Management of the Hemodialysis Unit: Core Curriculum 2016

Published:April 29, 2016DOI:
      Although an in-center hemodialysis facility is primarily perceived as a provider of health care, it is also a business that requires a leader. Analogous to the “Triple Aim” of the health care system envisioned by the Centers for Medicare & Medicaid Services (CMS), each hemodialysis facility has its own triple aim: (1) providing each patient with a safe, high-quality, pleasing experience of care; (2) complying with CMS’s certification requirements; and (3) ensuring that the facility remains financially viable. The common denominator for all 3 aims is quality of care, which is a focus for Medicare survey and certification activities, affects patient outcomes and perceptions, and affects payment through the Quality Incentive Program (QIP). The facility medical director is primarily responsible for the Quality Assessment and Performance Improvement (QAPI) program within the facility, but must partner with the facility administrator to ensure that resources are directed to address opportunities for improvement. The responsibilities of the medical director have been addressed in detail in a series of articles that appeared in the Clinical Journal of the American Society of Nephrology in 2015 and will not be extensively discussed in this article. Both the facility administrator and medical director report to the governing body of the facility and may be members of the governing body. It is ultimately the responsibility of the governing body to adopt and enforce rules and policies to allow for safe and effective care delivery in the hemodialysis unit (Box 1). The key responsibilities and qualifications of the facility administrator are summarized in Box 2.
      Key Requirements of the Governing Body
      • Adopt and enforce rules relative to:
        • Facility governance
        • Health care and safety of patients
        • Protection of patients’ personal and property rights
        • General operation of the facility
      • Facilities that are within a dialysis organization with multiple facilities must have a local governing body within each facility
      • The governing body can be 1 person or a group of persons
      • The following must be clear in governing body records:
        • Composition of governing body
        • Who has legal authority for governance and operation of facility
      Facility Administrator
      • Fiscal management
      • Staff training and coverage
      • Medical staff appointments and coverage
      • Quality assessment and process improvement program
      • Internal grievance process for patients
      • Emergency coverage and backup
      • Electronic data submission
      • Relationship with ESRD Network
      • Must possess sufficient educational and practical experience to fulfill expectations of role
      • If also acting as nurse manager, then:
        • Registered nurse
        • At least 12 mo of clinical nursing experience
        • An additional 6 mo of experience providing nursing care to dialysis patients
        • Must be a full-time employee of the facility
        • May not cover >1 facility
      Abbreviation: ESRD, End-Stage Renal Disease.
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