Congress amended Title XVIII of the Social Security Act in 1978 to establish ESRD Network Organizations. The goals and requirements have evolved over the life of the program and today’s Networks provide ESRD healthcare quality oversight and improvement, resolve patient complaints and grievances and help maintain the ESRD registry. Centers for Medicare & Medicaid Services (CMS) establishes a Statement of Work (SOW) for the Network program and currently contracts individually with 10 organizations to fulfill those requirements for the 18 ESRD Network areas. CMS funds this program by withholding $.50 per dialysis treatment and allocating the pooled resources for ESRD operations.

Excerpt from CMS’ ESRD Network Statement of Work - C.2.2. Role of Network
The Networks are critical to achieving bold CMS goals for health care transformation. The successful Networks will be patient care navigators and 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

The Network is uniquely positioned to ensure full participation of the ESRD community in achieving the Aims of the NQS [National Quality Strategy]. Therefore, this SOW emphasizes:

Network relationship with Medicare beneficiaries

  • Ensuring representation of Medicare beneficiaries in shared decision making related to ESRD care in order to promote person-centeredness and family engagement (NQS Principle 1)
  • Protecting Medicare beneficiaries’ access to and quality of dialysis care, especially among vulnerable populations (NQS Principle 3)

Network relationship with ESRD facilities (NQS Principle 4)

  • Identifying opportunities for quality improvement at the individual facility level and providing technical assistance (NQS Principle 5)
  • Promoting all modalities of care, including home modalities and transplantation, as appropriate, to promote patient independence and improve clinical outcomes (NQS Principle 5)
  • Facilitating processes to promote care coordination between different care settings(NQS Principle 8)
  • Ensuring accurate, complete, consistent,and timely data collection, analysis, and reporting by facilities in accordance with national standards and the ESRD QIP (NQS Principle 6)

Coordination and sharing across 18 Networks

  • Using standardized procedures to collect data and address grievances to promote consistency across Networks (NQS Principle 6)
  • Collaborating to share information such as patient migration across Networks to promote care coordination (NQS Principle 8)
  • Coordinating with regional Quality Improvement Organizations (QIOs) and other recognized subject matter experts in the quality improvement field
  • Sharing information to promote care coordination for ESRD patients (NQS Principle 8)
  • Sharing best practices to improve quality of care for ESRD patients, including Network involvement in LANs (NQS Principle 5)

Network acting on behalf of CMS

  • Conveying information from CMS to facilities on HHS and CMS goals, strategies, policies, and procedures including the ESRD QIP
  • Interpreting and conveying to CMS or its designee information relevant to the ESRD health care system to assist with monitoring and evaluation of policy and program impacts including the effects of the ESRD QIP