified complication of liver transplant 0 0 0 0 0

Unspecified complication of lung transplant 0 0 0 0 0

Unspecified complication of other transplanted tissue 0 0 0 0 0

Unspecified complication of unspecified transplanted organ and tissue

0 0 0 0 0

Unspecified nephritic syndrome with dense deposit disease 0 0 0 0 0

Unspecified nephritic syndrome with diffuse crescentic glomerulonephritis

0 0 0 0 0

Unspecified nephritic syndrome with diffuse membranous glomerulonephritis

0 0 0 0 0

Unspecified nephritic syndrome with focal and segmental glomerular lesions

0 0 0 0 0

86

Unspecified nephritic syndrome with minor glomerular abnormality

0 0 0 0 0

Unspecified nephritic syndrome with other morphologic changes

0 0 0 0 0

Unspecified nephritic syndrome with unspecified morphologic changes

0 0 0 0 0

Unspecified transplanted organ and tissue failure 0 0 0 0 0

Unspecified transplanted organ and tissue infection 0 0 0 0 0

Unspecified transplanted organ and tissue rejection 0 0 0 0 0

Urinary calculus, unspecified 0 0 0 0 0

Urinary tract tumor (benign) 0 0 0 0 0

Urinary tract tumor (malignant) 0 0 0 0 0

Urinary tract tumor (unspecified) 0 0 0 0 0

Urolithiasis 0 0 0 0 0

Wegener's granulomatosis 2 0 0 0 2

Wegener's granulomatosis with renal involvement 0 0 0 0 0

Wegener's granulomatosis without renal involvement 0 0 0 0 0

With lesion of rapidly progressive GN 4 1 0 0 5

Not Specified 9 6 3 0 18

Total 745 209 185 0 1,139

87

Dialysis Death Report (formerly Table 7) Network 9 Created 05/29/2015

Dialysis Deaths

As of 01/01/2014 - 12/31/2014

Age Group IN KY OH Other Total

00-04 1 0 0 0 1

05-09 0 0 1 0 1

10-14 0 0 0 0 0

15-19 0 0 1 0 1

20-24 2 1 4 0 7

25-29 9 5 16 1 31

30-34 9 11 21 1 42

35-39 21 10 41 2 74

40-44 18 28 55 2 103

45-49 47 42 97 3 189

50-54 92 77 184 7 360

55-59 144 86 274 8 512

60-64 182 136 366 15 699

65-69 219 160 493 22 894

70-74 257 154 462 34 907

75-79 230 178 513 24 945

80-84 175 134 486 28 823

>=85 226 121 479 25 851

Total 1,632 1,143 3,493 172 6,440

Gender IN KY OH Other Total

Female 726 508 1,539 57 2,830

Male 906 635 1,954 115 3,610

Not Specified 0 0 0 0 0

Total 1,632 1,143 3,493 172 6,440

Race IN KY OH Other Total

American Indian/Alaska Native 1 0 1 0 2

Asian 5 6 13 1 25

Black or African American 300 183 844 27 1,354

Multiracial 1 0 1 0 2

Native Hawaiian or Other Pacific Islander 3 1 1 0 5

White 1,321 951 2,630 144 5,046

Not Specified 1 2 3 0 6

Total 1,632 1,143 3,493 172 6,440

Primary Diagnosis IN KY OH Other Total

Cystic/Hereditary/Congenital Diseases 27 15 52 4 98

Diabetes 754 545 1,642 74 3,015

Glomerulonephritis 65 38 172 8 283

88

Hypertension/Large Vessel Disease 468 321 859 48 1,696

Interstitial Nephritis/Pyelonephritis 31 21 113 6 171

Miscellaneous Conditions 180 119 392 19 710

Neoplasms/Tumors 58 44 158 6 266

Secondary GN/Vasculitis 23 15 45 2 85

Not Specified 26 25 60 5 116

Total 1,632 1,143 3,493 172 6,440

Primary Cause of Death IN KY OH Other Total

Cardiac 501 402 1,248 57 2,208

Endocrine 1 0 3 0 4

Gastro-Intestinal 11 5 25 1 42

Infection 119 76 199 14 408

Liver Disease 16 10 21 0 47

Metabolic 5 7 5 2 19

Not Specified 84 51 154 10 299

Other 838 563 1,755 81 3,237

Vascular 57 29 83 7 176

Total 1,632 1,143 3,493 172 6,440

Source of Information: CROWNWeb Race: The categories are from the CMS-2728 Form Diagnosis: The categories are from the CMS-2728 Form This table cannot be compared to the CMS Facility Survey because the CMS Facility Survey is limited to those deaths reported by only Medicare-approved facilities. This table includes 53 Patient receiving treatment at VA facilities.

89

Vocational Rehabilitation Report (formerly Table 8) Network 9 Created 05/29/2015

Vocational Rehabilitation

As of: 01/01/2014 - 12/31/2014

IN Facility

CCN Aged 18 through

54 Patients Receiving Services from Voc

Rehab

Patients Employed Full-Time or Part-Time

Patients Attending School Full-Time or Part-Time

152543 33 1 5 1

152541 35 0 13 0

152515 31 0 5 0

152537 8 0 2 0

152501 49 0 11 0

153510 67 1 6 0

15003F 10 0 1 0

152601 38 0 11 0

152607 37 2 8 2

152525 41 0 10 0

152500 57 0 20 0

152502 45 0 13 0

152526 20 0 3 0

152516 24 0 3 0

152518 20 0 5 0

152509 28 0 4 0

152510 36 0 8 0

152512 28 0 5 0

152536 21 0 4 0

152592 20 0 1 0

152571 36 0 5 0

152594 12 0 1 0

152579 25 0 4 0

152503 27 0 5 1

152504 35 0 7 0

152507 4 0 2 0

152511 8 0 2 0

152517 18 0 7 0

152514 5 0 0 0

152520 33 0 5 0

152523 9 0 4 0

152522 49 0 10 0

152521 67 0 10 1

152524 29 0 7 0

153522 2 0 0 0

152527 11 0 1 1

152600 5 0 2 0

152530 40 0 13 0

152531 15 0 5 0

90

152532 9 0 1 0

152535 2 0 0 0

152534 10 0 2 0

152544 0 0 0 0

152546 22 0 6 0

152539 5 0 1 0

152538 4 0 0 0

152552 16 0 7 0

152553 7 0 1 0

152545 4 0 0 0

152542 31 0 5 0

152549 20 0 3 0

152582 3 0 1 0

152551 4 0 0 0

152547 72 0 6 0

152554 24 0 5 0

152550 7 0 2 0

152556 20 0 9 0

152602 4 0 2 0

152561 23 0 3 0

152560 24 0 3 1

152562 13 0 2 0

152566 14 0 4 0

152565 11 0 2 0

152564 20 0 3 0

152569 46 0 9 0

150056 0 0 0 0

152558 19 0 3 0

152565 11 0 4 0

152574 5 0 0 0

152573 8 0 0 0

152575 3 0 0 0

152576 20 0 6 0

152606 8 0 0 0

153515 26 0 4 0

152583 6 0 1 0

152598 8 0 1 0

152581 23 0 1 0

152584 8 0 4 0

150056 6 0 3 0

152585 29 0 10 0

152586 3 0 0 0

152588 0 0 0 0

152590 3 0 2 0

152589 5 0 1 0

152591 11 0 3 0

91

152593 27 0 6 0

152604 5 0 2 0

152599 17 0 4 0

152595 25 0 11 0

152597 21 0 9 0

152596 54 0 13 0

152603 7 0 0 0

153517 0 0 0 0

152608 2 0 0 0

152610 9 0 1 0

152609 11 0 6 0

152611 8 0 1 0

152613 5 0 0 0

152612 39 2 17 2

152617 16 0 2 0

152616 16 0 3 0

152614 8 0 0 0

152615 7 0 1 0

152619 9 0 2 0

152618 2 0 0 0

152624 1 0 0 0

152620 8 0 0 0

152621 1 0 0 0

152623 19 0 4 0

152622 5 0 1 0

152625 9 0 0 0

152626 6 0 2 0

150017 0 0 0 0

152628 2 0 1 0

152630 13 0 3 1

152627 9 0 5 0

152629 12 0 1 0

153521 58 0 15 0

152635 12 1 1 0

152631 10 0 3 0

152632 10 0 2 0

152640 9 0 2 0

152634 15 0 3 0

152637 16 0 9 0

152636 11 0 3 0

152639 0 0 0 0

152638 12 0 4 0

150084 0 0 0 0

152642 5 0 1 0

152641 4 0 0 0

152643 9 0 4 0

92

152646 4 0 0 0

152644 9 0 0 0

152645 14 0 0 0

152648 12 0 0 0

152649 21 0 5 0

152647 36 0 5 0

152650 4 0 0 0

152651 8 0 1 1

152652 7 0 0 0

152577 9 0 2 0

152605 7 0 0 0

152567 11 0 3 0

152568 14 0 3 0

152653 25 0 1 0

152654 23 0 9 0

152655 15 0 2 0

152656 1 0 0 0

152658 14 0 1 0

152657 13 0 4 0

152659 8 0 0 0

152662 0 0 0 0

152661 1 0 0 0

152663 1 0 0 0

152660 12 0 1 0

152665 1 0 0 0

152664 4 0 1 0

IN Total 2,513 7 528 11

KY Facility

CCN Aged 18 through

54 Patients Receiving Services from Voc

Rehab

Patients Employed Full-Time or Part-Time

Patients Attending School Full-Time or Part-Time

182503 25 0 3 0

182505 27 0 3 0

182519 26 0 4 0

182552 36 0 8 0

182501 49 2 13 1

182504 29 0 6 0

180088 0 0 0 0

182514 17 0 2 0

182523 23 0 6 0

182518 10 0 1 0

182508 21 0 1 0

182502 5 0 0 0

182509 10 0 0 0

182507 15 0 1 0

182512 10 0 1 0

182513 12 0 2 0

93

182516 25 0 3 0

182517 23 0 0 0

182521 25 0 7 0

18005F 4 0 1 0

182524 17 0 1 0

182526 11 0 0 0

182527 14 0 6 0

182529 12 0 4 0

182530 8 0 2 0

182532 28 0 5 0

182553 14 0 2 0

182533 8 0 0 0

182551 6 0 0 0

182536 15 0 0 0

182534 18 0 7 0

182535 15 0 3 0

182541 14 0 1 0

182538 14 0 0 0

182537 30 0 3 0

182540 19 0 2 0

182543 22 0 6 0

182542 13 0 2 0

182544 19 0 3 0

182547 17 0 3 0

180040 0 0 0 0

180067 0 0 0 0

182548 8 0 0 0

182549 12 0 0 0

182555 13 0 0 0

182556 32 0 5 0

182558 24 0 3 0

180017 10 0 2 0

182561 5 0 1 0

182560 8 0 0 0

182550 12 0 1 0

182557 0 0 0 0

182559 11 0 0 0

182554 12 0 3 0

182562 7 0 0 0

182566 8 0 0 0

182564 4 0 0 1

182565 5 0 0 0

182563 19 0 2 0

182567 18 0 5 0

182568 6 0 0 0

182571 0 0 0 0

94

182570 14 0 1 1

182569 10 0 3 0

182573 6 0 1 0

182565 2 0 0 0

182575 6 1 3 1

182574 7 0 1 0

182576 6 0 2 0

182578 10 0 2 0

182577 4 0 1 0

182580 6 0 1 0

182582 25 0 8 0

182581 29 0 5 0

182583 4 0 2 0

182584 9 0 2 0

182587 23 1 4 0

182586 27 0 6 0

182592 10 0 1 0

182588 5 0 1 0

182589 12 0 3 0

182590 10 0 5 0

182591 18 0 4 0

182594 12 0 0 0

182595 11 0 3 0

182596 14 0 1 0

182598 11 0 0 0

182601 20 0 3 0

182597 19 0 4 0

182599 14 0 5 0

182600 10 0 3 0

182602 8 0 2 0

182604 18 0 1 0

182603 8 0 1 0

182605 6 0 1 0

182607 12 0 0 0

182606 7 0 2 0

182608 2 0 0 0

182609 8 0 2 0

180067 0 0 0 0

182610 2 0 0 0

182611 13 0 3 0

182612 21 0 4 0

182613 17 0 7 0

182614 6 0 2 0

182615 26 1 3 1

182616 1 0 0 0

182618 9 0 1 0

95

182617 2 0 0 0

182619 17 0 3 0

182621 17 0 3 0

182620 13 0 2 1

182622 4 0 0 0

182624 14 0 2 0

182623 15 0 7 0

182625 20 1 4 0

182626 4 0 1 0

182627 27 0 7 0

182628 0 0 0 0

KY Total 1,571 6 267 6

OH Facility

CCN Aged 18 through

54 Patients Receiving Services from Voc

Rehab

Patients Employed Full-Time or Part-Time

Patients Attending School Full-Time or Part-Time

363300 5 0 0 0

360163 0 0 0 0

360003 0 0 0 0

362502 38 0 5 0

362504 60 0 9 0

362512 37 0 11 0

362796 20 0 1 0

36007F 3 0 0 0

360009 17 0 0 0

362509 35 0 6 0

360048 3 0 0 0

360024 16 0 2 0

362607 32 0 3 0

362501 43 0 8 1

362627 51 0 7 0

362534 3 0 1 0

362514 5 0 1 0

360084 0 0 0 0

362508 27 1 6 0

362503 24 0 4 0

363303 2 0 0 2

362569 84 0 15 0

362591 56 0 7 0

362500 108 1 22 0

362505 24 0 6 0

362589 14 0 6 0

362568 39 0 16 0

36004F 1 0 0 0

362554 13 0 0 0

362559 41 0 5 1

362558 20 0 4 0

96

362521 23 0 5 0

362519 17 0 5 0

362522 12 0 3 0

362516 8 0 0 0

362520 23 0 3 0

362523 11 0 1 0

362524 26 0 4 0

362526 4 0 2 0

362528 24 0 3 0

362529 3 0 2 0

36003F 2 0 0 0

364000 0 0 0 0

362570 35 0 12 0

360180 1 0 0 0

362530 28 0 2 0

362531 27 0 11 0

362604 28 0 4 0

362537 15 0 0 0

362539 17 0 6 0

362541 10 0 3 0

362576 34 0 14 0

362542 16 1 4 1

362545 12 0 2 0

362543 40 0 12 0

362551 7 0 0 0

362547 31 0 4 0

362549 25 0 8 0

362553 57 0 14 0

362552 29 0 3 0

362557 3 0 0 0

362556 3 0 0 0

362562 15 0 0 0

362563 10 0 2 0

362560 36 0 3 0

362566 8 0 0 0

362571 8 0 1 0

362567 38 1 7 1

362575 13 0 4 1

362577 70 0 8 2

362578 12 0 5 0

362564 1 0 0 0

362580 7 0 1 0

362581 6 0 3 0

362565 11 3 6 0

362579 11 0 3 0

362583 9 0 0 0

97

362584 14 0 2 0

362598 64 0 20 0

362590 24 1 7 1

362587 17 1 1 0

362582 41 0 8 0

362594 15 0 4 0

362585 23 0 3 1

362518 11 0 3 0

362597 13 0 1 0

362599 13 0 3 0

362593 32 0 2 0

362608 5 0 0 0

362600 44 4 6 4

362595 98 0 9 0

362592 29 0 4 0

362609 11 0 3 0

362602 11 0 3 0

362614 5 0 0 0

362610 7 1 1 1

362603 7 0 1 0

362613 41 1 13 1

362611 34 0 13 0

362612 16 0 4 0

362622 11 0 3 0

363509 43 2 13 0

362619 26 0 4 0

362616 17 0 3 0

362624 18 0 5 0

362618 14 0 3 0

362626 0 0 0 0

362628 19 0 6 0

362629 14 1 6 1

362632 7 0 0 0

363300 0 0 0 0

360163 0 0 0 0

360180 0 0 0 0

360048 0 0 0 0

360051 0 0 0 0

360064 0 0 0 0

360085 0 0 0 0

360003 0 0 0 0

360137 0 0 0 0

362630 10 1 3 1

362631 8 0 1 0

362634 15 0 4 0

362633 12 0 3 0

98

362625 32 0 5 0

362636 17 0 1 0

362637 18 0 4 0

362642 4 0 0 0

362635 9 0 1 0

362639 0 0 0 0

362644 12 0 3 0

362641 12 0 2 0

362640 21 0 2 1

362638 5 0 0 0

362643 18 0 2 0

362646 7 0 2 0

362651 11 0 3 0

362649 34 0 6 0

362650 25 0 4 1

362647 14 0 1 0

362648 17 0 4 0

362645 19 2 4 2

362652 13 0 1 1

362661 18 0 4 0

362653 38 0 14 0

362654 4 0 2 0

362657 35 0 5 0

362656 33 1 5 1

362655 16 0 2 0

360068 6 0 2 0

362772 9 0 0 0

360112 7 0 1 0

360066 0 0 0 0

360099 5 0 1 0

362754 25 0 0 0

360137 33 0 12 0

362756 17 1 1 0

362755 0 0 0 0

360229 2 0 0 0

362662 13 0 2 0

363304 5 1 0 3

362659 6 0 1 0

362663 0 0 0 0

362666 14 0 5 1

362665 15 0 4 0

362664 15 0 4 0

362668 16 0 1 0

362670 7 0 2 0

362671 7 0 2 0

362660 5 0 1 0

99

362667 0 0 0 0

362669 19 0 1 0

362672 7 0 0 0

362763 9 0 2 0

362677 15 0 2 0

362674 6 0 0 0

362675 7 0 0 0

362683 6 0 2 0

362680 14 0 1 0

362678 25 0 6 0

362682 2 0 1 0

362679 22 0 2 0

362686 21 0 1 0

362681 25 2 2 2

362684 5 0 2 0

362745 9 0 0 0

362694 6 0 0 0

362688 11 0 0 0

362687 25 0 11 0

362691 38 0 5 0

362690 23 0 4 1

362685 10 0 2 0

362689 6 0 3 0

362693 5 0 0 0

362697 3 0 0 0

362692 5 0 0 0

362696 9 0 4 0

362695 0 0 0 0

362700 9 0 6 0

362698 11 0 2 0

362701 5 0 0 0

362715 14 0 2 0

362703 6 0 1 0

362712 7 0 0 0

362709 0 0 0 0

362706 10 0 3 0

362710 7 0 1 0

362705 31 0 13 0

362702 12 0 4 0

362699 28 0 5 0

362704 16 0 7 0

362707 8 0 3 0

362718 0 0 0 0

362716 7 0 1 0

362713 15 0 4 0

362708 23 0 9 0

100

362721 15 0 2 0

362720 2 0 0 0

362717 18 0 5 0

362724 5 0 0 0

362723 9 0 2 0

362728 3 0 0 0

362730 3 0 2 0

362725 8 0 4 0

362731 9 0 1 0

362719 29 1 3 1

362733 16 0 2 0

362732 8 0 1 0

362729 8 0 0 0

362727 3 0 1 0

362734 27 0 3 0

362736 18 0 2 0

362738 7 0 1 0

362735 8 0 0 0

362739 13 0 1 0

363511 2 0 1 0

362740 4 0 0 0

362737 4 0 2 0

362741 7 1 1 1

362742 17 0 6 0

362743 3 0 0 0

362744 19 0 3 0

362751 7 0 3 0

362752 24 2 3 1

362748 12 0 2 0

362746 31 0 11 0

362749 3 0 2 0

362747 35 0 14 0

362757 10 0 4 0

362759 18 0 4 1

360229 0 0 0 0

362760 0 0 0 0

362750 3 0 1 0

362764 0 0 0 0

362761 25 0 5 0

362753 4 1 1 1

362758 2 0 0 0

362771 0 0 0 0

362765 11 0 2 0

362762 8 0 1 0

362775 9 0 2 0

362769 5 0 0 0

101

362767 11 1 1 0

362770 12 0 2 0

362766 12 0 2 0

362768 5 0 1 0

362776 8 0 0 0

362777 7 0 2 0

362773 16 1 6 1

362780 19 0 2 0

362774 1 0 0 0

362778 4 0 0 0

362781 7 0 0 0

362784 20 0 7 0

362782 11 0 0 0

362783 24 0 6 0

362779 22 0 7 0

362621 16 0 0 0

362561 14 0 2 0

362617 13 1 4 0

362623 18 0 5 0

362620 11 1 3 0

362787 2 0 0 0

362788 7 0 1 0

362786 12 0 2 0

362789 7 0 2 0

362785 10 0 2 0

362791 12 0 2 0

362794 2 0 0 0

362798 6 0 0 0

362800 4 0 1 0

362792 20 2 2 2

362790 10 1 0 1

362793 2 0 1 0

362797 4 0 1 0

362795 19 0 4 0

362804 7 0 0 0

362799 6 0 1 0

362803 17 0 4 0

362805 6 0 1 0

362808 4 0 1 0

362807 3 0 1 0

362802 3 0 0 0

362813 11 0 1 0

362801 4 0 0 0

36004F 9 0 0 0

362806 3 0 0 0

368839 4 0 0 0

102

362816 5 0 1 0

368842 0 0 0 0

362822 19 0 2 0

362818 4 0 0 0

362815 9 0 2 0

362809 7 0 2 0

362811 17 0 2 0

362810 16 0 1 0

362812 5 0 0 0

362820 1 0 0 0

368848 0 0 0 0

362814 21 0 9 0

362819 2 0 0 0

362817 0 0 0 0

362821 2 0 1 0

362823 0 0 0 0

362824 0 0 0 0

362825 0 0 0 0

OH Total 4,642 38 903 41

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Appendix. Network Staffing and Structure The management staff of ESRD Network 9 consists of:

Executive Director: Susan A. Stark, B.A. Ms. Stark serves as Executive Director of ESRD Network 9 and ESRD Network 10, and is the Chief Executive Officer for NSI, Inc. In these capacities, she is responsible for the successful execution of the ESRD Network contracts held by NSI, as well as the day-to-day operation of ESRD Network 9 and ESRD Network 10. Ms. Stark has served the ESRD Network system since 1980.

Patient Services Director: Kathleen Niccum, Ed.D. Dr. Niccum serves as Director of Patient Services for both ESRD Network 9 and ESRD Network 10. She directs the activities of Patient Services Coordinators in grievance resolution, and works with the Patient Advisory Councils and the Patient and Family Engagement LANs and to develop educational resources and programs for patients. Dr. Niccum has served the ESRD Network system since 1991.

Quality Improvement Director: Raynel Wilson, RN, CNN, CPHQ. Ms. Wilson serves as Quality Improvement Director for ESRD Network 9 and ESRD Network 10. She directs the activities of the Quality Improvement Coordinators in the Fistula First/Catheter Last project, the NHSN HAI LANs and patient safety initiatives, and the AIM 2 Innovation Pilot Projects. Ms. Wilson has served the ESRD Network system since 1997.

Data Manager: Stan Graber, B.S. Mr. Graber serves as Data Manager for ESRD Network 9 and ESRD Network 10. He directs the activities of the Information Management Coordinators. Mr. Graber has served the ESRD Network System since 2013.

Overall, the Network employed 10 full-time staff in 2014.

Network Boards and Committees Network Council The Network Council is composed of representatives of ESRD providers in Illinois (ESRD Network 10), and Indiana, Kentucky, and Ohio (ESRD Network 9) that are certified by the Secretary of Health and Human Services to furnish at least one specific ESRD service. The Council includes a representative of each of the current Medicare approved ESRD facilities, plus the membership of the Board of Directors, the Medical Review Board (MRB) and the Patient Advisory Council (PAC). The Network Council is responsible for the election of members to the Board of Directors (BOD) and the Medical Review Board (MRB). Elections are held by mail-in ballot. The Network Council meets annually. Throughout the year, communications are maintained with the Network Council via newsletters sent via eblasts with updates on Network projects. These communications are also used to solicit input from council members, as well as to seek volunteers for Network projects as needed.

104

The Network Council met on June 17, 2014 via webinar. The agenda included:

TRN Merger with ESRD Network 12 update

Facility ownership overview

Bloodstream Infection rate overview

Review of Network patient population by demographics

Grievance update

AIM 1 quality improvement projects

AIM 1 educational campaigns

Network Patient Representative Program

Vascular access update

Fistula First/Catheter Last Initiative

Affinity Groups

Lifeline for a Lifetime project

HAI LAN activities

AIM 2 On the Road To Home project update

AIM 3 ESRD QIP

5 Diamond Patient Safety Program

Network Facebook and Website updates

The webinar was held for Network 9 and Network 10 facilities. Of the total attendance, 78% were nurse/administrators, 7% were physicians, 11% were social workers, and 4% were dietitians. Following the webinar, an evaluation was emailed to the participants, 43 responded. Results showed: that the majority of respondents (79%) found the agenda topics to be pertinent; 74% responded that these webinars should be held twice per year.

The Network Council participated in the 2014 election to the Medical Review Board and the Board of

Directors. Ballots were mailed in October and results were tallied in November.

105

Board of Directors (BOD) The NSI ESRD Network Board of Directors is responsible for the administration of the ESRD Network contracts for ESRD Networks 9, 10 and 12, and is ultimately responsible for meeting contract deliverables and oversight of the administration of the Network budget. The Board of Directors has 20 members.

2014 Board of Directors Positions by Category

8 Physicians

1 Vascular Access Specialist

1 Administrator

1 Social Worker

1 Dietitian

1 Technician

1 Nurse

Up to 6 ESRD Patients

2014 Board of Directors Meeting Schedule

April 3 - In Person

July 17 - Webinar

September 11 - Webinar

October 23 – In Person

December 17 - Webinar

2014 Board of Directors Membership

Chairperson Christie Thomas, MD, Network 12

MRB Chairs (Ex Officio) Peter DeOreo, MD, Network 9 Tim Pflederer, MD, Network 10 Scott Solcher, MD, Network 12

Nephrologists Deepa Chand, MD, Network 10 Rosemary Ouseph, MD, Network 9

At Large Members

Cass Franklin, MD, Network 12 (Transplant) Patrick Brophy, MD, Network 12 (Pediatrics) Gordon McLennan, MD, Network 9 (IR) Cathy Colombo, RN, Network 10 Bonnie Orlins, MSW, Network 9 Linda Ulerich, RD, Network 9 Laurie Hippensteel, RN, Network 12 Dennis Muter, CHT, Network 9

Patient Representatives Jim Dineen, Network 9 Michael Turner, Network 10 Ardy Boucher, Network 12

Subject Matter Experts Ric Ayers, Network 9 Jim McFarlin, Network 10 Mike Ashley, Network 12

106

During 2014, the Board of Directors:

Ensured that the CMS contract deliverables were met and contract obligations were maintained.

Monitored the Internal Quality Improvement Plan and the Task Manager Internal Quality Improvement Program to gauge the effectiveness of Network efforts.

Reviewed and approved financial reports and expenditure reports related to the CMS contract.

Received and approved the annual audit from the accounting firm Alerding and Associates. The report was delivered with an “unqualified opinion.” This is the highest status that can be earned in the audit process.

Monitored and approved the activities of Network committees, including the MRB, the Vascular Access Advisory Panel, the PAC, the Nominating Committee, the Finance Committee, the Governance Committee, the Audit Committee, and the Strategic Planning Committee.

Received updates on all other activities conducted in conjunction with CMS, the ESRD NCC, the Forum of ESRD Networks, and on ESRD Network contract issues.

Approved the slates for election to the BOD and MRB and monitored the election.

Received updates on the NSI activities toward merger with a QIO partner in anticipation of the 2015 CMS Request for Proposal (RFP) for the 2016 contract award.

107

Medical Review Board (MRB) TRN maintains a Medical Review Board that includes representatives from both ESRD Network 9 and Network 10. The MRB functions with the concurrence of and subject to the review and control of the Board of Directors. The MRB performs functions prescribed by the regulations issued by the Secretary of Health and Human Services, as well as other duties related to quality improvement, vocational rehabilitation, and patient concerns as requested by the Network Council. The MRB is composed of up to 32 elected members plus appointed members who serve in an ad hoc capacity.

2014 MRB Positions by Category – ESRD Network 9 and ESRD Network 10

12 Renal Physicians

2 Pediatric Renal Physicians

Up to 8 ESRD Patients

2 Transplant Physicians

2 ESRD Facility Administrators

2 ESRD Dietitians

2 ESRD Nurses

2 ESRD Social Workers

2 ESRD Technicians

2014 MRB Meeting Schedule

January 8 - Webinar

March 27 – Webinar Orientation

April 2 – In Person Meeting

June 18 – Webinar

October 22 – In Person

2014 MRB Membership

Chairperson Peter B. DeOreo, MD, Network 9 (OH) Tim Pflederer, MD, Network 10 (IL)

ESRD Dietitian Beth Fry, RD, LD (OH) Mary Ellen Brabec, RD (IL)

ESRD Facility Administrator Francine JnBaptiste, RN (OH) Marcia Sorrill (IL)

ESRD Nurse Amanda Northrop, RN (IL) Beth Smith, RN (OH)

ESRD Patients Lorraine Edmond (IN) Yolanda Wynn (OH) Quinetta Taylor (IL) Lana Schmidt (IL)

ESRD Social Workers Craig Fisher, MSW, PhD (IL) Helen Neale, LISW, MSW (OH)

ESRD Technicians Hap Pierce, CHT (OH) Sandra Lynn Hashman, CHT (IN)

Pediatric Renal Physician Rene VanDeVoorde, MD (OH) Roberto Gordillo Perez, MD (IL)

108

Renal Physician Jane Drenkhahn, MD (KY) Robert Heyka, MD (OH) Robin Estes, MD (OH) Marcia Silver, MD (OH) Anthony Dengenhard, DO (OH) Jessica Lucas, DO (OH) Mary Hammes, DO (IL) Bharathi Reddy, MD (IL) George Kim, MD (IL) Rukhsana Muneer, MD (IL)

Transplant Physician Prabir Roy-Chaudhury, MD (OH)

Ad Hoc Members Michael Brier, PhD (KY) Michael Kraus, MD (IN) Ashwini Sehgal, MD (OH)

During 2014, the MRB:

Oversaw the progress of Network quality improvement activities and educational campaigns.

Oversaw the progress of the Network AIM 2 Pilot Innovation Project On The Road To Home. A subcommittee of MRB members acted as an advisory group for this activity.

Oversaw the progress of the Fistula First/Catheter Last activities. A subcommittee of MRB members joined the Vascular Access Advisory Panel (VAAP) which provided direction for this project.

Received updates on all outcomes reported to CMS on the monthly Dashboard Information Form.

Assisted in the dissemination of information on accessing the Dialysis Facility Report compiled by the Kidney Epidemiology Cost Center (KECC), which displays descriptive data from each facility, with comparisons of regional, state, Network and national statistics. The data include demographic and diagnosis data, as well as the standardized mortality rate (SMR) and gross mortality. These profiles are distributed annually to facilities to help them in their continuous quality improvement efforts. The reports provide data for benchmarking, and also provide a comparison to local, state and national trends. In 2014 the reports were available online only through the website www.dialysisreports.org.

Received continuous updates on the activities of CMS and the ESRD Network Statement of Work, the United States Renal Data System (USRDS), the National Coordinating Center, and the Forum of ESRD Networks.

Reviewed data profiles, including incidence, prevalence for ESRD, home therapy, and transplantation.

Reviewed the listing of facilities which received payment reductions in the ESRD QIP and ensured that resources were offered to these facilities to raise their QIP scores.

Reviewed and provided input regarding grievances, patient complaints and facility concerns filed with the Network and reviewed trends and areas of concern.

Received updates on the NSI activities toward merger with a QIO partner in anticipation of the 2015 RFP for the 2016 contract award.

109

Patient Advisory Council (PAC) The purpose of the PAC is to identify and address ESRD patient needs and concerns through the development of educational projects and activities. Membership on the PAC includes patients and dialysis facility staff from Network 9 and Network 10.

2014 Patient Advisory Council – ESRD Network 9 and ESRD Network 10

PAC Meeting Schedule July 25, 2014

2014 PAC Membership

NW Discipline Name

9 Social Worker Laura Blackwell

9 Social Worker Allison Blagg

9 Patient –Transplant James Dineen

9 Patient – Transplant Lorraine Edmond

9 Dietitian Beth Fry

9 Patient – Transplant Barbara Gronefeld

9 Social Worker Helen Neale

9 Patient – Transplant Martinlow Spaulding

9 Patient – In-Center Kathy Thomas

9 Nurse Lynn Winslow

9 Patient – Transplant Yolanda Wynn

10 Nurse Celia Chretien

10 Social Worker Craig Fisher

10 Patient – Transplant Jim McFarlin

10 Patient – Home Lana Schmidt

10 Patient – In-Center Eddie Taylor

10 Patient – In-Center Quinetta Taylor

10 Patient – In-Center Michael Turner

During 2014 the PAC accomplished the following:

Reviewed and discussed recent data trends for both grievances and involuntary discharges (IVDs). Trends were presented for yearly quarter totals, primary area of concern, demographics, staff-related sub categories, quality of care, fear of retaliation (new data collected since 2/2014), at-risk for IVD/T, and actual IVD/T.

Discussed the updated CMS-directed ESRD Network grievance processes.

Discussed the problem of retaliation against patients who file grievances or otherwise register complaints about their care.

Discussed the topic of disparity in the numbers of white patients who choose home therapies over in-center treatment. In recent TRN efforts to increase the number of patients selecting PD or home hemo, many more white patients selected the home modality when compared to patients of color.

110