1. 2011 ESRD Network of Texas, Inc.Network Coordinating Council Annual Meeting

2. CHAIRMAN’S REPORTMelvin Laski, MD • Network Coordinating Council (NCC) • Composition • Network Elections • Bylaws revision vote • Network Growth • Network Demographics Supporting Quality Care

3. Network Coordinating Council • Composition: • One representative appointed by each certified facility in the Network area (Texas) • Role of representative: • Annually Elect the: • Executive Committee • Nominating Committee • Approve Bylaws revisions • Provide input into activities of the Network

4. Communicating with the NCC Methods • Annual input requested via voluntary survey • Annual Goals & Objectives packet • Sent to NCC Rep • Submission of signed acknowledgement and agreement required

5. NOMINATING COMMITTEE 11-12 • Melvin Laski, MD, Lubbock • Richard Gibney, MD, Waco • Robert Hootkins, MD, Austin • Tom Lowery, MD, Tyler

6. Slate of Officers 11-12 EXECUTIVE COMMITTEE Melvin Laski, MD, Chairman Manny Alvarez, MD, Vice Chairman Larry McGowan, Treasurer Charles Orji, MD , Secretary Richard Gibney, MD Immediate Past Chairman Ruben Velez, MD, MRB Chair Laura Yates, RN, CNN, At Large JD Bell, MD, At Large Leigh Anne Tanzberger, At Large

7. ESRD Network of Texas, Inc. Bylaws Revision • Article IV. • Quorum: • Remove quorum requirements for delegates present at the meeting. • Allow for votes by mail to count in determining quorum. • Remove adjourning and rescheduling meetings due to lack of quorum. • Voting: Change from 2/3 to 1/2 the required delegate votes, with mail vote accepted, to remove an officer, delegate or committee member or to amend the bylaws . • Mail Voting: • Add voting by mail including electronic mail by receipt of the proposal with notice of the meeting, or • after the meeting to absent delegates, with votes counted together with those cast at the meeting if returned within specified time frame. • Count mail votes by delegates in quorum determination. When stated in notice, if a delegate is absent from the meeting and fails to vote by mail within the specified time period, the delegate vote may be counted in favor of the proposal.

8. Article V. • Officers: Replace Executive Committee for Council when secretary presents unaudited financial statements at the end of each fiscal year. • Article VI. • Meeting Notice: Add electronic mail notice. • Action without a Meeting: Replace all with 50% of delegates voting to approve. • Article XI. • Amendments: Replace 2/3 with 1/2 the number of votes required to repeal or amend the bylaws. • Changes to update terminology and agencies:

9. Network Coordinating Council VOTE

10. 2010 Network #14 Growth & Trends • CMS Certified Facilities • Facility Ownership • Growth in Patient Census • Patients Transplanted

11. NETWORK GROWTHNumber of Medicare Certified Providers 20 facilities awaiting Medicare Certification at year end CMS Annual Facility Survey Data

12. Ownership of Dialysis facilities by Percent of facilities 2010

13. National Chain Ownership TX Dialysis facilities 2010

14. Number of Patients, Texas 37,457 9,746 6,387

15. ESRD byPrimary Diagnosis Incident Prevalent

16. Prevalent Primary Diagnosis (%)

17. At the end of 2010 • 48,394 persons were receiving renal replacement therapy • Of these: • 37,457 dialysis • 10,937 transplanted 4,799,762 dialysis treatments delivered in Texas in 2010

18. Self care & Setting

19. Home Dialysis Modality

20. Texas & National Gross Mortality

21. Cause of Death % Diabetic = 57.8

23. Race of Prevalent Patients In Texas

24. Ethnicity Texas ESRD Patients

25. Prevalent Patient Gender (%)

26. Age of Prevalent ESRD patients in Texas 2010 Average Age Prevalent 59

27. Transplants by Race 804 1011 1187 1233 1275 1300 1352

28. Total Transplants by Donor Type

29. Percent of Patients Transplanted

30. Thank you

31. Report from the Executive Director Glenda Harbert, RN, CNN, CPHQ

32. MISSION Statement The ESRD Network of Texas, Inc. supports quality dialysis & kidney transplant healthcare through patient services, education, quality improvement & information management.

33. At year end 2010ESRD Network #14 The second largest Network in number of patients (48,394) at year end behind Network 6 (49,308) • The 3rdlargest Network in number of dialysis Providers (496) behind Network 6 (583) and Network 9 (520)

34. Topics • Overview- Network activities • Involuntary Discharge • TEEC & Disaster Preparedness • DSHS Referrals • The Future

35. Activities of the Network • Quality Improvement • Community Information & Outreach • Information Management

36. Quality Improvement • Quality Improvement Projects • Improving Management of Anemia • Quality of Care Concerns, Elab Data Collection & CPM’s • Vascular Access Improvement Projects • 2 year outliers for clinical labs

37. New Activities in 2010-11 • Patient Specific Profiles • Collaborative Site Visits • Large Nephrology Group Profiles

38. Facility Vascular Access Profile with Patient Specific Data (PSD) PSD Facility Profile PSD: Patient Specific Data

39. Facility Vascular Access Profile with Patient Specific Data (PSD) • I. Overview • Ranking with other Network Facilities • % AVF Utilization Rate • % Catheter Utilization < 90 days & > 90 days • Benchmarking July 2010 Facility Census 99 # of Facility AVFs in Use 56 % of Facility AVFs in Use 56.6

40. Facility Vascular Access Profile with PSD • II. Analysis • Vascular Access Patterns • Three Month Timeframe • Performance Categories

41. Facility Vascular Access Profile with PSD • III. Vascular Access Facility Priorities • Performance Levels – Caution Worse & Worse • Patient Identification Information • Questions designed to trigger a response/action for the specific vascular access per patient

42. Vascular Access Collaborative Site Visits • Based on Tracer methodology • 7 functions • Opening Conference • Tour of the Facility • Review of Key Documents • Patient Interviews • Staff Interviews • QAPI Committee • Exit Conference • 100% would recommend to other units Focus Facilities NW QI Staff CSVs across Texas Non-Maturing, Non-Functioning AVF Long Term Catheter Utilization

43. NW14CORECatheter Reduction CATHETER OPERATION REDUCTION& ELIMINATION • Focus Facilities • >15%Catheters > 90 days • Forum of ESRD Networks • Catheter Reduction Toolkit • Vascular Access Patient Specific Data profiles • Goal: Reduce the % of adult HD patients with catheter > 90 days in 70% of focus facilities • 20 Large Physician Groups • 8 or more physicians • Group Profiles based on payor source of patients who initiate with a catheter ONLY & are followed by a nephrologist prior • Focus on groups with highest catheter rates • Collaboration with TMF

44. Large Nephrology Group Profiles Data source 2728

45. Community Information & Outreach • TEEC & Disaster preparedness • Patient & Provider Technical Assistance & Education • Complaints & Grievances • Involuntary Discharge

46. What is TEEC? The mission of TEEC is to ensure a coordinated preparedness, plan, response and recovery to emergency events affecting the Texas ESRD community.

47. Mikki Ward, RN (Chair) Kelley Harris (Chair Elect) Debbie Heinrich, RN (Secretary) Karen Walton, RN (Treasurer) John Dahlin Eugenia De Los Reves, RN Balbi Godwin, RN Vanessa Guillory, RN Bobbi Wagner Glenda Harbert, RN (ED for Network 14) Doug Havron, RN, MS Becky Heinsohm, RN (consultant) Bonnie Leshikar Kevin Burns Nick Jayne Derek Jakovich, JD (consultant) Minnie Malone, RN (consultant) Connie Oden, RN Glenda Payne, RN (consultant) Alex Rosenblum, RN Narendra Singh Steven Tays Andrea Fichtner, MPH Sylvia Spencer Valerie Ficke TEEC Steering Committee

48. In the last year ….. • Wildfires • Snow, ice storms • Flooding • Brush with hurricanes

49. Disaster Preparation Activities • Drills with EMSystem • Mentoring for independent facilities • Disaster Plan checklist • Webinar

50. New Activities in 2010-11