ESRD NETWORK 6 2011 ANNUAL REPORT

“IMPROVING THE LIVES OF PEOPLE WITH OR AT RISK FOREND STAGE RENAL DISEASE BY PROMOTING ANDADVANCING QUALITY OF CARE”ESRD NETWORK 62011 ANNUALREPORTThe Southeastern Kidney Council is undercontract# HHSM 500-2010-NW006C withthe Centers for Medicare & MedicaidServices in Baltimore, Maryland.Southeastern Kidney Council, Inc.Phone: 919.855.0882Patient Line: 800.524.71391000 St. Albans Drive, Suite 270Raleigh, NC 27609WWW.MYSKC.ORGP a g e | 1

PREFACEP a g e | 2

STATEMENT FROM THE BOARD OF DIRECTORSP a g e | 3

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Table of ContentsPREFACE ................................................................................................................................................................................................. 2STATEMENT FROM THE BOARD OF DIRECTORS ...................................................................................................................................... 3TABLE OF CONTENTS .............................................................................................................................................................................. 5CONTENTS OF FIGURES AND TABLES ...................................................................................................................................................... 7DATA TABLES LISTING ............................................................................................................................................................................. 9INTRODUCTION .................................................................................................................................................................................... 10NETWORK DESCRIPTION ................................................................................................................................................................................. 11ESRD Network Program Overview ........................................................................................................................................................ 11GENERAL POPULATION ............................................................................................................................................................................. 13ESRD Program ...................................................................................................................................................................................... 13ESRD Prevalence and Incidence ............................................................................................................................................................ 15ESRD Facilities ...................................................................................................................................................................................... 17ABOUT THE NETWORK ......................................................................................................................................................................... 18MISSION ............................................................................................................................................................................................... 18VISION .................................................................................................................................................................................................. 18CORE VALUES ....................................................................................................................................................................................... 19NETWORK STRUCTURE ......................................................................................................................................................................... 202011 ESRD NETWORK GOALS .................................................................................................................................................................... 29STRATEGY TO ACCOMPLISH CMS GOALS .................................................................................................................................................. 30ESRD NETWORK 6 INTERNAL PROCESS MEASURES ................................................................................................................................... 31CMS GOAL 1...................................................................................................................................................................................... 32NETWORK 6 QUALITY IMPROVEMENT PROGRAM ................................................................................................................................................. 33NETWORK 6 QUALITY IMPROVEMENT WORK PLAN .............................................................................................................................................. 33PROJECT 1: INCREASING AVFs THROUGH FOCUS ON INCIDENT PATIENTS AND USING EXISTING AVFs ............................................. 34PROJECT 2: INCREASING AV FISTULAS THROUGH CATHETER REDUCTION .......................................................................................... 41PROJECT 3: ADEQUATE DIALYSIS FOR ESRD BENEFICIARIES................................................................................................................. 44PROJECT 4: INCREASING INFLUENZA IMMUNIZATIONS IN Network 6 ................................................................................................. 48IMPACT OF THE SOUTHEASTERN KIDNEY COUNCIL’S GOAL 1 ACCOMPLISHMENTS ON PATIENT CARE IN NETWORK 6 ......................................................... 51CMS GOAL 2...................................................................................................................................................................................... 52OVERVIEW ................................................................................................................................................................................................... 53NEW ESRD PATIENT ORIENTATION PACKET (NEPOP) ......................................................................................................................................... 53PATIENT EDUCATION CALENDAR ....................................................................................................................................................................... 54REHABILITATION ............................................................................................................................................................................................ 58TRANSPLANT COALITION ................................................................................................................................................................................. 58PATIENT AMBASSADOR PILOT PROGRAM ........................................................................................................................................................... 61COMMUNITY PARTNERSHIPS, ACTIVITIES AND PROGRAMS ..................................................................................................................................... 62IMPACT OF THE SOUTHEASTERN KIDNEY COUNCIL’S GOAL 2 ACCOMPLISHMENTS ...................................................................................................... 65P a g e | 5

CMS GOAL 3 ......................................................................................................................................................................................... 66Patient Web Pages – www.esrdnetwork6.org and www.MYSKC.org .................................................................................................. 67DISASTER PREPAREDNESS ACTIVITIES ................................................................................................................................................................. 67RESOLVING COMPLAINTS AND GRIEVANCES ........................................................................................................................................................ 68Technical Assistance ............................................................................................................................................................................. 71Trend Analyses ..................................................................................................................................................................................... 72IMPACT OF THE SOUTHEASTERN KIDNEY COUNCIL’S GOAL 3 ACCOMPLISHMENTS ...................................................................................................... 74CMS GOAL 4 ......................................................................................................................................................................................... 75OVERVIEW ................................................................................................................................................................................................... 76DIALYSIS AND TRANSPLANT FACILITIES ............................................................................................................................................................... 77RENAL ORGANIZATIONS .................................................................................................................................................................................. 78STATE SURVEY AGENCIES ................................................................................................................................................................................ 79KIDNEY COMMUNITY EMERGENCY RESPONSE COALITION ...................................................................................................................................... 79OTHER COLLABORATIONS ................................................................................................................................................................................ 80IMPACT OF THE SOUTHEASTERN KIDNEY COUNCIL’S GOAL 4 ACCOMPLISHMENTS ...................................................................................................... 81CMS GOAL 5 ......................................................................................................................................................................................... 82OVERVIEW ................................................................................................................................................................................................... 83Data Collection ..................................................................................................................................................................................... 83Data Validation .................................................................................................................................................................................... 85Data Compliance .................................................................................................................................................................................. 85TECHNICAL ASSISTANCE .................................................................................................................................................................................. 87VISION and QualityNet Electronic Data Submission ............................................................................................................................. 87Maintenance and Security of CMS Environment .................................................................................................................................. 87CROWNWeb ......................................................................................................................................................................................... 88IMPACT OF THE SOUTHEASTERN KIDNEY COUNCIL’S GOAL 5 ACCOMPLISHMENTS ...................................................................................................... 89SANCTION RECOMMENDATIONS .......................................................................................................................................................... 90SOUTHEASTERN KIDNEY COUNCIL SANCTION PROCESS .......................................................................................................................................... 912011 SOUTHEASTERN KIDNEY COUNCIL SANCTIONS ............................................................................................................................................ 99RECOMMENDATIONS FOR ADDITIONAL FACILITIES ......................................................................................................... 100DATA TABLES ...................................................................................................................................................................................... 102P a g e | 6

Contents of Figures and TablesFIGURE 1: GEOGRAPHICAL MAP OF THE ESRD RENAL DISEASE NETWORKS .......................................................................................... 11FIGURE 2. PREVALENT ESRD PATIENTS PER NETWORK AS OF 12/31/2011. .......................................................................................... 12FIGURE 3. NUMBER OF ESRD FACILITIES PER NETWORK AS OF 12/31/2011. ........................................................................................ 13TABLE 1. US CENSUS QUICK FACTS DATA ON RACIAL AND ETHNIC COMPOSITION OF THE US COMPARED TO NETWORK 6 ................. 14FIGURE 4. US CENSUS AND NETWORK RACIAL DISTRIBUTION COMPARISON ....................................................................................... 14TABLE 2. NETWORK 6 ESRD PREVALENCE AND INCIDENCE AS OF 12/31/2011...................................................................................... 15FIGURE 5. NETWORK 6 PATIENT POPULATION 5-YEAR GROWTH .......................................................................................................... 15TABLE 3. DEMOGRAPHICS OF NETWORK 6 INCIDENT ESRD PATIENTS .................................................................................................. 16FIGURE 6. NUMBER OF NEW ESRD PATIENTS BY AGE GROUP CALENDAR YEAR 2011 ........................................................................... 16FIGURE 7. NUMBER OF NEW ESRD PATIENTS BY RACE CALENDAR YEAR 2011 ...................................................................................... 16FIGURE 8. NUMBER OF NEW ESRD PATIENTS BY PRIMARY DIAGNOSIS CALENDAR YEAR 2011 ............................................................. 16FIGURE 9. NETWORK 6 NUMBER OF FACILITIES BY YEAR ...................................................................................................................... 17FIGURE 10. NETWORK 6 PERCENT OF FACILITIES BY OWNERSHIP ......................................................................................................... 17FIGURE 11. NETWORK 6 AV FISTULA RATE INTERVENTION PROGRESSION CHART ................................................................................ 34FIGURE 12. NETWORK 6 2011 NUMBER OF AV FISTULAS IN USE BY MONTH ........................................................................................ 35FIGURE 13. NETWORK 6 2011 NUMBER OF AV FISTULAS PLACED BY MONTH ...................................................................................... 35FIGURE 14. PERCENT OF NETWORK 6 FACILITIES THAT HAVE REACHED CMS AVF RATE OF 66% OR MORE BY MONTH ........................ 36FIGURE 15. AV FISTULA INTERVENTION FACILITY SELECTION FLOW CHART .......................................................................................... 37FIGURE 16. REPORT 101- ESRD NETWORK 6 VASCULAR ACCESS FEEDBACK REPORT. ........................................................................... 38FIGURE 17. REPORT 102- VASCULAR ACCESS RANKING REPORT ........................................................................................................... 39FIGURE 18. REPORTS 105 AND 105B ..................................................................................................................................................... 39FIGURE 19. NETWORK 6 2011 CATHETER USE DISTRIBUTION BY MONTH ............................................................................................. 41FIGURE 20. NETWORK 6 2011 LONG-TERM (>90 DAYS) CATHETER USE DISTRIBUTION BY MONTH ...................................................... 42FIGURE 21. DISTRIBUTION OF LONG-TERM CATHETER USE DURING THE 2011 FOCUSED INTERVENTION ............................................. 42FIGURE 22. CATHETER USE REDUCTION FACILITY-SPECIFIC FEEDBACK REPORT .................................................................................... 43FIGURE 24. DISTRIBUTION OF THE % OF NETWORK 6 PATIENTS WITH URR> 65 ................................................................................... 45FIGURE 23. PROGRESSION OF NETWORK 6 ADEQUACY FOCUS FACILITIES............................................................................................ 45FIGURE 25. DISTRIBUTION OF NETWORK 6 URR RATES BY FACILITY ..................................................................................................... 46FIGURE 26. HEMODIALYSIS ADEQUACY PROGRESSION REPORT ........................................................................................................... 47FIGURE 27. NETWORK 6 IMMUNIZATION RATES (2009-2012) .............................................................................................................. 48P a g e | 7

FIGURE 28. NETWORK 6 FACILITY-SPECIFIC IMMUNIZATION FEEDBACK REPORTS ............................................................................... 49FIGURE 29. 2010 AND 2011 PATIENT EDUCATION CALENDAR SURVEY RESPONSE: WHAT DOES SKC DO? ............................................ 57FIGURE 30. 2011 PATIENT EDUCATION CALENDAR SURVEY RESPONSE: WHAT WAS USEFUL ABOUT CALENDAR? ............................... 58FIGURE 31. USRDS 2011 ADR ADJUSTED TRANSPLANT RATES (DECEASED AND LIVING DONOR) .......................................................... 59FIGURE 32 NETWORK 6 CONTACTS BY CLASSIFICATION ....................................................................................................................... 71TABLE 8. DISTRIBUTION OF THE TYPE OF COMPLAINTS AND GRIEVANCES IN 2011 BY STATE ............................................................... 71FIGURE 33. NETWORK BENEFICIARY CALL CONTACTS BY TYPE AND QUARTER ..................................................................................... 73FIGURE 34. NETWORK FACILITY CALL CONTACTS BY TYPE AND QUARTER ............................................................................................ 73TABLE 9. NUMBER, TYPE AND DESCRIPTION OF FORMS ENTERED INTO SIMS MANUALLY IN 2011. ..................................................... 83FIGURE 35. NETWORK 1-18 2010 SUMMARY ANNUAL REPORT DATA OVERVIEW FORMS .................................................................... 84TABLE 10. PERCENT OF NETWORK 6 CMS FORMS COMPLIANCE BY YEAR AND FORM. ......................................................................... 85FIGURE 36. PERCENT OF FACILITIES THAT SUBMITTED FORMS ON TIME BY PERCENT OF FORMS SUBMITTED. .................................... 86FIGURE 37. PERCENT OF FACILITIES THAT SUBMITTED ACCURATE FORMS BY PERCENT OF FORMS SUBMITTED. ................................. 86P a g e | 8

DATA TABLES LISTINGDATA TABLE 1: NETWORK 6 ESRD INCIDENCE- 2011 STATISTICS ......................................................................................................... 103DATA TABLE 2: NETWORK 6 ESRD PREVALENCE- 2011 STATISTICS ..................................................................................................... 105DATA TABLE 3: NETWORK 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON 12/31/2011 ............................................................ 107DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011 ....................................................... 123DATA TABLE 5: NETWORK 6 NUMBER OF RENAL TRANSPLANTS BY TRANSPLANT CENTER AND STATE .............................................. 139DATA TABLE 6: NETWORK 6 NUMBER OF RENAL TRANSPLANTS BY TYPE, AGE, RACE, SEX, AND PRIMARY DIAGNOSIS ..................... 140DATA TABLE 7: NETWORK 6 DIALYSIS DEATHS ................................................................................................................................... 142DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATION .............................................................................................................. 144P a g e | 9

INTRODUCTIONThis report is submitted as an annual contract deliverable by the SoutheasternKidney Council, Inc., the Centers for Medicare & Medicaid (CMS) contractor forEnd Stage Renal Disease (ESRD) Network 6, covering Georgia, North Carolina,and South Carolina. The report covers the contract period January 1, 2011 –December 31, 2011. Network 6 encourages facilities to utilize this informationin quality improvement activities.P a g e | 10

Network DescriptionESRD Network ProgramOverviewFigure 1: Geographical map of the ESRD RenalDisease NetworksCongress amended Title XVIII of the Social Security Actin 1978 to establish ESRD Network Organizations.Goals and requirements have evolved over the life of theprogram and today’s Networks provide ESRD healthcarequality oversight and improvement, resolve patientcomplaints and grievances and maintain the ESRDregistry. Centers for Medicare & Medicaid Services(CMS) establish a Statement of Work (SOW) for theNetwork program and currently contracts individuallywith 14 organizations to fulfill those requirements for the18 ESRD Network areas. CMS funds this program bywithholding $.50 per dialysis treatment, pooling the fundsand distributing to the contractors.The Southeastern Kidney Council (SKC), a non-profit501(c) (3) corporation, governed by a volunteer Board ofDirectors, holds the contract for ESRD Network 6. Acoalition of the former ESRD Networks 20 (SouthCarolina and Georgia) and 21 (North Carolina)established the SKC in 1988, and since then have heldthe ESRD Network 6 contract.P a g e | 11

Number of PatientsThis report is an annual deliverable of the ESRD Network 6 Centers for Medicare & Medicaid Servicescontract. Southeastern Kidney Council is devoted to helping health care professionals and patients inthe Network 6 area to improve the treatment and control of ESRD, including the collection, analysis anddissemination of information; technical assistance; on-site review of facilities; review and resolution ofpatient grievances; professional and patient education and collaboration in research studies withregional universities. Network 6 is the largest ESRD Network in the US encompassing the largestpatient and provider populations. The Network serves 39,380 patients and 595 facilities in Georgia,North Carolina and South Carolina. (Figures 2 & 3).45,000Prevalent Dialysis Patients by Network Area as of 12/31/201140,00035,00030,000Network 6All other Networks25,00020,00015,00010,0005,000016 12 1 10 13 3 4 15 17 11 8 5 7 2 9 18 14 6Network NumberFigure 2. Prevalent ESRD Patients per Network as of 12/31/2011. Network 6 serves morepatients than any other single Network. (Data Source: CMS 2744 )P a g e | 12

Number of FacilitiesGENERAL POPULATIONESRD ProgramAccording to the United States Renal Data System (USRDS) ESRD Annual Report, in 2011 more than106,000 patients started ESRD treatment on hemodialysis, and 7,094 started on peritoneal dialysis. Therate of new ESRD cases per million population (pmp) has been relatively stable since 2000, and rose just1.1 percent to 355 in 2009. A linear increase in the number of patients age 45–64 continues to drivesgrowth in the incident population; while in contrast, growth in the population age 65 and older has slowedconsiderably.According to the latest statistical data from 2009 by race, rates of prevalent ESRD remain greatest in theAfrican American and Native American populations, at 5,284 and 2,735 pmp in 2009, compared to 1,279pmp and 2,101 pmp among Whites and Asians. The rate among Hispanics reached 2,538 pmp in 2009,1.5 times greater than that in the non-Hispanic population.Rates of ESRD attributed to diabetes and hypertension rose 2.2 and 2.7 percent, respectively, in 2009, to647 and 429 per million population. ESRD caused by cystic kidney disease rose 2.4 percent, to 83 pmp,and ESRD due to glomerulonephritis remained stable, at 263 pmp.The number of incident and prevalent patients has been steadily rising year by year at approximately thesame rate (Figure 5). Incident and prevalent rates by state can be found in the data tables of this annualreport.700600ESRD Facilities by Network Area as of 12/31/2011Network 6All other Networks500400300200100016 3 1 17 10 12 2 15 13 4 18 11 5 7 8 14 9 6Network NumberFigure 3. Number of ESRD facilities per Network as of 12/31/2011. (Data Source: CMS 2744)P a g e | 13

PercentNetworkTOTAL 23,848,502 308,745,538White 15,376,391 64.5% 223,553,265 72.4%African American 6,289,747 26.4% 38,929,319 12.6%Asian 582,480 2.4% 14,674,252 4.8%American Indian andAlaska Native 173,785 0.7% 2,932,248 0.9%Native Hawaiian andPacific Islander 16,109 0.1% 540,013 0.2%Other 916,366 3.8% 19,107,368 6.2%Identified by two ormore 493,623 2.1% 9,009,073 2.9%Table 1. US Census Quick Facts Data on Racial and EthnicComposition of the US compared to Network 680%60%40%20%0%Racial/ Ethnic Distribution of General USPopulation, General Network 6 AreaPopulation and Network 6 ESRD Patients72%65%White30%13%26%68%AfricanAmericanOtherRace/ Ethnic CategoryHispanicFigure 4. US Census and Network Racial Distribution ComparisonUS15% 16%9% 8% 2%*2%General Network Area Population(Source: US Census)General US Population(Source: US Census)Network 6 ESRD Population(Source:SIMS (*Hispanic data from USRDS))GENERAL POPULATIONRACIAL/ETHNICCOMPOSITION OFNETWORK 6The general population in the Network 6 areahas grown over the past years. According tothe United States Census as of January 1,2012, the total population of the Network 6area is 24,150,841 representing 7.8% of theUnited States population. Georgia’spopulation has increased by 18.3%, NorthCarolina’s has increased by 18.3%, andSouth Carolina’s has increased by 15.3%from 2000 to 2010. (Data not shown)The average median annual income in thethree-state area is $46,285 compared toUnited States median income of $51,914.Persons living below poverty encompass 16%of the tri-state population, compared to 14%nationally.Table 1 and Figure 4 detail racial/ethnic andcultural demographics of persons in theNetwork 6 area compared to the USpopulation. According to the US 2010Census, there were over 23 million people inthe Network region. Minorities in Network 6are over-represented compared to the USpopulation, with approximately 36%compared to the 27.6% in the US. AfricanAmericans are the largest contributingminority group within Network 6, representing26% of the overall Network population.P a g e | 14

Number of PatientsGENERAL POPULATIONESRD Prevalence andIncidenceAccording to the CMS Standardized InformationManagement System (SIMS), 39,380 dialysispatients were receiving dialysis treatment inNetwork 6 facilities as of December 31, 2011.One hundred ninety-three (193) of thesepatients were living outside of the Network threestate area.Overall, there were 9,342 Incident ESRDpatients in Network 6. Although South Carolinahad the smallest general population in size, ithad the largest dialysis per million prevalenceand ESRD incidence when compared to theother states, followed by Georgia and NorthCarolina. (Table 2)The ESRD population of Network 6 has beensteadily increasing. By trending this data, wecan predict that Network 6 will reach a patientpopulation of nearly 41,000 prevalent ESRDpatients by 2012 (Figure 5). In 2011, Network 6observed 7658 incident ESRD patients. WithSouth Carolina having the largest growth of newESRD patients compared to the other two states(Table 2). Incident and prevalent rates by statecan be found in the data tables section of thisannual report.Dialysis Prevalence and ESRD Incidence DataState 2011GeneralPopulation# ofDialysisPatients*DialysisPrevalenceper million# ofIncidentESRDPatients*ESRDIncidencepermillionGeorgia 9,815,210 16,646 1,696 4,023 410NorthCarolinaSouthCarolinaOtherStates9,656,401 14,564 1,508 3,455 3584,679,230 7,977 1,705 1,809 387193 45Network 24,150,841 39,380 1,631 9,342 387Table 2. Network 6 ESRD Prevalence and Incidence as of 12/31/2011Network 6 ESRD Patient Population Growth40,00039,00038,00037,00036,00035,00034,00033,00032,00031,0002007 2008 2009 2010 2011Patients 34,311 35,672 37,143 38,311 39,380YearFigure 5. Network 6 Patient population 5-year growth (Data Source: SIMS)The incident dialysis population is analyzed bypatient demographics and reported etiology ofESRD (Figures 6, 7, 8). Approximately half ofthe incident patients are age 65 or older,identified as African American and or female.Diabetes and hypertension continue to be thetwo leading reported causes of ESRD inNetwork 6. Refer to Table 2 at the end of thereport for a complete analysis of the prevalentESRD population by age, gender, race, andprimary diagnosis.P a g e | 15

Number of PatientsNumber of PatientsNumber of PatientsTable 3. Demographics of Network 6 Incident ESRDPatients in Calendar Year 2011Category N %Age0-19 89 1.0%20-34 451 4.8%35-44 773 8.3%45-54 1,529 16.4%55-64 2,370 25.4%65-74 2,258 24.2%75+ 1,872 20.0%GenderRaceFemale 4,237 45.4%Male 5,105 54.6%African American 5,096 54.5%White 4,027 43.1%Other Race 1,219 2.3%25002000150010005000Network 6 Incident ESRD Patients by AgeCalendar Year 20112,370 2,258894517731,5291,8720-19 20-34 35-44 45-54 55-64 65-74 75+Age GroupFigure 6. Number of New ESRD Patients by Age Group Calendar Year 20116000500040003000200010000Network 6 ESRD Incident Patients by Race andGenderCalendar Year 20114,2375,105 5,096Female Male AfricanAmericanDemographic4,027White219Other RaceFigure 7. Number of New ESRD Patients by Race Calendar Year 2011Network 6 Incident ESRD Patients by PrimaryDiagnosis * Calendar Year 20114500400035003000250020001500100050001673,9505493,2941,108Reported Primary DiagnosisFigure 8. Number of New ESRD Patients by Primary Diagnosis Calendar Year 2011* 313 Patients had an unknown primary diagnosis (not shown)P a g e | 16

GENERAL POPULATIONESRD FacilitiesAt the end of 2011, Network 6 observed a 3%increase in the total number of facilitiescompared to 2010. Network 6 had 595 facilitiesincluding Veterans Administration facilities (N=6)and transplant facilities (N=10).Seventy-one (71%) of the Network 6 facilitiesare operated by large dialysis organizations(LDO): DaVita, Dialysis Care Incorporated (DCI)and Fresenius Medical Care (FMC). More than85% of Network facilities were owned ormanaged by for-profit organizations.Dialysis facilities range in size from one patient(small hospital program) to 267 patients with theaverage at 66 patients. 46% percent of thedialysis facilities provide peritoneal dialysistraining and 25% provide home hemodialysistraining. All facilities are required to offer thesehome modalities to patients or refer patients toan alternate facility if training is not offered in thefacility.7006005004003002001000Network 6 ESRD Facilities byYear2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011Providers 377 407 433 448 459 497 508 526 543 562 579 595Figure 9. Network 6 Number of Facilities by YearNetwork 6 Facilities byOwnershipFMC, 32%DCI, 6%Non LDO,29%Davita,33%Figure 10. Network 6 Percent of Facilities by OwnershipP a g e | 17

ABOUT THE NETWORK.MISSIONThe mission of the Southeastern Kidney Council, Inc., End Stage Renal Disease (ESRD) Network 6is to improve the lives of people with or at risk for End Stage Renal Disease by promoting andadvancing quality of care.VISIONThe vision of the Southeastern Kidney Council, Inc. is to be a leader among ESRD Networks inimproving the lives of pre-ESRD and ESRD patients through timely and accurate data collection andreporting, effective and innovative quality improvement activities, and accessible patient andprovider education programs.ooWe strengthen our organization through consistently measuring and modifying ourinternal operations as part of Continuous Quality Improvement.We stimulate and encourage patients and professionals to seek the highest level ofquality care and outcomes.P a g e | 18

CORE VALUESIn achieving our Mission, we dedicate ourselves to these Core Values:Patient and Family-CenterednessWe recognize that CKD patients and their families are our primary focus and everything we do isto benefit the patient.We partner with the community we serve to foster the highest quality care for every patient everyday.We seek the voice of the patients and their families and the expertise and experience ofproviders to guide the direction of SKC.Commitment to ExcellenceWe can be depended upon to produce the highest quality work as individuals and as anorganization.We provide exemplary service through professional and ethical behavior.We respect the contributions of others by promoting teamwork and collaboration.KnowledgeWe strive to be lifelong learners and teach others in an ever-changing environment to ensure thehighest level of care and best outcomes.We collect, evaluate and disseminate current information to provide a solid foundation ofknowledge for ourselves and the renal community.We are accessible to patients and their families, providers and other organizations to share ourexpertise.RespectWe are responsible to ourselves and others in order to achieve individual goals in balance withour mission.We value one another, our organization and the community we serve; this drives us to do what isright and needed.We keep our commitments and are accountable for our conduct and decisions.Continuous ImprovementWe constantly seek better ways to ensure excellent, reliable patient care using accurate, timelyand reliable data.We strengthen our organization through consistently measuring and modifying our internaloperations as part of Continuous Quality Improvement.We stimulate and encourage patients and professionals to seek the highest level of quality careand outcomes.P a g e | 19

NETWORK STRUCTUREThe Southeastern Kidney Council, governed by the Board of Directors employs the staff listed below. Theleadership provided by the Board of Directors, Medical Review Board, and Consumer Committee helpsupport CMS goals and contract requirements.Staffing as of December 31, 2011Experienced professionals in Administration, Quality Improvement, Community Outreach, and InformationManagement staff the Southeastern Kidney Council, to ensure successful completion of CMS contractrequirements.Jenna Krisher, Executive DirectorMs. Krisher directs the organization's overall performance and initiatives to ensure adherence to allNetwork contract requirements as directed by CMS. She reports directly to the Board of Directors andacts as a liaison between the Board of Directors and Committees. Ms. Krisher serves as the primary CMSliaison for the Southeastern Kidney Council.AdministrationMelodye Aben, Corrine Knapp and Copelia Street, Administrative CoordinatorsMs. Aben administers the Southeastern Kidney Council’s financial accounting and operational functions insupport of the CMS contract and corporate requirements. She tracks deliverables and leads thecompletion of the Annual and Quarterly reports.Ms. Knapp and Ms. Street are primarily responsible for providing assistance to all activities and projects tocreate and maintain a favorable public image for the Network. Ms. Street is a temporary employee. Ms.Knapp joined the Network in October 2011.P a g e | 20

Quality ImprovementLeighann Sauls RN, CDN, Director of Quality ImprovementMs. Sauls oversees the Quality Improvement department. She works with the Medical Review Board(MRB) to design and implement quality improvement projects and activities as required by the Networkcontract, including technical assistance to facility staff in implementation of internal quality improvementprograms, and development of educational materials and workshops. Ms. Sauls is the primary liaison forthe MRB, which coordinates quality improvement initiatives.Debra Evans RN, BSN, Quality Improvement Nurse SpecialistMs. Evans assists with the development of educational materials, QI projects and patient grievances. Sheconducts Focused Review and provides technical assistance for facilities as identified by the MRB. Ms.Evans coordinates data collections for Clinical Performance Measures, lab data collection, and otherspecial studies and initiatives. Ms. Evans joined the Network in October 2011.Dee Tyburski, Quality Improvement AnalystMs. Tyburski provides support for the Quality Improvement department including performing Datavalidation activities to maintain the completeness, timeliness, validity, and accuracy of QualityImprovement data.Community OutreachAmy Williams, Community Outreach CoordinatorMs. Williams is responsible for enhancing partnerships and collaboration through educational andoutreach activities with the Network and the renal community. Ms. Williams coordinates Network 6educational materials, outreach projects and maintains the website. Additionally, she coordinates disasterpreparedness activities for patients and providers.Alesha May-Arthur MSW and Laura Gallaher MSW, Patient Services CoordinatorsMs. May-Arthur and Ms. Gallaher handle incoming patient complaints and grievances as well as facilityrelatedconcerns, serving in the role of expert investigator, facilitator, advocate, referral agent, coordinatorand/or educator, depending on the case. They serve as primary liaisons to state agencies for complaintand grievance issues. Ms. May-Arthur and Ms. Gallaher trend complaints and grievances to direct proactiveactivities to reduce them. They staff the Network 6 Consumer Committee and coordinate memberactivities.P a g e | 21

Information ManagementMargo Clay MIS, Director of Information ManagementMs. Clay leads the Information Management Department, ensuring timely and accurate data submissionand entry. Ms. Clay is the Security Point of Contact for the Network and maintains the BusinessContinuity and Contingency Plan.Nadine Reinheimer, Mary Rhodes, and Donna Irwin, Information Management CoordinatorsMs. Reinheimer, Ms. Rhodes, and Ms. Irwin conduct data entry and validation. They provide technicalassistance to facilities regarding Information Management in the areas of data collection, completion, andsubmission of organizational forms.M. Ahinee Amamoo, Senior Health Outcomes and Evaluation AnalystMs. Amamoo is responsible for identifying disparities between desired and actual outcomes in patient careand the underlying contributing factors. She assists in the design of interventions and educational projectsto improve patient outcomes and analyzes results to evaluate the effectiveness. Ms. Amamoo works withthe MRB, QI Director, Executive Director and other staff to design data collection, analysis and reportingtools. Ms. Amamoo joined the Network August 2011.COMMITTEESOne of the greatest strengths of the ESRD Network program is the expertise and guidance provided bythe volunteers serving on our Boards and Committees. These dedicated ESRD patients and nephrologyprofessionals identify regional concerns and ideas for projects. The Southeastern Kidney Council staffwork closely with these volunteers to design and implement the programs most beneficial to the patients inthe area. Every committee includes multiple patient members to ensure opportunities for patients to voicetheir ideas and opinions. The Committees incorporate these into goal setting and project design. TheNetwork has numerous procedures in place to address any potential conflicts of interest, which includehaving all volunteers sign confidentiality and conflict of interest statements and blinding all materials toensure unbiased review and discussion.Network CouncilThe Network Council includes one representative from every dialysis and transplant center in the Networkplus all Consumers committee members on the Board of Directors for 623 members. The members serveas liaisons between the Network and the facilities, offer input on Network activities and elect the membersof the Board of Directors.P a g e | 22

Board of DirectorsThe Board of Directors (BOD) manages and governs the business of the Southeastern Kidney Council.They are responsible for hiring the Executive Director, appointing members of the Medical Review Board,Finance Committee and Consumer Committee and approving the Southeastern Kidney Council’s workplans and budgets.The Network Council elects the members of the Board of Directors (Table 4). The Network Bylaws requirethe Board to have a well-balanced composition of Professionals and Consumers. The Board of Directorsselects the chairpersons for the Medical Review Board and Consumer Committee. The Board of Directorsmet face-to-face twice in 2011 with the following accomplishments and activities:Elected members to the 2011-2012 Medical Review Board and Consumer CommitteeEvaluated Executive DirectorProvided financial and program oversight for the Network contractReviewed and approved Medical Review Board and Committee activities and reportsReviewed and made edits to the Annual ReportReviewed the current Statement of Work and Network Work PlanApproved the recipient of the Chuck Brown Memorial AwardReviewed and approved the Network Internal Quality Improvement plan and outcomesReviewed the Network 6 Annual CMS EvaluationP a g e | 23

Table 4. Name, location and membership of 2011 Board of Directors MembersNAME LOCATION MEMBERSHIPBarry Freedman, MD Winston Salem, NC ChairpersonAnnie Simpson Bluffton , SC ConsumerLeland Garrett MD, FACP, FASNRaleigh, NCLequisha Harris RN, BSN Charleston , SC NurseImmediate PastChairpersonJohn Haynes CPA Mount Airy, NC ConsumerPearl Fu Magovern MSWCarlos Martinez MDDixie MoncusJen Morgan MHA, RDWinston Salem, NCMacon, GAOlin, NCLittle River, SCTransplant SocialWorkerGeorgia ViceChairpersonConsumer CommitteeChairpersonSouth Carolina ViceChairRichard Paul MD Hickory, NC MRB ChairpersonCatherine Phillips RN, CNN LaGrange, GA TreasurerMichelle Price RN, BSNForest Rawls BS, CHT, CCHTRaleigh, NCEast Point, GANephrology Nurse - AtlargePatient CareTechnician - At largeRobert Shay MD, FASN Augusta, GA Nephrologist - At largeBrenda Thrasher FNP-CCharlotte, NCNorth Carolina ViceChairpersonAmy Woodard RN, BSN, CNN, CCTC Apex, NC NurseSonia Wynne LPN, CHN, CCHTCochran, GAPatient CareTechnician - At largeJenna Krisher Raleigh, NC President, Non-VotingP a g e | 24

Finance CommitteeIn 2011, the Board of Directors (BOD) appointed a Finance Committee (Table 5) responsible for reviewingfinancial reports prior to Board review and working with the Executive Director to establish necessary policies,benefits and programs. In 2011, the committee:Held an orientation session to review and understand all financial operations of the Southeastern KidneyCouncilReviewed health insurance renewals for staff and worked with Executive Director to select an appropriateplanReviewed the 2010-11 audit for presentation to the Board of DirectorsReviewed and approved submission of the IRS-990 tax formTable 5. Name, location and membership of 2011 Finance Committee members as of 12/31/2011.NAME LOCATION MEMBERSHIPLeland Garrett MD, FACP, FASN Raleigh, NC Immediate Past ChairpersonJohn Haynes CPA Mount Airy, NC ConsumerCatherine Phillips RN, CNN Lagrange, GA TreasurerJenna Krisher Raleigh, NC Non-VotingConsumer CommitteeThe Consumer Committee (Table 6) is composed of patients, family members and nephrology professionals inthe Network region. The function of this committee is to provide a consumer voice to the Board of Directors andMedical Review Board regarding quality of care, patient grievances, patient rights and Network role. TheConsumer Committee is involved in developing and implementing the Network’s grievance procedure and patienteducational materials. This committee met face-to-face twice in 2011, with the following accomplishments andactivities:Developed 2012 Patient Education CalendarSelected the 2011-12 Chuck Brown Memorial Award RecipientProvided input on the Quality Improvement Work Plan (QIWP)Reviewed and offered input on challenging situations reported in facilitiesReviewed the Network 6 Annual CMS EvaluationLaunched the Patient Ambassador Pilot ProgramGuided the branding of Southeastern Kidney CouncilP a g e | 25

Table 6. Name, location and membership of Consumer Committee members of 12/31/2011NAME LOCATION MEMBERSHIPDixie Moncus Olin, NC ChairpersonRhonda Bussey East Point, GA ConsumerElbert Elvis King, NC ConsumerJennifer Graves Mebane, NC ConsumerJohn Haynes CPA Mount Airy, NC ConsumerMary Ann Cooke Murrells Inlet, SC ConsumerPearl Fu Magovern MSW Winston Salem, NC Transplant Social WorkerDiane Barber MSW Landrum , SC ConsumerAlvin Moore Charleston, SC ConsumerDeborah Moyé Decatur, GA ConsumerNoreen Rogers Jonesboro, GA Consumer Family MemberElizabeth Simmons Beaufort, SC ConsumerMichael Sykes Alpharetta, GA ConsumerChristina Wiggins RN, BSN Augusta, GA Nephrology NurseP a g e | 26

Medical Review BoardThe Medical Review Board (MRB) (Table 7) is primarily responsible for overseeing Quality Improvement projectsand activities by reviewing performance data, selecting intervention facilities and monitoring the progress of eachfacility in improving the quality of care provided to patients. The MRB uses Clinical Performance Measures andother data to evaluate the overall quality of care. This committee provides technical assistance, mentoring,educational materials and workshops. The Medical Review Board makes suggestions and provides support ondifficult grievance situations. The Medical Review Board and Consumer Committee work together to developoutreach materials for patients, family members and facility staff. The MRB is geographically and professionallydiverse, including nephrology nurses, physicians, social workers, dietitians and Consumers. They met threetimes face-to-face in 2011 and accomplished the following:Formulated the 2011-2012 Quality Improvement Work Plan (QIWP)Reviewed the Network 6 Annual CMS EvaluationPrepared and implemented a Performance Improvement Plan for increasing AVF useAnalyzed current data to include lab data and vascular access data to identify opportunities forimprovement in careChose focused review facilities for catheter, fistula, anemia and immunization based on ClinicalPerformance Measures (CPM), Lab Data and Fistula First DataReviewed all complaints and grievances and provided technical assistance where necessaryAnalyzed complaint and grievance data to identify and address trends in the Network area, includinginvoluntary dischargesDeveloped sub groups that met quarterly to analyze the data and review progress of projects in theseareas of care:o Catheter Reductiono Fistula Increaseso Anemia Managemento Increasing Immunizationo Trending Complaints and Grievances and assisting with difficult casesP a g e | 27

Table 7. Name, location and membership of Medical Review Board Members as of 12/13/2011.Name Location MembershipRichard Paul MD Hickory, NC ChairpersonJoseph Brannigan MD Columbia, SC NephrologistTerri Browne MSW, PHD Irmo, SC Social WorkerKeith Dimond MD Savannah, GA NephrologistCharlotte Faker RN Greensboro, NC Nephrology NurseJane Glenn BSN Charlotte, NC ConsumerJeffrey Hoggard MD, FACP, FASN Raleigh, NC NephrologistTeresa Hoosier RN, CDN Winston Salem, NC Nephrology NurseApril Ingram Hamilton RN, BSN Ridgeland, SC Nephrology NurseDeborah Moyé Decatur, GA ConsumerKimberly Kerns RN, BSN, CHN Willoughby, OH Nephrology NurseDebra Shultman MSN, ANP-C, CNN Charlotte, NC Nephrology NurseFelicia Speed LMSW Anderson, SC Social WorkerTiffiny Parker RD, LDN Raleigh, NC DietitianMubarak Waldron Greenville, NC ConsumerRandal Bast MD Lenoir, NC SurgeonRebecca Ford RD Spartanburg, SC DietitianP a g e | 28

CMS NATIONAL GOALS & NETWORK ACTIVITIES.During 2011, End Stage Renal Disease Network 6 continued efforts to meetthe CMS national goals. CMS specifies five primary goals for each Networkcontract as listed below. The SKC conducted the activities and projectsdescribed in this report to accomplish these goals.2011 ESRD NETWORK GOALSI. Improve the quality and safety of dialysis-related services provided forindividuals with ESRD.II.III.IV.Improve the independence, quality of life, and rehabilitation (to theextent possible) of individuals with ESRD through support fortransplantation, use of self-care modalities (e.g., peritoneal dialysis,home hemodialysis), and in-center self-care, as medicallyappropriate, through the end of life.Improve patient perception of care and experience of care, andresolve patients’ complaints and grievances.Improve collaboration with providers and facilities to ensureachievement of goals 1 through 3 through the most efficient andeffective means possible, with recognition of the differences amongproviders (independent, hospital-based, member of a group, affiliateof an organization, etc.) and the associated possibilities/capabilities.V. Improve the collection, reliability, timeliness, and use of data tomeasure processes of care and outcomes; to maintain a patientregistry; and to support the goals of the ESRD Network Program.P a g e | 29

STRATEGY TO ACCOMPLISH CMS GOALSThe Board of Directors recognizes the need for a strong partnership of patients, providers,regulators and allied health organizations to accomplish CMS goals. The Board and its Committeesbelieve a collegial, collaborative, and continuous quality improvement environment is most effectivefor achieving the goals. When this approach does not provide expected outcomes, the Networkcontract includes the ability for the Network to recommend a non-performer to CMS for sanction oralternative sanction (see Sanction section later in this report.).The dialysis and transplant facilities in the Network 6 area, with the Consumer members of theBoard of Directors form the Network Coordinating Council. As members of the Council, each facilitysigns a Quality of Care Commitment Statement with the Southeastern Kidney Council, joining inmembership with other approved ESRD facilities in Network 6 to ensure patients receive safe,effective, high quality care. Each facility agrees to participate in the activities of the SoutheasternKidney Council and to support Network goals. Facilities acknowledge that compliance with thesegoals is a condition for approval to receive Medicare reimbursement for the provision of ESRDservices. (42 CFR §494.180 Condition: Governance)The Quality of Care Commitment states that all facilities will:Provide the highest quality of care to every patient we treat by staying abreast of currentscience, seeking and using Best Practices, and striving to meet Network Quality Goals usinga data-driven quality assessment and performance improvement plan.Advocate for the patient to ensure every patient receives the right care, every time.Cooperate with the Network, participate in Network activities, and pursue Network goals tofulfill the terms of the current Network Statement of Work.Identify a governing body that receives and acts upon Network recommendations.Provide timely and accurate data and information to support the national ESRD registry, tofacilitate measurement and improvement of care and to resolve patient complaints.Cooperate with the Network Medical Review Board (MRB) on all QI activities including QIProjects and Focused Review, including submission of information and responding to MRBrecommendations.Cooperate with the Network in prevention and resolution of patient concerns, complaintsand grievances. This includes educating patients on the Network’s role in complaint andgrievance resolution, posting the Network address and phone number and notifying theNetwork at least 30 days prior to involuntarily discharging a patient.Share educational information with patients as requested by the Network and helps educatepatients on the role and services of the Network.Follow all CMS/HIPAA rules for secure transmission of data.P a g e | 30

The Quality of Care Commitment states that the Southeastern Kidney Council agrees to:Provide educational resources and technical assistance to facilities and patients to helpimprove the quality of care.Provide comparative feedback reports that facilities can incorporate into local QI projects.Provide education, tools and technical assistance to assist patients and facilities to:o Prevent and resolve conflict between patients and providerso Improve the quality of careo Ensure data submission is accurate and timelyOversee all Network activities through the multidisciplinary Board of Directors and itscommittees to ensure projects are effective, reasonable and appropriate for patients andproviders in the Network 6 area and that SKC conducts activities in an environment freefrom conflict of interest and with a cultural awareness and sensitivity.ESRD NETWORK 6 INTERNAL PROCESS MEASURESUsing the same Quality Improvement Principles employed with facilities to improve care, Network 6conducts Internal Quality Improvement (IQI) to monitor processes related to delivery of the contract.The Network 6 IQI plan, prepared and submitted to CMS for approval, includes these components:IQI Indicators – Defines each Indicator and provides the numerator and denominator, thedata source for calculating it, the frequency on which it is calculated and which staff memberwill champion the Indicator.IQI Radar Screen – Created monthly, based on the Indicator definitions, SKC uses theRadar Screen to review all Network 6 Indicators, as any Indicator crossing trigger point willautomatically light up red for further study.RCA Template – Guides staff through the RCA steps and documents all actions. Thisfollows Network 6’s 7-step PDCA methodology.Plan:Describe the problemDescribe the current processIdentify root causesDevelop a solution and action planDo: Implement the solutionCheck: Review and evaluate resultsAct: Reflect and act on learningsProject Management Software tracking and review – each week, staff meets to review thework plan, identify barriers and celebrate successes.APPDCAMethodsCDP a g e | 31

CMS Goal 1Improve the quality and safety of dialysis-relatedservices provided for individuals with ESRDP a g e | 32

Network 6 Quality Improvement ProgramThe Network continued to enhance its Quality Improvement Program in 2011,guided by the definition of quality set forth by the Institute of Medicine (IOM),which is “The degree to which health services for individuals and populationsincrease the likelihood of desired health outcomes and are consistent withcurrent professional knowledge.”Network 6’s Quality Improvement Program adheres to these principles:Providers will measure outcomes, implement appropriate interventions and improvecareNetwork 6 will provide technical assistance, training and oversight toassist facilities in improving careProviders and Network 6 will strive for early identification of opportunitiesfor improvementProviders and Network 6 will use available data to identify opportunitiesfor improvement and to measure progressNetwork 6 Quality Improvement Work PlanThe Quality Improvement program incorporates a Quality Improvement Work Plan(QIWP) that guides all the Network activities aimed at improving the quality of caredelivered. The Network 6 Medical Review Board under the direction of the Board ofDirectors collaboratively developed the 2011 plan, which includes interventions andprojects aimed at addressing specific CMS and Network goals. The MRB and QI staffcontinually review the QI Work Plan and update as needed. The 2011 QIWP had fourmajor projects in 2011:I. Increasing AVFs through Focus on Incident Patients and Using Existing AVFsII. Adequately Dialyzing ESRD BeneficiariesIII. Increasing Influenza Immunizations in Network 6IV. Increasing AVFs Through Catheter ReductionP a g e | 33

AVF RatePROJECT 1: INCREASING AVFs THROUGH FOCUS ON INCIDENT PATIENTSAND USING EXISTING AVFsThe majority of 2011 QI program activities focused on the promotion of AV fistulacreation and use among Network patients. Although the Network 6 fistula use ratehas increased from less than 30% to approximately 55% as of 12/2011 during thetenure of our previous Fistula First Breakthrough Initiative activities over the past tenyears, Network 6 has had the lowest current fistula usage rate among all Networks. InJune 2011, the Medical Review Board’s intensified efforts to increase AV fistula userate to meet the CMS March 2012 goal of 55.4%.The MRB developed an innovative approach to address the low AVF rates, whichrequired the active participation of the corporate leadership of the Large DialysisOrganizations (LDO) within the Network. The Network held introduction and updatemeetings with the Chief Medical Officer (CMO) of each LDO to discuss theintervention and the Network expectations and progress. In addition, the Networkconducted monthly meetings with the Regional/Divisional Vice-presidents(RVP/DVPs) of the LDOs to discuss monthly- self-reported vascular access data, rootcauses and action plans and to discuss actions for recalcitrant facilities. The VascularAccess Subcommittee (VASC) of the Network Medical Review Board reviews theintervention data monthly to monitor the progress of the interventions.Vascular Access Success: Increasing AVF UseThrough the implementation of the vascular access project, Network 6 was able to surpass theCMS AV Fistula rate goal within 4 months of implementation of the interventions. Whencompared to the intervention baseline, Network 6 achieved the following improvements as ofDecember 2011:‣ Achieving the CMS March 2012 AV Fistula rate goal of 55.4% by November 2011(Figure 11)‣ 1,570 more AV FISTULA in use (Figure 12)‣ 1,481 more AV FISTULA in place (Figure 13)‣ 6.7% more facilities reaching the CMS goal of 66% (Figure 14)66.0%61.0%56.0%Network 6 AVF Rate Monthly Goals to obtain theCMS AVF Goal 55.4% by March 2012 vs Actual Performance52.8% 53.1% 53.4% 53.8% 54.1% 54.3% 54.8% 55.3% 55.5% 55.7%Where weneed to beWhere We Are51.0%46.0%41.0%52.8% 53.0% 53.3% 53.5% 53.7% 53.9% 54.2% 54.4% 54.6% 54.8% 55.1% 55.3% 55.5%36.0%MonthFigure 11. Network 6 AV Fistula Rate Intervention Progression ChartP a g e | 34

Number of AVFsNumber of AVF in Use20,00019,500AVF in Use for Prevalent Patients by MonthJanuary 2011- December 201119,00018,50018,00017,50017,000Jan Feb Mar Apr May June July Aug Sept Oct Nov DecNumber of AVF in Use 18,27 18,25 18,492 18,726 18,878 19,071 19,161 19,242 19,407 19,574 19,716 19,848MonthFigure 12. Network 6 2011 Number of AV Fistulas In Use by Month2200021500Measure of AVF in Place for Network 6January 2011- December 201121000205002000019500Jan Feb Mar Apr May June July Aug Sept Oct Nov DecNumber of AVF 20343 20419 20700 20965 21081 21210 21258 21378 21515 21586 21744 21824MonthFigure 13. Network 6 2011 Number of AV Fistulas Placed by monthP a g e | 35

Percent20.0%18.0%16.0%14.0%12.0%10.0%8.0%6.0%4.0%2.0%0.0%Percent of Network 6 facilities meeting or exceeding CMS 66%AVF rate goalJan Feb Mar Apr May June July Aug Sept Oct Nov Dec% OF Facilities 12.1% 12.9% 13.2% 13.8% 13.8% 14.0% 14.8% 16.5% 17.2% 17.6% 17.7% 18.8%MonthFigure 14. Percent of Network 6 Facilities that have reached CMS AVF rate of 66% or more by monthVascular Access Intervention OverviewFacility Selection:All Network 6 facilities were included on the vascular access intervention. The MRBdivided facilities into intensive and intermediate intervention groups.Intensive Intervention: (N=176 dialysis facilities total for Vascular Access / N=111 for thisQIP, the remaining 65 in the intensive intervention facilities for the Catheter Reduction QIP)The MRB selected facilities with a prevalent AV FISTULA rate below 66% in March 2011and operated by a corporate group of at least 20, based on the following criteria:At least 15 incident patients in 2010 (N=102)A prevalent long-term catheter rate greater than 10% in March 2011 (N=65) – thesefacilities were be the focus of the 1d project (outlined in green in the figure below)At least 10 AV fistulas in place in prevalent patients in March 2011 that were notbeing used (N=9)Intermediate Intervention: All remaining Network 6 facilities not selected for theintensive arm of the intervention were included in the intermediate intervention arm. (N=384)P a g e | 36

Figure 15. AV Fistula Intervention Facility Selection Flow ChartIntervention Implementation:Step 1- Notified LDO Chief Medical Officers (CMO) of the Intervention andExpectationsStep 2- Notified LDO Regional and Divisional Vice-Presidents (RVP/DVP) of projectoverview and Network 6 expectations of their leadership role in the projectStep 3- Notified facilities of intervention expectations via meetings with the MedicalDirector and Clinic ManagerFacility expectations for the intervention:Monthly self-report data collectionMonthly root cause analysisMonthly updates to action plansEducation learning session with required visual component via bulletinboard for beneficiaries and staffStep 4- Notified State Surveyors of project goals, interventions and desired outcomesStep 5- Provided feedback, technical assistance and education to all facilitiesP a g e | 37

Feedback Reports to each RVP/DVP (monthly for intensive intervention andquarterly for intermediate intervention)Report 101 – ESRD Network 6 Vascular Access Feedback Report.Purpose: This 2-page facility-specific report is based on the Fistula First Dashboard data and showsthe following: Number of AV FISTULAs needed to reach CMS’ goal of 66%, 2010 Incident PatientData Monthly Prevalent Patient DataFigure 16. Report 101- ESRD Network 6 Vascular Access Feedback Report.P a g e | 38

Report 102 – VascularAccess Ranking ReportPurpose: This facilityspecificreport is based onthe Fistula First Dashboarddata and shows thefollowing:Number of AV FISTULAsneeded to reach CMS goalof 66% and where eachfacility’s AV FISTULA userate ranksCompared to theindividual stateCompared to theNetworkAmong all facilities inall NetworksFigure 17. Report 102- Vascular Access Ranking ReportReport 105 AV FistulaGoal Projections ReportPurpose: This facilityspecificreport shows howeach facility is doingcompared to their monthlygoal. This report usesFistula First Dashboard datafor Intermediate Interventionfacilities and MonthlyVascular Access DataCollection Survey data (selfreportedVascular Accessdata) for IntensiveIntervention facilities.Report 105b AV FistulaGoal ProjectionsSummary Report –Purpose: This report showsfacility-specific projectionsrelated to meeting theMarch 2012 goal(Intermediate=2%;Intensive=4%).Figure 18. Reports 105 and 105bP a g e | 39

SKC provided technical assistance to all facilities via the following:• Monthly meetings for RVP/DVP to report on successes,barriers, progress, recognition of successful providers. Allwebinars posted to Network 6 website for use by allproviders.• August 2011 call to introduce the project andexpectations• September 2011 call, including facility MedicalDirectors, to explain the project and next steps• September 2011 face-to-face meeting to review rootcause analysis (submitted prior to meeting) andaction plans• October webinar to review action plans and discussprogress• November technical assistance webinar on bestpractices, interventions and how to organize data• November face-to-face meeting to share bestpractices• Open Resource Call – This monthly call is an open line forNetwork Nephrologist Consultant to provide technicalassistance, answer questions and discuss current barriersand best practices• October 18• November 15• December 20• Network provided AV FISTULA toolkit to all facilities• Self Cannulation Policy• AV Fistula Cannulation Resources for Staff• Buttonhole• Buttonhole Brochure for Patients• Cannulation Presentation Handouts• Cannulation Resources• Catheter Brochure• Clamp Policy• Constant Site Article• Fistula Action Plan• Sample Action Plan TemplateEducation to surgeons, providers, and facilities• Networks 5 and 6 co hosted a Network-wide Surgeon outreachand training in Atlanta on December 2• Surgeon Feedback Reports created from Medicare billing data, distributed tosurgeons for evaluation.• Each Intensive Intervention facility held a patient educational learning sessionutilizing tools in the Network provided AV FISTULA toolkit.• Each Intensive Intervention facility was required to develop an AV fistulafocusedbulletin board for patient and provider education.P a g e | 40

Number of CathtersPROJECT 2: INCREASING AV FISTULAS THROUGH CATHETER REDUCTIONThe MRB’s long-term vascular access strategy is to addresses overall AV access placementand dialysis adequacy. The ultimate goal is to ensure patients are adequately dialyzed and theAV fistula (AVF) is the preferred access type to accomplish this. Venous catheters areassociated with an increased risk of all-cause and infection-related mortality amonghemodialysis patients. The MRB worked with facilities to reduce long-term catheter use and tomaintain low catheter rates while increasing AVF use. The MRB designed this project toincrease the prevalent AVF rate among hemodialysis patients focusing on facilities with thehighest long-term Central Venous Catheter (CVC) rate in the ESRD Network 6 with a primaryfocus of decreasing catheters while increasing prevalent AVFs.Since catheter reduction has a unique set of root causes, barriers, and solutions, Network 6selected facilities with the highest long-term catheter use rates for intervention to have thegreatest impact on the Network 6 overall AVF rate. Facilities with a prevalent AVF rate below66% in March 2011 and operated by a corporate group of at least 20 facilities were selected ifthey had a prevalent long-term catheter rate greater than 10% in March 2011. Network 6assessed project progress of intensive intervention facilities monthly by collection of: vascularaccess data element, catheter reduction worksheet, updates to action steps.Catheter Reduction Success‣ 733 fewer catheters in use (Figure 19)‣ 452 fewer long-term (90-days) catheters in use (Figure 20)Measure of Catheter Use in Network 6 by Month6,8006,6006,4006,2006,0005,8005,6005,4005,200Jan Feb Mar Apr May June July Aug Sept Oct Nov DecNumber of Catheters 6,508 6,601 6,532 6,542 6,468 6,386 6,274 6,220 6,014 5,810 5,774 5,775MonthFigure 19. Network 6 2011 Catheter Use Distribution by MonthP a g e | 41

Number of CatheterPercentageMeasure of Long Term Catheter Use in Network 6 By Month3,0002,5002,0001,5001,000500-Jan Feb Mar Apr May June July Aug Sept Oct Nov DecNumber of Catheters 2,443 2,401 2,327 2,290 2,281 2,282 2,243 2,189 2,130 2,032 2,031 1,991MonthFigure 20. Network 6 2011 Long-term (>90 days) Catheter Use Distribution by MonthCatheter Intervention overviewFacility Selection:Intensive Intervention: (N=65) Facilities with a prevalent AVF rate below 66% in March 2011and operated by a corporate group of at least 20 facilities were selected if they had a prevalentlong-term catheter rate greater than 10% in March 2011.Percentage of Facilities with 90 day Catheter Rate > 10%Intensive Intervention Subgroup - 65 FacilitiesData Source - Self-reported survey data120.0%100.0%80.0%60.0%40.0%20.0%0.0%100.0%47.7% 43.1% 40.0% 35.4% 38.5% 38.5% 43.1% 36.9% 29.2%% of FacilitiesMonthFigure 21. Distribution of Long-term Catheter Use during the 2011 Focused InterventionP a g e | 42

Intervention ImplementationSKC employed the vascular access intervention described above to intervene on thecatheter use rates in the Network. Additionally, the facilities selected for the vascularaccess intervention based upon the catheter rates also received a facility-specificcatheter rate report – Report #107.Figure 22. Catheter Use Reduction Facility-specific Feedback reportP a g e | 43

PROJECT 3: ADEQUATE DIALYSIS FOR ESRD BENEFICIARIESThe MRB designed this project, which began August 2011, to increase the mean urea reductionratio (URR) in the poorest performing facilities through root cause analysis, focusedinterventions, feedback, technical assistance, and peer-to-peer review. The Network MRBreviewed ELab, Clinical Performance Measures data, and the Lab Data Correction results andset a goal that 90% of hemodialysis patients will have a URR >65.The MRB measured project progression via a monthly Adequacy Data Collection Tool,submitted by each focus facility, which collected the following:URR• Kt/VPrescribed Treatment Time• Vascular access in Use• Prescribed Blood Flow Rate• Treatment Time for the month (Average)Monthly Blood Flow Rate (Average)A comment section for narrative of outliers and descriptionsThe data collection tool auto populates a facility progression chart with the adequacy goal sothat the facility can assess their progression toward the goal of 90% of patients with a URR of>65% and review at monthly CQI. The MRB calculates and reviews an average of threemonths data.Facilities that have met the set goal for adequacy focused review will continue to bemonitored for sustainability of progression made or a minimum goal of 90% patientswith URR >65%, monthly for a minimum of 3 months. If any facility does not sustain orcontinue their improvement, the facility, the MRB asks for an action plan detailing rootcause analysis of the decline for review. If the facility fails to progress, as evidencedby the monthly tracking, Network staff calls the facility to discuss current issues andformulate a plan for forward progression.Hemodialysis Adequately Success‣ Based on collected data, 80% of Network 6 focused facilities are meeting the goal of90%. (Figure 23)‣ Increase in Network-level URR data from 88.2% in 2006 to 95.8% in 2011. (Figure 24)P a g e | 44

Figure 23. Progression of Network 6 Adequacy Focus facilitiesFigure 24. Distribution of the % of Network 6 Patients with URR> 65P a g e | 45

% URR >65%Adequacy Focused Review Intervention OverviewFacility Selection:Thirty of the poorest performing facilities were selected for the “Adequacy Focused Review”based on not meeting the set goal of 90% of patients dialyzing with a URR of >65%. Focusfacilities were the facilities with > 40 patients and less than 80% of the patients with a URR >65%. The Network 6 Medical Review Board utilized the 2011 Lab Data Collection gathered inQuarter 4 of 2010, to identify the focus facilities based on designated cut points. The MRBexcluded pediatric facilities and those facilities with less than 40 patients.1101009080706050403020100Facilities Chosen ->40 patients and65% -N=30Facilities below theNational Average of91.1% (N=157)Adequacy - Distribution of URRData Source: ELab Q4 2010Network 6 FacilitiesFigure 25. Distribution of Network 6 URR rates by facilityIntervention Implementation:Step 1- Notified facilities’ Medical Directors, Regional Management, Clinical Manager and StateSurveyors of inclusion into projectStep 2- Notified facilities of the intervention and sent project information. SKCinformed facilities of their reporting requirements: Monthly Lab Data Collectionwith required elements, first action plan with Root cause analysis and quarterlyRoot Causes with interventions and process changes based on previous monthsdataStep 3- Provided feedback, technical assistance and education to all facilitiesP a g e | 46

Feedback Reports to each focus facilityNetwork reviewed information and sent feedback reports monthly (sample below)Figure 26. Hemodialysis Adequacy Progression ReportSKC provided technical assistance to focus facilities via the following:Network 6 sponsored Webinarso November Webinar: Project outline and Adequacy Management• Goals, Activities, Timelines• CQI process for development of action plan• Fundamentals of problem statement with root cause analysiso December Webinar: Action Plans• Adequacy Root Causes• Best Practices• Proven interventionso Webinar 3: Identifying and addressing Root CausesNetwork QI Nurse collected and reviewed facility Adequacy Action Plans,providing written technical assistance to each facility. Six facilities were requiredto resubmit plans based on this review.Learning Session Summary Sheets were reviewed and approved by the NetworkQI NurseP a g e | 47

Percent of Patiente ImmunizedPROJECT 4: INCREASING INFLUENZA IMMUNIZATIONS IN Network 6The ESRD population has long been recognized as a vulnerable and underserved populationthat would benefit from immunizations, thus reducing the risk for hospitalizations and deathassociated with Influenza, Pneumococcal and Hepatitis B infections. Immunization is one of themost cost effective strategies to reduce unnecessary hospitalization and death.The Network MRB aligned the Immunization goals based on Healthy People 2020 objectivesand goals. Network 6 has realized a large increase in patients vaccinated againstPneumococcal (31.7% increase from 2009-2011) and Hepatitis B (24.4% increase from 2009-2011) infections. However, the overall increase in patients vaccinated against influenza hasonly increased 0.9% from 2009-2011. Based on the small increase in the influenza vaccinationrate, the Network MRB spent this past year focusing on low performing influenza immunizationfacilities and focused interventions to increase their immunization rates based on the goals ofthe Network MRB and Healthy People 2020 of 90% of patients vaccinated against influenza.Immunization Rates Years 2009-2012100.0%90.0%80.0%70.0%60.0%50.0%40.0%30.0%20.0%10.0%0.0%2009-10 2010-11 2011/12Hepatitis B Rate 69.1% 78.7% 93.5%Pneumococcal Rate 44.1% 67.5% 75.8%Influenza Rate 82.9% 83.0% 83.7%Figure 27. Network 6 Immunization Rates (2009-2012)Influenza Immunizations Success‣ All immunization QI project participants submitted the requested action plans andNetwork 6 reviewed and approved them‣ Each of the 72 intervention facilities completed all requirements.‣ 100% of facilities completed the webinar and either agreed or strongly agreed that theinformation presented would assist them in formulating a plan to increaseimmunizations within their facility.‣ Network 6 increased in each of the 3 immunization ratesP a g e | 48

Immunization Intervention overviewFacility Selection: The MRB used the 2010-11 Influenza data to select 72 IntensiveIntervention facilities, including any facility that had at least 25 eligible patients and met either orboth of these criteria:An influenza rate of 10% of their census not offered the vaccine n=10 (range from 10.8% to 77.3%)Both n=10.Intervention levelsLevel 1: Intensive Intervention: 72 total facilities meeting the above criteriaLevel 2: Intermediate Intervention: All other Network 6 facilities as of July 1, 2011.Intervention ImplementationStep 1- Notified facilities’ Medical Directors, Regional Management, Clinical Manager and StateSurveyors of inclusion into projectStep 2- Notified facilities of the intervention and sent project information Facilitieswere given facility-specific Immunization reports (Sample below)Figure 28. Network 6 Facility-Specific Immunization Feedback reportsP a g e | 49

Step 3- Network 6 provided facilities educational information and resources to share withbeneficiaries and facility staffVaccine Information Statements (English and Spanish versions):o It’s Federal Lawo Influenzao Hepatitis Bo Pneumococcal PolysaccharideCDC Guidelines for Vaccinating Kidney Dialysis Patients and Patients with ChronicKidney DiseaseFacility Education Poster: Are You Ready? Influenza Season Is Here flyerPatient Education Poster - Should You Get a Flu Shot?Patient Education Poster - Influenza, Hepatitis B, Pneumococcal PolysaccharidevaccinesImmunization Newsletter: It’s All About Staying HealthyStep 4: Network 6 led a webinar, attended by all intensive intervention facilities, providingtechnical assistance on root cause identification and action plan development.Step 5: Intensive intervention facilities submitted action plans, review by the Network. Network6 sent facility-specific feedback on each action plan.Step 6: All Network 6 facilities received monthly reminder fax blasts of flu season, importance ofimmunizing, available resources and tips for vaccinating patients – also reminded to keepaccurate records for the 2011-12 data collection.P a g e | 50

Impact of the Southeastern Kidney Council’s Goal 1Accomplishments on Patient Care in Network 6It is essential to keep the patient central throughout all projects and activities that theSoutheastern Kidney Council conducts with patients and providers. The CMS goal of the rightcare for every person every time and the Southeastern Kidney Council mission of improving thelives of people with or at risk of ESRD by promoting and advancing quality of care guide us inthis effort. Comparing December 2010 outcomes to December 2011 (source: FF Dashboarddata and Lab Data Collection Report):• 55.4% of people dialyzing with an AVF, CMS March 2012 Goal for Network 6,achieved November 2011 (Figure 11)• 1,570 more AVF in use (Figure 12)• 1,481 more AVF in place (Figure 13)• 6.7% more facilities reaching the CMS goal of 66% (Figure 14)• 733 fewer catheters in use (Figure 19)• 452 fewer long-term (90-days) catheters in use (Figure 20)• 80% of Network 6 Adequacy focused facilities met the goal of 90% of peopleachieving URR of 65% or better (Figure 23)• 7.6% increase in Network-level URR data from 88.2% in 2006 to 95.8% in 2011.(Figure 24)• 24.4% increase in the number of patients vaccinated against Hepatitis B over thepast 3 years (Figure 27)• 31.7% increase in the number of patients vaccinated against Pneumococcal overthe past 3 years (Figure 27)• 0.8% increase in the number of patients vaccinated against Influenza over thepast 3 years (Figure 27)P a g e | 51

CMS Goal 2Improve the independence, quality of life, and rehabilitation(to the extent possible) of individuals with ESRD throughsupport for transplantation, use of self-care modalities (e.g.,peritoneal dialysis, home hemodialysis), and in-center selfcare,as medically appropriate, through the end of life.P a g e | 52

OverviewThe Network meets the expectations of Goal 2 through provision of technical assistance andeducational outreach, providing educational materials to ESRD patients and their families toempower them to make informed and educated choices about their rehabilitation, treatment,including modalities and improve their quality of life. Additionally, the Network aspires to work intandem with the facilities to supplement their own patient and staff education to improve patientcare. The Network conducts the following activities to meet the educational needs of ESRD 6patients:I. New ESRD Patient Orientation Packet (NEPOP)II. Patient Education CalendarIII. Transplant CoalitionIV. Patient Ambassador ProgramV. Community Partnerships, Activities and ProgramsThe Network met the expectations of Goal 2 through program development, communitycollaborating, and educational outreach. The Network participated in several community eventsto promote awareness of kidney disease; partnered with organizations, locally and nationally,that promote the beneficiary as their own best advocate; collaborated with related organizationssuch as ANNA and KCER to increase awareness about kidney disease; and held variousworkshops and trainings throughout the calendar year to address needs within the ESRDpopulation.Further details on each project under Goal 2 are provided in the following pages.New ESRD Patient Orientation Packet (NEPOP)CMS has established a clearinghouse to send a New Patient Orientation Packet (NEPOP) to allpatients for whom facilities have submitted a CMS form 2728. In 2011, 8531 new patients inNetwork 6 received a NEPOP. For any packets that were returned (17 due to death and 399due to invalid address) the Network follows up to validate addresses and to ensure all newpatients receive the information. The NEPOP mailing includes the following resources:A Medicare beneficiary letter from the CMS administratorA letter from ESRD Network 6 Executive Director including:o Network 6 contact informationo Network’s toll-free number for patientso The Network’s grievance procedureo Services and assistance offered by Network 6o ESRD related patient careo Treatment optionso State Survey Agency contact informationMedicare Coverage of Kidney Dialysis and Kidney Transplant Services (CMS booklet)Preparing for Emergencies: A Guide for People on Dialysis (CMS booklet)You Can Live (CMS booklet)People Like Us (National Kidney Foundation [NKF] brochure)P a g e | 53

AAKP Resources (American Association of Kidney Patients [AAKP] Brochure)Dialysis Facility Compare (CMS Brochure)Vascular Access Card (CMS Insert Card)Patient Education CalendarThe Consumer Committee has designed the annual patient education calendar and monthlysupplemental mailings as the primary method for reaching all people with ESRD in the Network6 region. The SKC mails the calendar each December, allowing us to send one annual mailingproviding education on multiple ESRD related topics. The Southeastern Kidney Councilreinforces the message by sending each facility a monthly educational packet related to thetopic of the month.The Consumer Committee selects a theme each year and determines the topics, based on theirown experiences, discussions with other patients and surveys and contacts received at theNetwork. “Your Health Is A Family Affair” was the theme used for 2011 and featured thefollowing topic.Monthly Topics and Monthly Supplemental Materials included:Role of Southeastern Kidney Council and Consumer CommitteeKidney Failure and Family HistoryExercise and Nutritiono Just the Facts: Exercise for Life (English and Spanish)o Just the Facts: Fluid and Dialysis (English and Spanish)o Staying Healthy & Staying Fit Resource Tip Sheetso DVD: Exercise, Live Well, & Feel BetterP a g e | 54

Mental Healtho Living and Loving Life Flyero Tips for Facility Staff in working with Mental Health patients FlyerVascular Accesso Vascular Access for Hemodialysis Stop Light Postero DVD: Dialysis Patients Speak: A Conversation About the Importance of AVFistulaso Patient and Family Guide to Vascular Access Newslettero Choosing Your Vascular Access Brochureo Facility Staff Education: DVD: Cannulation of the Arteriovenous Fistula (AVF)and DVD: Atlas of Vascular AccessTransplantationo Kidney Transplant Basics Brochure• Complaints and Grievance Processo DVD: Because I Counto Patient Flyer: Patients Rights and Responsibilities and Complaints andGrievance Processo Facility Education: Tools for Facility Staff in Handling Complaints and Grievances• Emergency Preparednesso Emergency Preparedness Guideso Emergency Preparedness Guides (Spanish)• Taking Control of Your Health Careo Missed Treatment Flyero Compliance Flyero Additional Facility Tools:o Missed Treatment Moduleo Sample Reinforcement Flier• Vocational Rehabilitationo Social Security Brochureso Your Ticket to Work Brochureo Working While Disabled—How We Can Help Brochureo The Ticket To Work Program and Other Work Incentives Flyero Vocational Rehabilitation Checklisto Staff Education - Best Practices• Immunizationso Vaccine Information Statementso CDC Guidelines for Vaccinating Kidney Dialysis Patients and Patients withChronic Kidney Diseaseo Facility Education Poster: Are You Ready? Influenza Season Is Here Flyero Patient Education Poster - Should You Get a Flu Shot?o Patient Education Poster - Influenza , Hepatitis B , PneumococcalPolysaccharide Vaccineso Immunization Newsletter: It’s All About Staying HealthyP a g e | 55

• Medicare Part Do Medicare Part D Brochureo Medicare Coverage of Kidney Dialysis and Kidney Transplant Serviceso Things to Think about when You Compare Medicare Drug Coverageo Medicare Drug Coverage under Medicare Part A, Part B, and Part D Tip Sheet• Advanced Care Planningo Advanced Care Planning: For the Dialysis Patient and their Family Order Formo Who Uses Five Wishes?o End-of-Life Care for the Dialysis Patient: An Introduction for Patients andFamilies• Treatment Optionso Home Dialysis Postcard: Home Dialysis Central offers various educationalmaterials on Peritoneal Dialysis, Home Dialysis and alternate therapies to includeself-cannulation.o Kidney School Postcard to introduce the Kidney School online learning programson various topics to include Treatment Options.o Home Dialysis Central Comparison Flyero How-To Manual: The Art of Teaching Buttonhole Self-Cannulation -o Kidney School Module 2: Treatment Options for Kidney Failure(www.kidneyschool.org )o Treatment Methods for Kidney Failure Series Boxed Seto Understanding Your Hemodialysis Options and Understanding Your PeritonealDialysis OptionsP a g e | 56

Impact of the Southeastern Kidney Council Patient EducationCalendarIn 2011, Network 6 sent approximately 42,000 calendars to 563 facilities. Network 6 directedfacilities to disseminate the calendars to every patient and to utilize the calendar in their monthlyeducational initiatives. The Network conducted a survey during the summer 2011 to evaluatethe effectiveness and usefulness of the calendar. Based upon power calculations, SKC needed380 surveys to ensure accurate and reliable statistical judgments on the effectiveness of thecalendar. The Network identified a random sample of 55 facilities, each to have 10 patientscomplete the survey for 550 total surveys. SCK received 398 completed surveys.‣ Compared to 2010 more respondents knew what services the Southeastern KidneyCouncil offered. (Figure 29)‣ In 2011, more than 50% of the surveyed calendar respondents knew what servicesthe Southeastern Kidney Council offered (Figure 29)‣ More than half of the 2011 surveyed calendar respondents found that the layout, theactivities, educational materials and the overall calendar were useful. (Figure 30)70.0%60.0%2010 and 2011 Patient Education Calendar SurveyResponses:What does the Southeastern Kidney Council do?59.8%50.0%40.0%30.0%20.0%10.0%11.9%20.3%6.5%3.1%12.4%24.4%6.7% 7.7%41.1%201020110.0%AssistanceComplaints andGrievancesEducation Monitor Care No Answer/Don't KnowFigure 29. 2010 and 2011 Patient Education Calendar Survey Response: What does SKC do?P a g e | 57

Percent4540353025201510508.6 8.62011 Patient Education Calendar SurveyResponses:What was useful about calendar5.21942.412.42.4 1.4Figure 30. 2011 Patient Education Calendar Survey Response: What was useful about calendar?RehabilitationNetwork 6 calculated facility-specific rates of patients using vocational rehabilitation servicesand rates of patients either employed or attending school. The Network conducted phoneinterviews with a random sample of facilities with low Vocational Rehabilitation referral rates andno patients reported as working or attending school to offer technical assistance. Majority offacility staff (Social Workers) reported that patients are not interested due to medical inability orfear of losing benefits.Transplant CoalitionNetwork 6’s Transplant Coalition began in calendar year 2010 and expanded during the 2011calendar year.Georgia, North Carolina and South Carolina, the states of ESRD Network 6 area are among thelowest for kidney transplantation, as illustrated by the USRDS 1 2011 ADR (Figure 31). The1 U.S. Renal Data System, USRDS 2011 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, 2011. Publications based upon USRDSdata reported here or supplied upon request must include this citation and the following notice: The data reported here have been supplied by theUnited States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way shouldbe seen as an official policy or interpretation of the U.S. government.P a g e | 58

Medical Review Board and Board of Directors identified this as an area for further study andintervention. In September 2010, with CMS approval, SKC launched the Southeastern KidneyTransplant Coalition (SKTC) and continued the activities of this coalition in 2011.The SKTC mission, vision and goals:Mission: To increase the kidney transplantation rate by identifying and reducing barriers in theorgan procurement and transplant process.Vision: The SKTC is a coalition of committed individuals and organizations dedicated toexcellence in patient care, serving as the catalyst for change to become a recognized leader inensuring equitable access to kidney transplantation.Goals:1. To increase education and awareness about kidney transplantation among ChronicKidney Disease patients, dialysis providers and staff, and the public.2. To build an alliance of the transplant centers in Network 6 in order to improvecollaboration, standardize policies, and clarify procedures.3. To increase the availability of deceased and living donor organs.4. To identify, test, and distribute best practices in all phases of the kidney transplantprocess.Figure 31. USRDS 2011 ADR Adjusted Transplant rates (Deceased and Living Donor)Throughout 2011, the coalition continued its collaborations with its members:Transplant facility representatives to include Medical Directors and SurgeonsBeneficiariesOrgan Procurement OrganizationsDialysis facility staffRenal organizations such as Georgia Transplant Foundation, AAKP and NKFQuality Improvement OrganizationsP a g e | 59

During 2011, the Coalition hosted a plethora of events to include the following:oooKick off meeting February 4, 2011 in Atlanta, Georgia with 36 members from thefollowing organizations:• American Associations of Kidney Patients• Beneficiaries from the renal community• Dialysis Facility Staff• National Kidney Foundation of Georgia and Alabama• North Carolina/ South Carolina Quality Improvement Organizations• Organ Procurement Organizations• Georgia Quality Improvement Organizations• Georgia Transplant Foundation• Transplant Facilities – Medical Directors, Financial Coordinators,Transplant Administrators, etc.Coalition members brainstormed collectively and completed root cause analysisby identifying all possible root causes and barriers and divided into workinggroups:• Organ Availability• Transplant Education and Attitudes• Coordination of Transplant Centers• Best Practices• PolicySteering Committee meetingsP a g e | 60

Patient Ambassador Pilot ProgramIn 2011, Network 6 continued the activities of the pilot Patient Ambassador Program, designedto educate and build a stronger relationship with patients and the Southeastern Kidney Council.SKC identified local “Ambassadors” to provide peer-to-peer interaction with patients, providefeedback on Network for outreach and education activities. The activities of the ambassadors in2011 focused on identifying barriers to quality patient care and ways to improve the patients’experience of care. Additionally, throughout the year, SKC held monthly calls with Ambassadorsand conducted site visits to help encourage and support the Ambassadors.The vision: “To develop patient-centered resources and tools to empower ESRD patients”Program Goals:I. Facilitate patient-family support groupsII. Advocate for quality patient careIII. Develop educational tools and resourcesIV. Assist in distributing Network 6 educational materialsV. Communicate with patients on the role of the AmbassadorMonthly CallsThe Ambassadors, facility staff and Network staff shared information about monthly facilityeducation activities, suggestions, concerns, and ideas shared by peer beneficiaries on monthlyconference calls. Network 6 held these calls on a Wednesday and a Thursday of each month toaccommodate treatment schedules. Additionally during these monthly meetings Network staffpresented on topics that included: Taking Control of Your Health Care, VocationalRehabilitation, Immunizations, Medicare Part D, Advanced Care Planning, Nutrition andwellness, Mental Health, and Treatment Options.Site Visits with Patient AmbassadorsPatient Services Coordinator and Patient Services Specialist visited 13 Patient Ambassadors at13 clinics to discuss implementation of the Ambassador program at each clinic and future goalsfor the Patient Ambassador Program. Staff offered support to each Patient Ambassador andencouraged their continued efforts as Ambassadors.P a g e | 61

Community Partnerships, Activities and ProgramsIn 2011, Network 6 collaborated with many renal community organizations. To host meetings,trainings,January• Promoted Nephrology News & Issues WebEx on DOPPS dataFebruaryMarchAprilMay• Vascular Access collaboration with the community of Athens, GA to include FMC, DaVitaand non-LDOs to focus on vascular access barriers. Forty-three (43) Nurses, PCTs,Regional Administrators, and other facility staff attended the workshops from 12 areafacilities.• PSC provided training on reducing complaints/grievances at a Regional FMC SocialWorkers meeting in Atlanta, GA.• The Network sent a fax broadcast to all facilities informing them of the upcoming AAKPConference Call/Online Webinar "Understanding the New ESRD Bundling PaymentSystem: How will this change affect me and my dialysis treatments?" to distribute topatients.• Network 6 and ANNA Chapters of Georgia collaborated to present, Nephrology NurseKnowledge Exchange 2011 in Atlanta, GA.• Executive Director presented, Pathway to Success: Increasing AV Fistula Rates jointpresentation with Non-LDO on Focused Review for Catheters and Fistulas.• Patient Services Coordinator visited two dialysis facilities in Charleston, SC area andspoke with patients on the role of the Network and how to contact the Network with acomplaint or grievance.• Professionalism training for RAI Center Directors and Social Workers was facilitated byPSC and QI nurse specialist in Charleston, SC• Community Outreach Coordinator, Patient Services Coordinator and QI Nurse Specialistconducted DPC Training in Atlanta, GA. Sixty-three (63) Nurses, PCTs, and SocialWorkers attended the workshops from 40 area facilities.• Provided Cannulation training at the request of FMC in Georgia for 49 attendees from 13different Medicare Providers, Acute Dialysis Centers, and Corporate representatives.Thirty (30) Nurses, 16 Patient Care Technicians, and 3 Corporate Representativesattended.• PSC & COC attended DCI Community Health Awareness Fair in Greenville, SC.Network 6 set up vendor table and spoke with patients about various topics to includeP a g e | 62

ole of Network 6, Dialysis Facility Compare, Emergency Preparedness and VascularAccess.• Network 6 exhibited at the AAKP Kidney Beginning Lives Program in Raleigh, NC.June• QID and MRB Chair hosted a surgeon training/meeting in Columbia, SC due to low AVFrates – top rate North Carolina surgeon presented on best practices and technique• Network 6 promoted Dialysis Patient Citizens information regarding conference call, CallAgenda: Centers for Medicare and Medicaid Services (CMS) Update.July• The Network sent a fax broadcast to all GA facilities notifying them of the 2011 ANNADogwood Event.August• PSC presented “Taking the Proper Steps in Improving Patient Care” to a regionalprovider meeting.• The Network notified all facilities about the fall ANNA meeting.• The Network sent fax broadcast to NC facilities regarding NC CNSW meeting onSeptember 29, 2011 in Greensboro, NC.September• Network 6 presented, “Increasing AVFs in Network 6” a vascular access training forIntensive Intervention facilities in Raleigh, NC. Forty-five (45) participants attendedincluding LDO RVPs, DVPs and their colleagues, Network 6 staff, Consumer andMedical Review Board members.• Network 6 provided a patient panelist for the Kidney Community Emergency Response(KCER) Coalition Community Partners Meeting, entitled “Linking Dialysis andEmergency Planning” in Atlanta, GA.• Information Management Webinar conducted for facilities with more than three formssubmitted with errors (47 facilities) and those under focused review for forms compliance(7 facilities).• Patient Services Coordinator presented, “Boundaries and Professionalism” to 26 SocialWorkers at the NC CNSW in Greensboro, NC.October• The Network notified all facilities about Network 5’s WebEx on Palliative Care onNovember 3, 2011.• QID presented AVF Training to Regional Group of Providers• MRB Chair presented AVF information to regional clinic manager’s meeting of a dialysiscorporation• Network 6 sent fax broadcast to GA facilities regarding ANNA Dogwood Webinar onNovember 1, 2011.• Network 6 coordinated with the NKF of SC for a patient workshop covering multipletopics of interest.P a g e | 63

November• QID presented to regional meeting of corporate Medical Directors on the AVF project,best practices and barriers• Increasing AVFs through Focus on Incident Patients and Using Existing AV Fistulas.Facilities in the AVF project shared best practices and brainstormed solutions to barriers• Network 6 promoted CDC Immunization WebEx - “Update on Influenza Vaccination forHealth Care Personnel: Recent Coverage, Recommendations, Reporting, andResources”• Network 6 sent fax broadcast to GA facilities regarding ANNA Dogwood Event “In-DepthLook at Hyperparathyroidism/A Closer Look at 1,25D and 25D”December• Network 6, Network 5 and FFBI collaborated to present, “2011 Fistula FirstComprehensive Fistula Construction and Management Program for Surgeons – How toMake Fistulas that Work.” One hundred and seven (107) Surgeons attended the training.NC – 10; GA – 27; SC – 13• Network 6 sent a broadcast fax promoting 3 Nephrology education meetings in 2012:o March 22-23, 2012 – Network Annual Meeting in Greenville, SCo March 30-31, 2012 – Network and GA ANNA Chapters Collaboration in Atlanta,GAo May 23-24, 2012 - Network and NC ANNA Chapters Collaboration inGreensboro, NC• COC presented on the role of the Southeastern Kidney Council, emergency planning,Networks, and KCER at the request of Gwinnett, Newton, and Rockdale County HealthDepartments in Georgia.P a g e | 64

Impact of the Southeastern Kidney Council’s Goal 2 Accomplishmentson Improving the independence, quality of life, and rehabilitation (toextent possible) of individuals with ESRD in Network 6Through 2011, Network 6 provided educational materials, technical assistance and conductededucational outreach activities to empower ESRD patients and their families to make informeddecisions about their rehabilitation, treatment and ways to improve their quality of life. Network6 Activities for 2011 included:• 8,531 New ESRD Patients in Network 6 received New Patient OrientationPackets (NEPOP), which provided patients with resources on ESRD Patientrelated Care topics such as Treatment options, Information on the Network’sgrievance procedure and contacts for State Survey Agencies.• The Consumer Committee developed and disseminated over 42,000 copies oftheir annual Patient Education Calendar:”Your Health A Family Affair” whichprovided all ESRD patients in Network 6 educational materials on multiple ESRDrelated topics such as: Treatment options, Vocational Rehabilitation, ImprovingQuality of life.• More than 50% of surveyed calendar recipients were able to identify servicesoffered by the Southeastern Kidney Council. (Figure 29)• More than half of the 2011 surveyed calendar respondents found that the layout,the activities, educational materials and the overall calendar were useful. (Figure30)• Conducted a Vocational Rehabilitation study among those facilities with lowreferral rates and identified root causes to be patients disinterest in VR due tomedical inability or fear of losing benefits.• SKC continued its activities to increase the kidney transplantation rate in Network6 by supporting the activities of the Southeastern Kidney Transplant Coalition.• In 2011, Network 6 continued the activities of the pilot Patient AmbassadorProgram., where “Ambassadors” provide peer-to-peer interaction with patientsthat focused on barriers to quality patient care and how to improve the patients’experience of care.• In 2011, Network 6 collaborated with many renal community organizations tohost over 30 meetings and trainings.P a g e | 65

CMS Goal 3Improve patient perception of care and experience of care, andresolve patients’ complaints and grievances.P a g e | 66

OverviewIn 2011, Southeastern Kidney Council provided educational resources and technical assistanceto achieve the Network’s mission and goals. By educating the ESRD community, Network 6 isable to improve the ESRD patient perception of care. Southeastern Kidney Council providedvarious, newsletters, educational pamphlets and tools to improve patient perception andexperience of care. Southeastern Kidney Council actively worked to resolve patients’complaints and grievances. The below activities, projects, tools and workshops detail theNetwork’s active role in patient care.Patient Web Pages – www.esrdnetwork6.org and www.MYSKC.orgThe Southeastern Kidney Council website provides educational materials on kidney disease,complaint and grievance procedure, vascular access, disaster preparedness, patientnewsletters, vocational rehabilitation and more. Also included on the website is informationregarding how to volunteer for the Network 6 Consumer Committee. The website includes linksto various government and renal organizations including CMS Dialysis Facility Compare andMedicare Part D. In 2011, the website had 17,773 visits and over 48,000 views.Disaster Preparedness ActivitiesThe goal of emergency preparedness is to ensure patients do not have an interruption intreatment due to an emergency. This includes ensuring facilities have a plan in place toaddress emergencies, working with facilities to educate and train patients to be prepared anddeveloping a plan to ensure the Network is available in the event of a disaster.The Network sends new facilities the All Hazard Educational Series toolkit.this includeseducational materials that provide important resource information and How to’s in the areas of:Staying prepared for an emergencyWhere to find disaster assistanceStress managementManaging ino Extreme weather conditionso Flash floodso Fire hazardso Terrorist attackso PandemicsProtecting pets in a disaster or hazard situationHelpful safety tips in post-storm safetyThe Kidney Community Emergency Response (KCER) Dialysis Facility Disaster PlanTemplateDepartment of Homeland Security - Preparing Makes Sense for People with Disabilities andSpecial NeedsDepartment of Homeland Security - Emergency Supply ListState specific emergency management contact informationP a g e | 67

The 2011 Patient Education calendar included a month focused on Emergency Preparednessfor the Month of June. Network 6 provided “Preparing for an Emergency guides” to all dialysisfacilities to disseminate to all patients.In the event of a disaster, Southeastern Kidney Council is prepared to assist facilities andpatients with locating dialysis services. The Network tracks which facilities are open or closedand uses SIMS to record temporary placement of patients. In August 2011, Hurricane Ireneimpacted the Network 6 area. Network 6 sent reminders to facilities in advance with tips andlinks and followed up with patients and facilities after the storm to ensure no interuption indialysis services.The Southeastern Kidney Council has a written emergency and disaster plan that addressesoperations, the Southeastern Kidney Council role and function in national disasters relative todialysis facilities located in the service area. We operate an emergency line whre patients andfacilities are encouraged to call wtith any issues. The Southeastern Kidney Council also has anongoing relationship with a partner Network, #9/10 to provide back-up assistance in the event ofdisaster that impairs local operations.Internally, Network 6 reviews disaster preparedness plans annually. Network 6 sendsalerts/notifications to affected areas to notify facilities and patients of a pending disaster,including floods, snowstorms and other weather related disasters. The Network 6 CommunityOutreach Coordinator is a member of the KCER Patient Advisory Committee and PandemicTeam.Resolving Complaints and GrievancesPeople with ESRD who are dissatisfied with the care they are receiving are encouraged tocontact the Southeastern Kidney Council for assistance in resolving their concerns. They maysubmit complaints or grievances verbally or in writing and may remain anonymous if desired.Some complaints are so specific that they cannot be investigated anonymously and this isdiscussed with the patient before proceeding. Since dialysis is a long-term relationship betweenthe patient and his/her provider, we do encourage patients to use their local complaint process.If the patient is not comfortable doing this or if this has been unsatisfactory, the SoutheasternKidney Council investigates and resolves the problem. It is not mandatory that patients first usetheir local procedure. During the initial intake, the Southeastern Kidney Council gathers asmuch information as possible from the caller, including dates and times of any specific eventsand an understanding of all contributing factors.P a g e | 68

CMS requires that Networks assume a proactive role in the prevention, facilitation andresolution of complaints and greivances. The Network manual defines the role of ESRDNetworks in this process which may vary depending on the situation:Expert InvestigatorThe Network may assume the role of an expert investigator, when the quality of care provided toa patient(s) is an issue, the investigation's focus is the individual complaint and any overallpatterns of care within the facility related to the complaint. For example, if a patient complainsabout the procedures used to initiate dialysis, the Network investigates the complaint byreviewing the techniques used by the facility to initiate dialysis on potentially affected patients.FacilitatorWhen communication between the patient and the facility is problematic, the Network’s role maybe to facilitate communication and the resolution of differences.AdvocateNetworks advocate for individual patient's rights and/or the rights of all patients at a facility,depending on the situation. A Network acts for the greater good when the situation involves athreatening or violent patient.Referral AgentIssues that are not specifically ESRD Network issues, such as staff safety, fraud, andcompliance with the Conditions for Coverage (CfC), should be handled by SAs or other local,State, or Federal agencies. Each Network must maintain a current list of appropriate local,State, and Federal resources to use as referrals for beneficiaries and/or complainants in need ofassistance. (See §130.6)CoordinatorWhere potentially serious quality of care concerns and/or CfC issues are involved, the Networkalerts the appropriate RO and RO PO immediately and coordinateits investigation with the SA to avoid duplication of effort andconflicting outcomes. (See §130.8.)EducatorThe Network acts as an educator providing information and/or areferral to an appropriate resource when patients, families or facilitystaff request or require information/ education about ESRD,treatment of ESRD, or appropriateness of care.P a g e | 69

Southeastern Kidney Council encourages patients and facilities to contact the SoutheasternKidney Council with questions and concerns to prevent patient/facility complaints andgrievances. The Southeastern Kidney Council provides a poster for every facility to post withcontact information and an explanation of the Southeastern Kidney Council’s role in complaintresolution. This information is also available on the Annual Patient Educational Calendar, theSoutheastern Kidney Council website, the NEPOP letter, and the on-hold phone message.The 2011 Patient Education calendar included a page that defined complaints and grievancesand what to do if you have one, shown below. It instructed patients on how to call theSoutheastern Kidney Council for help. The Southeastern Kidney Council provided educationalresources to facility staff for patient distribution as follows:I Count DVD: This DVD teaches dialysis patients about their rights and responsibilitiesand ways patients can take an active role in their healthcare.Patient Education Flyer: Patients Rights and Responsibilities and Complaints andGrievance Process. Facilities made copies, distributed to all patients and posted flyer inpatient waiting areaTools for Facility Staff in Handling Complaints and GrievancesThe Southeastern Kidney Council expects every facility to display the SKC poster that instructspatients on how to contact us if they have a complaint or grievance.P a g e | 70

Number of ContactsTechnical AssistanceThe Southeastern Kidney Council also works with dialysis and transplant providers, providingguidance, technical assistance and strategies in handling difficult situations. Providers areencouraged to contact us early in the process so the issue does not intensify. Early, proactiveresolution serves both the patient and the provider.Southeastern Kidney Council processed approximately 1,551 contacts from patients and facilitiesin 2011 (Table 8). Approximately 38% of the calls in 2011 were Facility Inquiries. Most calls in2011 originated from either Georgia (45.0%) or North Carolina (33.7%). There were no formalgrievances in 2011. Of the 1,551 contacts in 2011, 262 were beneficiary complaints, all of whichwere resolved, with 19 cases referred to the State Survey Agency, and none unresolved.700600500Distribution of the Network 6Contacts for 2011All CallsGA400NC3002001000BeneficiaryComplaintBeneficiaryInquiryDataProcessingFacilityConcernsContact DescriptionFacilityInquiryOtherInquiryFigure 32 Network 6 Contacts by ClassificationTable 8. Distribution of the Type of Complaints and Grievances in 2011 by stateType of Grievance orComplaintAll CallsN=1551GAn=699(45.1%)NCn=523(33.7%)SCn=249(16.0%)OtherStatesn=80(5.2%)Beneficiary Complaint262 (16.9%) 110 (15.7%) 99 (18.9%) 48 (19.3%) 5 (6.3%)Beneficiary Inquiry 44 (2.8%) 19 (2.7%) 10 (1.9%) 6 (2.4%) 9 (11.3%)Data Processing 273 (17.6%) 136 (19.5%) 61 (11.7%) 32 (12.9%) 44 (55.0%)Facility Concerns 247 (15.9%) 108 (15.5%) 105 (20.1%) 31 (12.4%) 3 (3.8%)Facility Inquiry 591 (38.1%) 270 (38.6%) 212 (40.5%) 104 (41.8%) 5 (6.3%)Other Inquiry 134 (8.6%) 56 (8.0%) 36 (6.9%) 28 (11.2%) 14 (17.5%)P a g e | 71

Trend AnalysesSoutheastern Kidney Council enters all contacts received into the SIMS database, recordingdates opened and closed/resolved/referred, type of complaint, type of caller, issues discussedand resolution reached. This allows profiling by facility, state, demographics and reason for call.Southeastern Kidney Council trends contact data in six key ways:Caller StateAffiliation such as Large Dialysis Organizations or Non-Large Dialysis OrganizationsAge and RaceContact ClassificationArea of Concern/SubcodeInvoluntary DischargesInterventions are developed to target geographical areas or providers such as on-line trainingmodules, trainings/presentations provided by Southeastern Kidney Council. SoutheasternKidney Council Medical Review Board reviews the trends, provides feedback, and interventions.Southeastern Kidney Council also has an internal process for data trends. It trends data tomonitor and improve its internal processes as part of its IQI process. Indicators include the timebetween opening and resolving all contacts as well as the completeness and accuracy ofcontacts data recorded.P a g e | 72

Number of CallsNumber of CallsThe overall bar graphs (Figures 33 & 34) represent the types of calls during the year by quarterfor beneficiaries and facilities. For Beneficiary calls, most calls in 2011 concerned the quality oftheir care or the dialysis facility environment. The next most frequent complaint for beneficiarieswas the Professionalism of the facility staff and providers. Similarly, most facility calls in 2011were concerning staff and Professionalism, with the next most frequent type of concernregarding requests for Educational materials.50Beneficiary/Representative Calls byCategory by Quarter4030201002011 Q1 2011 Q2 2011 Q3 2011 Q4QuarterQual of Care/EnviEdu/InfoProf/StaffReimbursTrans/DischAbuse/DisruptOtherFigure 33. Network Beneficiary Call Contacts by Type and QuarterFacility Contacts by Category by Quarter2502001501005002011 Q1 2011 Q2 2011 Q3 2011 Q4QuarterQual of Care/EnviEdu/InfoProf/StaffReimbursTrans/DischAbuse/DisruptOtherTech Asst - QITech Asst IMFigure 34. Network Facility Call Contacts by Type and QuarterP a g e | 73

Impact of the Southeastern Kidney Council’s Goal 3 Accomplishmentson Improving patient perception of care and experience of care, andresolve patients’ complaints and grievancesIn 2011, Southeastern Kidney Council provided educational resources and technical assistanceto educate the ESRD community and to improve the ESRD patient perception and experienceof care. Additionally, the Southeastern Kidney Council actively worked to resolve patients’complaints and grievances. Network 6 Activities for 2011 included:The Southeastern Kidney Council website, which provides education materials on kidneydisease, complaint and grievance procedure, vascular access and many more topicshad over 48,00 views and 17,773 visitsNetwork 6 assisted Hurricane Irene impacted facilities and patients with locating dialysisservices in August 2011Network 6 handled 1,551 contacts from patients and facilities in 2011 (Table 8)Network 6 referred 19 cases to the State Survey AgencyThe top areas of concerns for beneficiaries were quality of care, the dialysis facilitytreatment environment, and staff professionalismP a g e | 74

CMS Goal 4Improve collaboration with providers and facilities to ensure achievement ofgoals 1 through 3 through the most efficient and effective means possible, withrecognition of the differences among providers (independent, hospital-based,member of a group, affiliate of an organization, etc.) and the associatedpossibilities/capabilities.P a g e | 75

OverviewThe Network 6 continued its collaborations with providers and facilities to ensure CMS goals 1to 3 were achieved in the most efficient and effective manner by utilizing several methods ofeducation and technical assistance such as:Broadcast FaxesNetwork WebsiteWebEx SeminarsMeetings and WorkshopsThe Southeastern Kidney Council distributes updates via broadcast fax and posts materials onthe Network website, www.esrdnetwork6.org. Samples of the notifications include:Conditions for Coverage UpdatesCenters for Medicare & Medicaid Services UpdatesDialysis Facility ReportsIn 2011, the website had 17,773 visits and over 48,000 views. The Network 6 website(www.MYSKC.org) contains a wealth of information including:Toolkits for clinical quality improvementBest practicesQAPI assistanceData reportsPresentations and trainingsAnnouncements of live meetingsRecorded WebEx trainingsOn-line training modulesConditions for Coverage and Interpretive GuidelinesFDA alertsPatient Education materialsLinks to other sites including CMS and Dialysis Facility CompareP a g e | 76

A collaborative project is a systematic approach to healthcare quality improvement in whichteams of healthcare providers test and measure practice innovations. They share theirexperiences in an effort to accelerate learning and widespread implementation of best practices.The Southeastern Kidney Council collaborated with the following groups in 2011:Dialysis and Transplant FacilitiesNetwork 6 utilized Vascular Access collaboration with the community of Athens, GA to includeFMC, DaVita and non-LDOs to focus on vascular access barriers. Forty-three (43) Nurses,PCTs, Regional Administrators, and other facility staff attended the workshops from 12 areafacilities.Network 6 presented, “Increasing AVFs in Network 6”, a vascular access training for IntensiveIntervention facilities in Raleigh, NC. Forty-five (45) participants attended including LDO RVPs,DVPs and their colleagues, Network 6 staff, Consumer and Medical Review Board members.Network 6 presented Cannulation training at the request of FMC in Georgia. It included 49attendees from 13 different GA Medicare Provider Numbers, Acute Dialysis Center, andCorporate reps and 30 Nurses, 16 Patient Care Technicians, and 3 Corporate Representatives.Forty-two (42) participants completed the evaluation. The majority (95%) of participants statedthat the difficulty level of the meeting content was appropriate and 78% of participants rated theworkshop content as excellent, and the remaining 22% rated it as satisfactory. Data from preandpost-evaluation surveys suggested that participants increased their knowledge aboutvascular access. Participants improved their knowledge in all topic areas, including how toassess vascular access, how to identify a maturing AVF, when to evaluate a fistula for nonmaturation,and who should be involved in-patient care.Network 6, the Chief Medical Officers, Regional Vice Presidents and Divisional Vice Presidentsof the Large Dialysis Organizations within our region formed a unique collaboration in 2011.Network 6 hosted “Increasing AVFs through Focus on Incident Patients and Using Existing AVFistulas” and each RVP/DVP participated in a face-to-face meeting in Atlanta, Georgia onNovember 10, 2011. Each region presented a PowerPoint Presentation on successes andbarriers.The use of WebEx as a mode of communication and teaching resource was effective.Comments from participants about the medium included “WebEx is excellent medium to reachthe most people while managing costs and very effective - easy to log into.”The Southeastern Kidney Council recognizes that the dialysis and transplant facilities in thearea are key partners to improving care and need to be engaged in the process. To remindfacilities of this expectation and to document this relationship, every facility signs an annualQuality of Care Commitment statement, which explains their role in achieving Network and CMSgoals.P a g e | 77

The Southeastern Kidney Council distributes FDA alerts related to general population andnephrology via broadcast fax to all dialysis and transplant facilities. SKC also posts FDA alertson the Southeastern Kidney Council website.1/5/2011: Class 1 Recall: Angiosculpt Scoring Balloon Catheter1/20/2011: FMC CombiSet Blood Tubing Set03/03/2011: B. Braun Outlook 400ES Safety Infusion System, Model #621-400ES: Class1 Recall - Hardware May Become Unresponsive04/04/2011: Roche ACCU-CHEK FlexLink Plus Infusion Set: Class I Recall - Potentialfor Under-Delivery of Insulin05/04/2011: Coumadin (warfarin sodium) Crystalline 5mg Tablets: Recall - Tablets MayHave Higher than Expected Potency05/11/2011: Weck Hem-o-Lok Ligating Clips: Contraindicated for Ligation of RenalArtery During Laparoscopic Living-Donor Nephrectomy06/27/2011: FDA MedWatch - Erythropoiesis-Stimulating Agents (ESAs) In ChronicKidney Disease: Drug Safety Communication - Modified Dosing Recommendations07/08/2011: Fax broadcast to all transplant facilities regarding Nulojix (belatacept): RiskEvaluation and Mitigation Strategy (REMS)08/04/2011: Fax broadcast to facilities regarding Arrow Catheter FDA Alert.08/03/2011: Fax broadcast to all facilities regarding HP Industries Recall.Renal OrganizationsThe Community Outreach Coordinator participated in several planning meetings with thevarious ANNA chapters in our region.In addition to attending and presenting at renal organization meetings, the Southeastern KidneyCouncil promoted various events of renal organizations by faxing to dialysis centers to includethe following:The Network sent a fax broadcast to 183 NC facilities to remind them of the upcomingANNA NC Statewide Symposium 2011 and the Network 6 NC Annual Meeting.The Network sent a fax broadcast to 277 GA facilities regarding ANNA Dogwood DanceParty.The Network sent a fax broadcast to all GA facilities regarding 2011 ANNA DogwoodEventThe Network sent a fax broadcast to 282 facilities regarding Anna Event December 13,2011P a g e | 78

State Survey AgenciesSoutheastern Kidney Council met face-to-face or via conference call with the individual StateSurvey Agency staff to discuss Network 6 role, State Survey role, Focused Review, Complaintsand Grievances, and cited deficiencies.State Survey Agencies call the Network for information when performing facility surveys.Network 6 fulfilled 105 State Surveyor requests with the following information:Complaints and/or GrievancesCurrent Lab Data ReportVascular Access Ranking ReportsData Forms ComplianceNetwork 6 Quality of Care AgreementIf the facility is under Network focus for a quality improvement indicatorThe Southeastern Kidney Council participates in quarterly calls with the Division of Survey andCertification to discuss updates related to ESRD Networks and State Surveyors. TheSoutheastern Kidney Council routinely works with State Survey Agencies on patient complaintsand grievances.The North Carolina, South Carolina and Georgia QIOs are all active participants of theSoutheastern Kidney Council Coalition devoted to increasing transplant rates in Network 6region.Kidney Community Emergency Response CoalitionNetwork 6 staff actively participated in the Kidney Community Emergency Response Coalition(KCER) activities. The Community Outreach Coordinator is a member of the KCER PatientAssistance Team and KCER Pandemic Team and participated in monthly conference calls.Network 6 collaborates with Georgia, North Carolina and South Carolina EmergencyManagement Departments regarding disasters.P a g e | 79

Other CollaborationsIn 2011, Network 6 also collaborated with the following organizations:Centers for Medicare & Medicaid Services, through meetings and conference calls withthe Dallas regional office and central office in Baltimore, MDESRD Networks: Network 6 collaborated with Networks 1, 5, 9/10, 11, and 14 on aWebinar regarding common patient complaints related to safety titled: Safety. Network14 developed this. Thirty-two (32) Network 6 facilities participated (31% of allparticipants). The Network also collaborated Networks 1, 5, 9/10, 11, and 14 on aproject to explore disparities of care that included a face to face meeting with physicianand staff representation from each Network and collaboration with the Center forReducing Health Disparities at Case Western Reserve University in Cleveland, Ohio.Preliminary multivariate analyses indicate that no patient characteristics were statisticallysignificant; however, small dialysis units had a statistically significantly higher risk ofpayment deductions.P a g e | 80

Impact of the Southeastern Kidney Council’s Goal 4 Accomplishmentson improving collaboration with providers and facilities to ensureachievement of goals 1 through 3 the most efficient and effectivemeansIn 2011, Southeastern Kidney Council fulfilled 105 State Surveyor Requests and metface-to-face or via conference call with the individual State Survey Agency staff todiscuss Network 6 role, State Survey role, Focused Review, Complaints andGrievances, and cited deficiencies.The Southeastern Kidney Council distributed 10 FDA alerts related to general populationand nephrology via broadcast fax to all dialysis and transplant facilities.Network 6 utilized WebEx technology as a teaching resource for various meetings andseminars in 2011.In 2011, Network 6 brought about a unique partnership between Network 6 and theChief Medical Officers, Regional Vice Presidents and Divisional Vice Presidents of theLarge Dialysis Organizations within our region to examine and address root causes forlow AVF rates in their facilities.Network 6 trained over 100 professionals during a Cannulation training in GeorgiaNetwork staff participated in planning meetings with the various ANNA chapters in NorthCarolina, South Carolina and GeorgiaP a g e | 81

CMS Goal 5Improve the collection, reliability, timeliness, and use of data to measureprocesses of care and outcomes; to maintain a patient registry; and tosupport the goals of the ESRD Network Program.P a g e | 82

OverviewSoutheastern Kidney Council collects ESRD patient and facility data in Georgia, North Carolinaand South Carolina, thus providing crucial support and analysis of quality improvement andcommunity outreach activities to support the goals of the ESRD Networks. Previous sections ofthis report describe those activities.Southeastern Kidney Council enters and validates data through the Standard InformationManagement System (SIMS) as defined by CMS. Southeastern Kidney Council maintainsaccurate, complete, and current information for CMS-designated systems accounts. Networkstaff performs daily entry and analysis of data, and monthly validations to the active database.Data CollectionNetwork 6 processed 24,990 forms in 2011 (Table 9). The Network is responsible for obtainingcompleted CMS ESRD forms per the ESRD Network Organizations Manual. The followingnarratives describe how the Network met the goal of collecting data from facilities.Table 9. Number, type and description of forms entered into SIMS manually in 2011.CMS Forms Entered Manually into SIMS in 2011Form Form Description NumberEnteredCMS 2728 Medical Evidence The form is completed to determineMedicare entitlement for ESRD9,963CMS 2744 Facility SurveyCMS 2746 Death NotificationNetwork Patient Activity Report(NPAR) (Number of NPARS notevents)Vascular Access (non-LDO)The form is completed annually tovalidate all patient event data for theyear and capture treatment andstaffingThe form is completed for all expiredESRD patientsThe form is completed monthly toreport all patient events (new patient,receipt of transplant, transfer, death,etc)The form is collected monthly tocapture vascular access data for eachpatient5836,6266,626 forms37,762 events1,192Total Number of Forms Entered 24,990P a g e | 83

Number of Data Forms ProcessedAccording to the 2010 Summary of Annual Reports the number of CMS forms entered by theSoutheastern Kidney Council (Network 6) was greater than any other Network in 2010,accounting for 9% of all forms entered into the CMS system. (Figure 35)20,000Data Forms Processed in Calendar Year 201018,00016,00014,00012,00010,0008,0006,0004,0002,000-16 3 1 17 10 2 4 13 12 15 5 18 7 8 11 14 9 6Forms Entered 5,998 7,062 7,957 8,446 8,568 8,884 9,429 9,563 10,208 10,723 11,209 12,041 13,392 13,903 15,842 16,611 17,257 17,946Figure 35. Network 1-18 2010 Summary annual report data overview forms.ESRD NetworkMonthly, SKC collected aggregate Vascular Access information for each non-LDO facility. Staffentered all forms in the Vascular Access Utility to ensure inclusion in the appropriate monthlyFistula First Outcomes Dashboard.The Network Patient Activity Report (NPAR) provides monthly updates to a patient’s currentstatus in the CMS-designated ESRD information system. Updates from the NPAR ensure thatCMS has access to each patient’s status in a timely manner for appropriate enrollment andtermination in the Medicare program for ESRD benefits.The SKC maintains forms in offsite forms storage quarterly in a secure, bonded storage facility.SKC retains forms for two years, destroying forms after the two-year period, per the CMSsecurity guidelines.P a g e | 84

Data ValidationSoutheastern Kidney Council analyzes data received at several points in the process, beginningwith a visual edit at the point of receipt. As staff enters forms into the SIMS database, thedatabase performs system edits that notify the entry specialist if data is incomplete orinaccurate. The system checks for missing data and inconsistent data (such as date of birthlater than first date of dialysis). SKC returns forms that fail the edit checks to the facility forcorrection. On average, Southeastern Kidney Council has to reject about 20% of 2728 forms(Medical Evidence Report) and about 3% of 2746 forms (Death Notifications).In addition to point of entry edits, staff performs monthly data analysis and clean up. TheNetwork runs approximately 85 independent checks to locate data issues and anomalies. Manyof these issues are reliant on more than one form, so point of entry checks alone would notcatch the issues. The Network performed analysis and cleaned 23,156 records. For example,the clean up catches:Patients who have been reported as transferring out of a facility, but have not yet beenreported by the receiving facility (dangling transfers)New ESRD patients reported by more than one facilityDuplicate patient records when a patient is reported on two forms and demographics donot matchFacility record with no personnel reported in key positionsSoutheastern Kidney Council receives notifications and accretions from CMS to update andcomplete data elements. Notifications are additional or changed data elements for existingpatients and may include updates received through the Social Security office or throughMedicare. Southeastern Kidney Council averages about 1600 notifications per month.Accretions are patients added to the system. This often includes transplant patients for whomno facility has submitted a 2728 and may include patients already in the system who havesignificantly different information in the CMS system. Southeastern Kidney Council averagesapproximately 15 accretions per month.Data ComplianceAfter data entry and cleanup, staff track and report facilities’compliance (Table 10) with submitting CMS forms accurately(Figure 37) and on time (Figure 36). CMS requires all ESRDfacilities to maintain a compliance rate of 90% or better foraccuracy and timeliness.Table 10. Percent of Network 6 CMS formscompliance by year and form.NW Semi-annualCompliance 2010Southeastern Kidney Council implemented a targetedintervention with 26 facilities to help improve compliance inJanuary 2011. Network 6 directed facilities to online tools toassist with increasing compliance rate, attended a27282746Combined85.6%93.2%88.7%mandatory conference call with Southeastern Kidney Council focusing on their compliance issueRate2728 85.0%2746 93.1%Combined 88.2%NW Annual Compliance2010 RateP a g e | 85

(timeliness and/or accuracy) and received monthly feedback reports. Staff re-measured inDecember 2011 for forms submitted January through December 2011, 26 facilitiesdemonstrated improvement. The Network continues to monitor accuracy and timeliness for allfacilities.Figure 36. Percent of Facilities that submitted forms on time by percent of forms submitted.Figure 37. Percent of Facilities that submitted accurate forms by percent of forms submitted.P a g e | 86

Technical AssistanceThe Southeastern Kidney Council provided technical assistance to facilities to improve datacollection, reliability and timeliness. In 2011, staff responded to approximately 650 inquires forassistance. The CMS 2728 form generated 44% of technical assistance inquires.Staff conducted two Education Information Calls during the year to assist facilities withcompleting the CMS 2728, CMS 2746 and the Network Patient Activity Report. Approximately70 participants attended the calls.VISION and QualityNet Electronic Data SubmissionSoutheastern Kidney Council supported 22 facilities using Vital Information Systems to ImproveOutcomes in Nephrology (VISION) during 2010. Each year staff validates 3% of CMS-2728forms submitted via VISION for physician and patient signatures. In 2011, VISION facilitiessubmitted 672 forms and both physician and patient signed 100% of the validated forms.Facilities use QualityNet Exchange to securely submit CMS 2728, 2746 and patient event data.In addition, dialysis facilities and CMS contractors use the system to submit other sensitive,patient-specific information to the Network. In 2011, facilities submitted 468 CMS-2728 formsand 323 CMS’ 2746 forms via QualityNet ExchangeMaintenance and Security of CMS EnvironmentNetwork staff provided technical support to maintain CMS hardware, software and patient data.Tasks included:Network server maintenance: This included troubleshooting problems with systembackups, replications and conductivity issues. Manual system backups and replicationsperformed as needed.Remedy: System used to maintain an accurate inventory of hardware and software inthe CMS environment, track tickets submit to the CMS contractor regarding systembackups, replications, conductivity issues and security breachesSecurity Awareness Training (SAT): The Network Security Point of Contact (SPOC)ensured all staff completed Security Awareness Training. Upon completion of trainingstaff printed a certificate to demonstrate completion of the course. Once all trainingcertificates are completed, SPOC provided information to CMS indicating all staffcompleted the CMS required security training.Business Continuity and Contingency Plan (BCCP): Network staff maintains a BCCP toensure the contingency and disaster recovery in the event of disasters that threaten theoperation of the Network or the security of patient data. The BCCP updated withpertinent personnel and vendor changes during 2011.P a g e | 87

CROWNWebSoutheastern Kidney Council staff participated in CROWNWeb Phase II testing and providedfeedback reports to CMS. Staff responded to technical assistance inquires regarding the use ofthe system. Southeastern Kidney Council participated in monthly calls with all CROWN users,CMS, other Networks and developers to help facilitate resolution of issues identified and helpPhase II facilities succeed. Southeastern Kidney Council also participated on CROWN datadiscrepancy calls, CRAFT calls and LDO batch processing calls. Southeastern Kidney Councilstaff resolved near matches with batch files submitted electronically by the large dialysisorganizations. Monthly, the submitted records were required to pass a six-point matchingalgorithm. CROWNWeb rejected any records failing to match on the six-points and labeledthem a “near match”, preventing duplicate records in the system. SKC staff received a filemonthly of the near matches and processed the file manually to determine the accuracy of therecords. SKC resolved approximately 900 records by manual intervention and successfullycorrected and resubmitted them for submission into the CROWNWeb system.P a g e | 88

Impact of the Southeastern Kidney Council’s Goal 5 Accomplishmentson improving the collection, reliability, timeliness and use of data tomeasure process of care and outcomesNetwork 6 processed 24,990 forms in 2011. (Table 9)According to the 2010 Summary of Annual Reports the number of CMS forms enteredby the Southeastern Kidney Council (Network 6) was greater than any other Network in2010, accounting for 9% of all forms entered into the CMS system. (Figure 35)Southeastern Kidney Council rejected about 20% of 2728 forms (Medical EvidenceReport) and about 3% of 2746 forms (Death Notifications) due to failed edit checks andreturned those to facilities for correction.The Network performed analysis and cleaned 23,156 records, utilizing 85 independentdata check processes.The Southeastern Kidney Council receives on average 1600 notifications and accretionsfrom CMS to update and complete data elements per month.The Southeastern Kidney Council responded to approximately 650 inquires for technicalto assistance facilities improve data collection, reliability and timeliness.P a g e | 89

Sanction RecommendationsP a g e | 90

Background and OverviewSoutheastern Kidney Council Sanction ProcessThe Centers for Medicare and Medicaid services (CMS) published the sanction regulations in theApril 15, 2008 Conditions for Coverage for ESRD. Under contract with CMS, the ESRD Networks’responsibilities for sanctions or alternative sanction recommendations and referrals include thefollowing:Recommending to CMS sanctions or alternative sanctions for facilities/providers that do notcomply with Network goals and/or are not providing appropriate medical care;Providing the necessary documentation to support the recommendation; and,Referring to the QIO or the State Office of the Inspector General information collected whileconducting contract activities that indicate that a physician may be failing to meet his/herobligation to provide quality care or involved in Medicare fraud.Role of the NetworkCongress and CMS charge the Southeastern Kidney Council, as the Network 6 contractor, toprotect ESRD Medicare beneficiaries by monitoring and improving care provided and ensuringfacilities meet the Network goals. Network 6 believes that prompt identification and resolution ofquality issues through a collaborative, collegial approach best serves the patients. Network 6creates measurable goals, notifies providers of the expectations/deliverables in meeting thosegoals, and provides on-going technical assistance and education for ESRD providers to supportthem in reaching the goals and providing the highest level of care possible. When SKC identifiesfacilities as having opportunities to improve, the Network provides intensive technical assistance toaddress and resolve the issues. If quality issues continue despite this intensive intervention and thefacility fails to meet Network goals, Network 6 will pursue sanctions to protect the beneficiariesand/or enforce CMS requirements and standards.The Conditions for Coverage for ESRD, excerpted below, allow for alternative sanctions for anyprovider that does not participate in the activities and pursue the goals of the Network. Every year,each facility in the Network 6 area signs a Quality of Care Commitment with the Network (found inthe CMS National Goals and Network Activities section of this report) which states the expectationsof the Network. This includes providing the highest quality of care, cooperating with the MedicalReview Board in quality improvement projects, cooperating with the Network in the resolution ofcomplaints, submitting data and improvement plans as requested. Facilities selected for focusedreview sign an additional agreement to ensure they understand the goals and the performancematrix for expected deliverables and outcomes.The Network 6 is committed to rapid identification and correction of problems. The severity of theissue and the pace at which the facility improves determines the rate at which SKC requestsinterventions and sanctions. Generally, this will not exceed one year, but may be much shorter forcritical issues or repeat issues.Network 6 will refer any regulatory issues to the State Survey Agency. Network 6 will refer allissues that are specific to the physician(s) or involve Medicare fraud to the Quality ImprovementOrganization (QIO), state Medical Board and/or the Office of the Inspector General (OIG).P a g e | 91

42 CFR Parts 405, 410, 413 et al. Medicare and Medicaid Programs; Conditions forCoverage for EndStage Renal Disease Facilities; Final RuleSubpart H—Termination of Medicare Coverage and Alternative Sanctions for End-StageRenal Disease (ESRD) FacilitiesSec.488.604 Termination of Medicare coverage.488.606 Alternative sanctions.488.608 Notice of alternative sanction and appeal rights: Termination of coverage.488.610 Notice of appeal rights: Alternative sanctions.Subpart H—Termination of Medicare Coverage and Alternative Sanctions for End-StageRenal Disease (ESRD) Facilities§ 488.604 Termination of Medicare coverage.(a) Except as otherwise provided in this subpart, failure of a supplier of ESRD services to meet oneor more of the conditions for coverage set forth in part 494 of this chapter will result in termination ofMedicare coverage of the services furnished by the supplier.(b) If termination of coverage is based solely on a supplier’s failure to participate in Networkactivities and pursue Network goals, as required at § 494.180(i) of this chapter, coverage may bereinstated when CMS determines that the supplier is making reasonable and appropriate efforts tomeet that condition.(c) If termination of coverage is based on failure to meet any of the other conditions specified in part494 of this chapter, coverage will not be reinstated until CMS finds that the reason for terminationhas been removed and there is reasonable assurance that it will not recur.P a g e | 92

§ 488.606 Alternative sanctions.(a) Basis for application of alternative sanctions. CMS may, as an alternative to termination ofMedicare coverage, impose one of the sanctions specified in paragraph (b) of this section if CMSfinds that—(1) The supplier fails to participate in the activities and pursue the goals of the ESRDNetwork that is designated to encompass the supplier’s geographic area; and(2) This failure does not jeopardize patient health and safety.(b) Alternative sanctions. The alternative sanctions that CMS may apply in the circumstancesspecified in paragraph (a) of this section include the following:(1) Denial of payment for services furnished to patients first accepted for care after theeffective date of the sanction as specified in the sanction notice.(2) Reduction of payments, for all ESRD services furnished by the supplier, by 20 percentfor each 30-day period after the effective date of the sanction.(3) Withholding of all payments, without interest, for all ESRD services furnished by thesupplier to Medicare beneficiaries.(c) Duration of alternative sanction. An alternative sanction remains in effect until CMS finds that thesupplier is in substantial compliance with the requirement to cooperate in the Network plans andgoals, or terminates coverage of the supplier’s services for lack of compliance.§ 488.608 Notice of alternative sanction and appeal rights: Termination of coverage.(a) Notice of alternative sanction. CMS gives the supplier and the general public notice of thealternative sanction and of the effective date of the sanction. The effective date of the alternativesanction is at least 30 days after the date of the notice.(b) Appeal rights. Termination of Medicare coverage of a supplier’s ESRD services because thesupplier no longer meets the conditions for coverage of its services is an initial determinationappealable under part 498 of this chapter.P a g e | 93

§ 488.610 Notice of appeal rights: Alternative sanctions. If CMS proposes to apply analternative sanction specified in § 488.606(b), the following rules apply:(a) CMS gives the facility notice of the proposed alternative sanction and 15 days in which torequest a hearing.(b) If the facility requests a hearing, CMS provides an informal hearing by a CMS official who wasnot involved in making the appealed decision.(c) During the informal hearing, the facility—(1) May be represented by counsel;(2) Has access to the information on which the allegation was based; and(3) May present, orally or in writing, evidence and documentation to refute the finding offailure to participate in Network activities and pursue Network goals.(d) If the written decision of the informal hearing supports application of the alternative sanction,CMS provides the facility and the public, at least 30 days before the effective date of the alternativesanction, a written notice that specifies the effective date and the reasons for the alternativesanction.P a g e | 94

Congress extended Medicarecoverage to ESRD & set programgoalsCMS translates law into Federal RegulationState Survey Agency AdministersRegulationsCMS translates law into ESRD NetworkContractSoutheastern Kidney Council (SKC) signscontract with CMS to administer ESRDNetwork #6SKC notifies providers of CMS expectationsand goalsSKC provides educational materials andtechnical assistance to help providers meetgoalsSKC refers to State Survey AgencySKC monitors performance of all providersYesYesDoes provider meetCMS / Network goals?NoIs the issue regulatory orimmediate & serious?NoP a g e | 95

SKC notifies provider (Nurse Manager, MedicalDirector), offers educational materials andtechnical assistance & requests Action PlanWas ActionPlan sent?NoHas SKC notifiedMedical Directorof missing plan?NoSKC notifies MedicalDirector and sets duedateYesYesSKC notifies CMS andState SurveyorYesDoes facilityrefuse to sendplan?NoSKC considers sanctionAction Planacceptable?NoIs this a resubmit?NoSKC provides technicalassistance, asks for new planYesYesIs facility making agood faith effort*?YesSKC monitors facility progressNo*Evaluated by a Board of your peersSKC conducts site visitSKC notifies CMS & State SurveyorSKC considers sanctionP a g e | 96

Return to routine monitoringHas facilityreached goal?YesReturn to focusedreview monitoringNoHas facility madesignificant*progress?YesNo*Evaluated by a Board of your peers. Time not toexceed 1 yearHas facility hadenough time toprogress*?NoReturn to “WasAction Plan Sent?”YesHas BOD/MRBtalked to MedicalDirector?NoBOD/MRB/Other calls MedicalDirectorMed Dir/ facilitycommitted toimprovement?YesRevisedAction PlanrequestedYesNoYesHas staff visitedfacility?NoStaff visits/providestechnical assistanceRegulatoryissuesidentified.NoMed Dir / facilitycommitted toimprovement?YesHas BOD/MRB/Other visitedfacility?NoBOD/MRB/Other visitsYesSKC refers to StateSurvey AgencyReturn to StateSurveyor AdministersRegulationYesSKC ConsidersSanctionNoMed Dir / facilitycommitted toimprovement?YesP a g e | 97

SKC reviews with CMS & StateSurveyorSanctionsupported?NoReturn tofocused reviewmonitoringYesBoard of Directors beginsSanction processSKC compiles documentationSKC sends Sanction Referral toRegional CMS officeDoes CMS concur?NoYesCMS determines type of sanction/ terminationCMS enforces sanctionNoHas facilitycomplied?YesSanction removedP a g e | 98

2011 Southeastern Kidney Council SanctionsThe Quality Improvement initiatives of the Southeastern Kidney Council identified a facility with pooroutcomes in anemia management, fistula placement and immunization. The Medical Review Boardworked with the facility to develop action plans and protocols in all three areas to assist the facilitywith improving their patient outcomes. However, the facility failed to show improvement in theareas. The Medical Review Board asked the State Surveyor to review the facility in December2010. The state confirmed the issues and cited four Immediate Jeopardy Conditions. Afterpermission from CMS, Network 6 conducted joint site visit with state surveyors and reviewed charts,QA/QI meeting notes and outcomes. The team identified multiple concerns with facility’s inadequateprotocols, failure to follow protocols, failure to review lab data and failure in documentation.Following the joint site visit, the State Surveyors opted to terminate Medicare coverage of the facilityand notified the facility and patients of planned Medicare termination. Network 6 staff went on site3/15/2011-3/17/2011 to assist with the placement of 50 patients from this clinic to alternate facilities.The facility closed on 3/17/2011.P a g e | 99

Recommendations for Additional FacilitiesP a g e | 100

RecommendationsPeople with end stage renal disease are often managing comorbid conditions for which dialysisfacilities and their staff are neither trained, equipped, nor reimbursed. This may include mentalhealth needs, diabetic care and other coexisting issues. The system of ESRD care needs to bebetter coordinated to support and address these needs. CMS should study the referral andpayment system and look for ways to improve the overall patient-centered care.Network 6 recommends that CMS waive the three-month waiting period for new Medicarebeneficiaries to have an arteriovenous fistula placed prior to beginning dialysis or at the start ofdialysis. Currently the waiting period is waived if the patient completes home training or receives atransplant. Waiving the wait period for fistula placement would remove one of the barriers topatients beginning dialysis with an AV fistula, the preferred access, in place.Network 6 recommends CMS study medication payment policies for ESRD Medicare Beneficiariesin support of Aim 3 to identify ways to reduce costs by improving care. Currently, CMSdiscontinues Medicare coverage three years post-transplant (unless qualified due to age ordisability). Many people choose not to pursue a transplant due to the expense of thesemedications. Others lose the transplant because they are not able to pay for the medications. Thecost of the medications is high, but less than returning to a regular course of dialysis. Similarly,some persons on dialysis are unable to afford basic medications, including phosphate binders. Ifthese medications were more affordable, patients would have better outcomes on dialysis, includingfewer hospitalizations.There is a need in the ESRD system to address the treatment of patients who have been deniedaccess to care because they have previously been involuntarily discharged. These patients may bedenied access to care because they have been involuntarily discharged from their previous dialysisfacility for non-compliance, or disruptive or abusive behavior. These patients are often mentally ill,or have an underlying mental health issue that has not been addressed. Another category ofinvoluntary discharge are those patients discharged by their physican when no other physician withprivileges at the facility will accept them. Once patients are discharged, they have great difficultyfinding a facility or physician willing to care for them. They often overburden local EmergencyDepartments and are inadequately dialyzed because of the constraints and criteria for dialyzing inan inpatient hospital setting.A need exists for outpatient facilities to care for patients who are difficult to place, including the subacutedialysis patients who have special needs such as wound and tracheotomy care. Most chronicdialysis facilities are ill equipped to care for these needs and do not have trained staff or the level ofstaffing needed to provide this type of care.P a g e | 101

Data TablesP a g e | 102

DATA TABLE 1: NETWORK 6 ESRD INCIDENCE- 2011 STATISTICSNewly Diagnosed Chronic ESRD Patients(ESRD Incidence)Newly diagnosed chronic ESRD patients by state of residence, age, gender, race and primarydiagnosis for calendar year 2011Age Group GA NC SC Other Total00-04 9 10 3 1 2305-09 6 6 1 0 1310-14 10 4 1 1 1615-19 13 19 4 1 3720-24 33 29 17 2 8125-29 55 45 28 0 12830-34 106 95 41 0 24235-39 144 119 48 2 31340-44 210 146 100 4 46045-49 296 225 122 4 64750-54 375 324 175 8 88255-59 463 379 217 6 106560-64 558 487 253 7 130565-69 490 444 254 2 119070-74 459 394 206 9 106875-79 366 342 169 4 88180-84 252 251 122 4 629>=85 178 136 48 0 362Missing 0 0 0 0 0Total 4023 3455 1809 55 9342GenderFemale 1853 1535 830 19 4237Male 2170 1920 979 36 5105Missing 0 0 0 0 0Total 4023 3455 1809 55 9342RaceAmerican Indian/Alaska Native 8 47 5 0 60Asian 67 38 9 0 114Black or African American 2288 1720 1069 19 5096More than one race selected 3 5 2 0 10Native Hawaiian or Other Pacific Islander 19 12 4 0 35White 1638 1633 720 36 4027Missing 0 0 0 0 0Total 4023 3455 1809 55 9342P a g e | 103

DATA TABLE 1: Network 6 ESRD Incidence- 2011 STATISTICSNewly Diagnosed Chronic ESRD Patients(ESRD Incidence) ContinuedPrimary Diagnosis GA NC SC Other TotalCystic Kidney 60 70 34 3 167Diabetes 1631 1546 755 18 3950Glomerulonephritis 170 277 100 2 549Hypertension 1593 1015 673 13 3294Other 439 391 177 11 1017Other Urologic 28 38 25 0 91Missing 0 0 0 0 0Unknown 102 118 45 8 266Total 4023 3455 1809 55 9342Source of information: Network SIMS DatabaseDate of Preparation: May 2012Race: The categories are from the CMS-2728 Form.Diagnosis: Categories are from the CMS-2728. A diagnosis of 'unknown' is ICD-9 code 7999.This table cannot be compared to the CMS facility survey because the CMS Facility Survey is limited todialysis patients receiving outpatient services from Medicare approved dialysis facilities.This table includes 215 patients with transplant therapy as an initial treatment.This table includes 101 patients receiving treatment at VA facilities.P a g e | 104

DATA TABLE 2: NETWORK 6 ESRD PREVALENCE- 2011 STATISTICSLiving ESRD Dialysis Patients(ESRD Dialysis Prevalence)All active Dialysis Patients by state of residence, age, race, gender and primary diagnosis as of 12/31/2011.Age Group GA NC SC Other Total00-04 13 13 5 0 3105-09 4 6 0 0 1010-14 15 11 1 0 2715-19 36 40 8 0 8420-24 148 104 62 3 31725-29 293 237 136 1 66730-34 465 416 193 4 107835-39 778 582 311 5 167640-44 1085 817 464 14 238045-49 1499 1188 613 12 331250-54 1704 1509 873 19 410555-59 2194 1812 1035 25 506660-64 2342 2109 1167 33 565165-69 1990 1775 1016 27 480870-74 1591 1484 849 19 394375-79 1275 1235 679 11 320080-84 756 785 379 12 1932>=85 458 441 186 8 1093Missing 0 0 0 0 0Total 16646 14564 7977 193 39380GenderFemale 7779 6606 3755 87 18227Male 8867 7958 4222 106 21153Missing 0 0 0 0 0Total 16646 14564 7977 193 39380RaceAmerican Indian/Alaska Native 31 217 18 0 266Asian 225 149 37 1 412Black or African American 11679 9221 5691 102 26693More than one race selected 30 33 14 0 77Native Hawaiian or Other Pacific Islander 53 36 14 0 103White 4628 4908 2203 90 11829Missing 0 0 0 0 0Total 16646 14564 7977 193 39380P a g e | 105

DATA TABLE 2: Network 6 ESRD Prevalence- 2011 STATISTICSLiving ESRD Dialysis Patients(ESRD Dialysis Prevalence)Primary Diagnosis GA NC SC Other TotalCystic Kidney 343 319 155 5 822Diabetes 6416 6257 3243 85 16001Glomerulonephritis 1273 1539 634 19 3465Hypertension 6441 4294 3005 59 13799Other 1581 1433 704 18 3736Other Urologic 152 154 82 2 390Missing 1 2 1 0 4Unknown 439 566 153 5 1163Total 16646 14564 7977 193 39380Source of information: Network SIMS DatabaseDate of Preparation: June 2012Race: The categories are from the CMS-2728 Form.Diagnosis: Categories are from the CMS-2728. A diagnosis of 'unknown' is ICD-9 code7999.This table cannot be compared to the CMS facility survey because the CMS Facility Surveyis limited to dialysis patients receiving outpatient services from Medicare approved dialysisfacilities.The numbers may not reflect the true point prevalence due to different definitions fortransient patients.This table includes 221 patients receiving treatment at VA facilities.P a g e | 106

DATA TABLE 3: NETWORK 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON12/31/2011Dialysis ModalityNumber of living patients by modality by dialysis facility self-care settings as of December 31, 2010and December 31, 2011Self-Care Settings - HomeHEMO CAPD CCPD IPD TOTAL2010 2011 2010 2011 2010 2011 2010 2011 2010 2011Provider110016 1 0 7 6 6 7 0 0 14 13110038 15 14 8 8 10 14 0 0 33 36110095 0 0 5 4 6 7 0 0 11 11110104 0 0 0 0 0 0 0 0 0 0110105 0 0 0 0 0 0 0 0 0 011029F 1 0 0 0 0 0 0 0 1 0112501 0 0 2 7 0 1 0 0 2 8112503^ 0 0 0 0 0 0 0 0 0 0112504 0 0 0 2 0 0 0 0 0 2112505 18 12 5 6 5 5 0 0 28 23112507 5 5 7 10 10 11 0 0 22 26112509 0 0 0 0 0 1 0 0 0 1112510 1 3 19 28 24 17 0 0 44 48112511 1 2 3 3 1 1 0 0 5 6112512 0 0 3 3 0 0 0 0 3 3112513 0 0 0 0 0 0 0 0 0 0112514 2 2 1 1 22 23 2 1 27 27112515 0 0 3 5 3 2 0 0 6 7112516 2 2 2 5 3 5 0 0 7 12112517 0 0 1 2 12 15 0 0 13 17112518 0 0 0 1 0 0 0 0 0 1112519 0 0 0 0 0 0 0 0 0 0112521^ 0 0 0 0 0 0 0 0 0 0112522 2 2 6 6 1 1 0 0 9 9112523 0 0 0 0 0 0 0 0 0 0112524 0 3 21 19 5 1 0 0 26 23112526 0 0 5 1 15 20 0 0 20 21112527 0 0 0 0 0 0 0 0 0 0112528 0 0 3 1 0 1 0 0 3 2112529 0 0 0 0 0 0 0 0 0 0112530 0 0 2 2 38 36 0 0 40 38112531 1 0 8 10 24 16 0 0 33 26112532 0 0 0 0 0 0 0 0 0 0112533 0 0 0 0 0 0 0 0 0 0112534 0 0 0 0 0 0 0 0 0 0112535 0 0 1 0 10 10 0 0 11 10112540 0 0 0 0 0 0 0 0 0 0112541 0 0 1 0 0 1 0 0 1 1P a g e | 107

DATA TABLE 3: Network 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON 12/31/2011Dialysis ModalityNumber of living patients by modality by dialysis facility self-care settings as of December 31, 2010and December 31, 2011Self-Care Settings - HomeHEMO CAPD CCPD IPD TOTAL2010 2011 2010 2011 2010 2011 2010 2011 2010 2011Provider112544 0 0 2 1 0 0 0 0 2 1112545 0 0 0 0 0 0 0 0 0 0112546 0 0 0 0 0 0 0 0 0 0112551 0 0 2 3 3 1 0 0 5 4112553 0 0 0 0 0 0 0 0 0 0112554 0 0 0 0 0 0 0 0 0 0112555 0 0 0 0 0 0 0 0 0 0112557 0 0 4 3 12 14 0 0 16 17112558 1 1 0 0 4 5 0 0 5 6112559 0 0 0 0 0 0 0 0 0 0112561 0 0 0 0 0 0 0 0 0 0112562 0 0 0 0 0 0 0 0 0 0112563 0 0 0 0 0 0 0 0 0 0112566 0 0 43 42 3 2 0 0 46 44112567 0 0 5 4 12 6 0 0 17 10112568 0 0 7 15 1 0 0 0 8 15112569 0 0 4 6 13 6 0 0 17 12112571 0 0 0 0 1 0 0 0 1 0112573 0 0 0 0 0 0 0 0 0 0112574 0 0 0 0 0 0 0 0 0 0112576 0 0 0 0 0 0 0 0 0 0112578 0 0 5 13 29 43 0 0 34 56112579 0 0 3 1 4 3 0 0 7 4112581 0 0 0 0 0 0 0 0 0 0112582 0 0 0 2 0 0 0 0 0 2112583 0 0 0 1 0 0 0 0 0 1112584 0 0 0 0 0 0 0 0 0 0112587 0 0 0 0 0 0 0 0 0 0112588 0 0 0 0 0 0 0 0 0 0112590 1 2 11 15 2 1 0 0 14 18112591 0 0 0 0 0 0 0 0 0 0112593 0 0 0 0 0 0 0 0 0 0112594 0 0 0 0 0 0 0 0 0 0112596 0 0 0 0 0 0 0 0 0 0112598 0 0 0 0 0 0 0 0 0 0112599 0 0 0 0 0 0 0 0 0 0112600 0 0 0 0 0 0 0 0 0 0112601 0 0 1 1 8 7 0 0 9 8112602 5 6 6 4 2 1 0 0 13 11112603 0 0 0 0 0 0 0 0 0 0P a g e | 108

DATA TABLE 3: Network 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON 12/31/2011Dialysis ModalityNumber of living patients by modality by dialysis facility self-care settings as of December 31, 2010and December 31, 2011Self-Care Settings - HomeHEMO CAPD CCPD IPD TOTAL2010 2011 2010 2011 2010 2011 2010 2011 2010 2011Provider112608 0 0 0 0 0 0 0 0 0 0112609 0 0 4 5 11 9 0 0 15 14112610 0 0 0 0 0 0 0 0 0 0112611 0 0 0 0 0 0 0 0 0 0112614^ 0 0 0 0 0 0 0 0 0 0112615 0 0 0 0 0 0 0 0 0 0112617 0 0 5 6 10 12 0 0 15 18112619 0 0 0 1 1 2 0 0 1 3112620 0 0 11 11 2 0 0 0 13 11112622 0 0 7 7 2 2 0 0 9 9112624 0 0 0 0 2 2 0 0 2 2112627 0 0 0 0 0 0 0 0 0 0112628 0 0 0 0 3 2 0 0 3 2112630 0 0 0 0 0 0 0 0 0 0112631 0 0 0 0 0 1 0 0 0 1112632 0 0 0 0 0 0 0 0 0 0112633 0 0 0 0 0 0 0 0 0 0112634 0 0 1 4 4 6 0 0 5 10112636 0 0 0 0 0 0 0 0 0 0112637 2 1 1 1 1 2 0 0 4 4112638 0 0 0 0 0 0 0 0 0 0112639 1 1 9 10 10 7 0 0 20 18112640 0 0 0 0 1 1 0 0 1 1112641 0 0 14 8 0 3 0 0 14 11112643 0 0 0 0 0 0 0 0 0 0112645 0 3 5 4 3 8 0 0 8 15112646 0 0 11 10 3 7 0 0 14 17112647 0 0 0 0 0 0 0 0 0 0112648 6 6 2 2 5 3 0 1 13 12112649 0 1 0 0 0 0 0 0 0 1112651 0 0 0 0 0 0 0 0 0 0112652 0 0 0 0 0 0 0 0 0 0112653^ 0 0 0 0 0 0 0 0 0 0112655 0 0 0 0 0 0 0 0 0 0112656 0 0 5 3 0 1 0 0 5 4112657 0 0 6 5 16 13 0 0 22 18112658 0 0 1 1 0 0 0 0 1 1112659 1 0 3 0 3 0 0 0 7 0112660 0 0 0 0 0 0 0 0 0 0112661 0 0 0 0 0 0 0 0 0 0P a g e | 109

DATA TABLE 3: Network 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON 12/31/2011Dialysis ModalityNumber of living patients by modality by dialysis facility self-care settings as of December 31, 2010and December 31, 2011Self-Care Settings - HomeHEMO CAPD CCPD IPD TOTAL2010 2011 2010 2011 2010 2011 2010 2011 2010 2011Provider112664 0 0 0 0 0 0 0 0 0 0112667 0 0 0 0 0 0 0 0 0 0112668 0 0 1 5 0 1 0 0 1 6112669 0 0 0 0 0 0 0 0 0 0112670 0 0 0 0 0 0 0 0 0 0112671 0 0 0 0 0 0 0 0 0 0112672 0 0 9 9 4 4 0 0 13 13112674 0 0 0 0 0 0 0 0 0 0112675 0 0 4 4 7 6 0 0 11 10112676 0 0 0 2 2 0 0 0 2 2112677 0 0 7 7 1 1 0 0 8 8112678 0 0 0 0 0 0 0 0 0 0112679 0 0 3 7 4 3 0 0 7 10112680 0 0 0 0 10 7 0 0 10 7112681 0 0 0 0 0 0 0 0 0 0112683 0 0 0 0 0 0 0 0 0 0112685 0 0 0 0 0 0 0 0 0 0112688 2 3 0 0 1 2 0 0 3 5112689 0 0 3 2 4 4 0 0 7 6112691 0 0 1 0 3 0 0 0 4 0112692 0 0 0 0 0 0 0 0 0 0112693 1 0 3 2 13 11 0 0 17 13112694 0 0 3 1 2 2 0 0 5 3112695 0 0 1 0 3 2 0 0 4 2112696 0 0 0 0 0 0 0 0 0 0112697 0 0 0 0 0 0 0 0 0 0112698 0 0 0 0 0 0 0 0 0 0112699 0 0 0 0 0 0 0 0 0 0112700 0 0 0 2 0 4 0 0 0 6112702 0 0 0 0 0 0 0 0 0 0112703 35 3 5 2 6 7 0 0 46 12112704 0 0 0 0 0 0 0 0 0 0112705 0 0 0 0 0 0 0 0 0 0112706 0 0 13 15 3 7 0 0 16 22112707 1 1 4 3 3 2 0 0 8 6112708 0 0 12 11 1 0 0 0 13 11112709 0 0 0 0 0 0 0 0 0 0112710 0 0 1 2 1 1 0 0 2 3112711 0 0 0 0 0 0 0 0 0 0112712 3 4 19 22 4 6 0 0 26 32P a g e | 110

DATA TABLE 3: Network 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON 12/31/2011Dialysis ModalityNumber of living patients by modality by dialysis facility self-care settings as of December 31, 2010and December 31, 2011Self-Care Settings - HomeHEMO CAPD CCPD IPD TOTAL2010 2011 2010 2011 2010 2011 2010 2011 2010 2011Provider112713^ 0 0 0 0 0 0 0 0 0 0112714 0 0 0 0 0 0 0 0 0 0112715 0 0 0 0 0 0 0 0 0 0112716 0 0 0 0 0 0 0 0 0 0112718 0 0 4 3 0 3 0 0 4 6112719 0 0 0 0 0 0 0 0 0 0112720 0 0 1 2 6 9 0 0 7 11112721 0 0 0 0 0 0 0 0 0 0112722 0 0 2 3 12 12 0 0 14 15112723 0 0 0 0 0 0 0 0 0 0112724 0 0 0 0 0 0 0 0 0 0112725 0 0 0 0 0 0 0 0 0 0112726 0 0 0 0 0 0 0 0 0 0112727 0 0 0 0 0 0 0 0 0 0112728 0 0 3 2 3 0 0 0 6 2112729 0 0 0 0 0 0 0 0 0 0112730 3 3 7 6 6 5 0 0 16 14112732 0 0 0 0 0 0 0 0 0 0112733 0 0 0 0 0 0 0 0 0 0112734 0 0 0 0 0 0 0 0 0 0112735 0 0 0 0 0 0 0 0 0 0112736 0 0 0 0 0 0 0 0 0 0112737 0 0 2 3 4 3 0 0 6 6112738 0 0 0 0 0 0 0 0 0 0112741 0 0 1 1 0 1 0 0 1 2112742 12 9 2 3 18 21 0 0 32 33112743 0 0 6 8 12 11 0 0 18 19112744 0 0 0 0 0 0 0 0 0 0112745 0 0 1 0 0 0 0 0 1 0112746 7 4 0 0 0 0 0 0 7 4112747 79 55 11 8 24 34 0 0 114 97112748 0 0 0 0 0 0 0 0 0 0112749 0 0 10 18 15 15 0 0 25 33112750 6 8 11 8 4 2 0 0 21 18112751 0 0 0 0 0 0 0 0 0 0112752 0 0 0 0 23 26 0 0 23 26112753 0 0 10 6 8 7 0 0 18 13112754 3 3 26 22 7 10 0 0 36 35112755 0 0 2 0 1 2 0 0 3 2112756 0 0 0 0 0 0 0 0 0 0P a g e | 111

DATA TABLE 3: Network 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON 12/31/2011Dialysis ModalityNumber of living patients by modality by dialysis facility self-care settings as of December 31, 2010and December 31, 2011Self-Care Settings - HomeHEMO CAPD CCPD IPD TOTAL2010 2011 2010 2011 2010 2011 2010 2011 2010 2011Provider112757 0 0 0 0 0 0 0 0 0 0112758 0 0 1 1 25 23 0 0 26 24112759 0 0 0 4 0 0 0 0 0 4112760 4 9 2 0 4 1 0 0 10 10112761 1 1 19 25 0 1 0 0 20 27112762 5 7 1 1 9 10 0 0 15 18112763 0 0 0 2 0 1 0 0 0 3112765 0 0 7 8 10 13 0 0 17 21112766 1 1 4 3 4 4 0 0 9 8112767 0 0 0 0 0 0 0 0 0 0112768 1 1 3 6 4 3 0 0 8 10112769 0 0 1 1 0 0 0 0 1 1112770 0 0 0 0 0 0 0 0 0 0112771 0 0 0 0 0 0 0 0 0 0112772 0 2 0 1 0 1 0 0 0 4112773 1 1 0 0 0 3 0 0 1 4112774 7 6 6 9 24 16 0 0 37 31112775 0 0 0 0 0 0 0 0 0 0112776 0 0 0 0 0 0 0 0 0 0112777 0 0 0 0 0 0 0 0 0 0112778 0 0 0 1 0 1 0 0 0 2112779 3 1 13 12 6 5 0 0 22 18112780 0 0 2 1 6 0 0 0 8 1112781 0 0 8 13 6 4 0 0 14 17112782 0 0 0 0 0 0 0 0 0 0112783 0 0 0 0 0 0 0 0 0 0112784 0 0 0 0 0 0 0 0 0 0112785 0 0 0 0 1 0 0 0 1 0112786 0 0 0 0 0 0 0 0 0 0112787^ 0 0 0 0 0 0 0 0 0 0112788 4 5 0 3 5 8 0 0 9 16112789 2 0 1 2 3 2 0 0 6 4112790 0 0 0 0 0 0 0 0 0 0112791 0 0 0 0 0 0 0 0 0 0112792 0 0 0 0 0 0 0 0 0 0112793 0 0 0 0 0 0 0 0 0 0112794 0 0 0 0 1 1 0 0 1 1112795 0 0 0 0 0 0 0 0 0 0112796 0 0 0 0 0 0 0 0 0 0112797 0 0 8 9 13 17 0 0 21 26P a g e | 112

DATA TABLE 3: Network 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON 12/31/2011Dialysis ModalityNumber of living patients by modality by dialysis facility self-care settings as of December 31, 2010and December 31, 2011Self-Care Settings - HomeHEMO CAPD CCPD IPD TOTAL2010 2011 2010 2011 2010 2011 2010 2011 2010 2011Provider112798 1 1 6 9 1 3 0 0 8 13112799 0 0 0 0 0 0 0 0 0 0112800 0 0 0 0 0 0 0 0 0 0112801 11 14 3 0 41 51 0 0 55 65112802 0 0 0 0 0 0 0 0 0 0112803 0 0 5 3 26 25 0 0 31 28112804 0 0 0 0 0 0 0 0 0 0112805 4 5 0 0 4 5 0 0 8 10112806 0 0 3 4 5 4 0 0 8 8112807 0 0 0 0 0 0 0 0 0 0112808 0 0 0 0 0 0 0 0 0 0112809 0 0 0 0 0 0 0 0 0 0112810 5 3 1 6 7 4 0 0 13 13112811 0 0 1 1 3 6 0 0 4 7112812 0 0 0 0 0 0 0 0 0 0112813 0 0 0 1 20 29 0 0 20 30112814 0 0 0 0 0 0 0 0 0 0112815 0 0 2 1 3 5 0 0 5 6112816 0 0 0 0 0 0 0 0 0 0112817 0 0 0 0 7 5 0 0 7 5112818 0 0 0 0 0 0 0 0 0 0112819 1 0 0 0 0 0 0 0 1 0112820 0 0 1 1 16 18 0 0 17 19112821 0 0 0 0 0 2 0 0 0 2112822 0 0 0 0 0 0 0 0 0 0112823 0 0 1 1 0 0 0 0 1 1112824 13 19 16 19 14 27 0 0 43 65112825 0 0 0 0 1 0 0 0 1 0112826 0 0 0 0 0 0 0 0 0 0112827 0 0 0 0 0 0 0 0 0 0112828 0 0 1 2 1 1 0 0 2 3112829 2 1 0 1 1 1 0 0 3 3112830 0 0 0 2 0 1 0 0 0 3112831 1 2 0 0 8 11 0 0 9 13112832 0 0 0 2 0 0 0 0 0 2112833 0 0 0 0 0 0 0 0 0 0112834 0 0 0 0 0 0 0 0 0 0112835 0 0 0 0 0 0 0 0 0 0112836 0 0 2 6 0 0 0 0 2 6112837# 0 0 0 0 0 0 0 0 0 0P a g e | 113

DATA TABLE 3: Network 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON 12/31/2011Dialysis ModalityNumber of living patients by modality by dialysis facility self-care settings as of December 31, 2010and December 31, 2011Self-Care Settings - HomeHEMO CAPD CCPD IPD TOTAL2010 2011 2010 2011 2010 2011 2010 2011 2010 2011Provider112838 0 0 0 0 0 0 0 0 0 0112839# 0 1 0 0 0 6 0 0 0 7112840# 0 0 0 0 0 0 0 0 0 0112841# 0 0 0 0 0 0 0 0 0 0112842# 0 25 0 0 0 0 0 0 0 25112843# 0 0 0 0 0 0 0 0 0 0112844# 0 1 0 2 0 1 0 0 0 4112845# 0 0 0 0 0 1 0 0 0 1112846# 0 0 0 0 0 0 0 0 0 0113300 0 0 2 1 16 20 0 0 18 21113500 0 0 0 0 0 0 0 0 0 0113501 0 1 0 0 0 0 0 0 0 1113502 0 0 0 0 0 0 0 0 0 0113504 0 0 0 0 0 0 0 0 0 0GA Total 285 266 599 672 876 936 2 2 1762 1876340030 0 0 0 0 0 0 0 0 0 0340040 0 0 0 0 0 0 0 0 0 0340047 0 0 0 0 0 0 0 0 0 0340064 0 0 0 0 0 0 0 0 0 0340113 0 0 0 0 5 4 0 0 5 434012F 0 0 1 1 8 8 0 0 9 934013F# 0 0 0 0 0 0 0 0 0 034014F# 0 0 0 0 0 0 0 0 0 0342502 10 15 18 14 49 40 0 0 77 69342503 7 10 4 4 31 31 0 0 42 45342504 6 8 5 6 19 12 0 0 30 26342505 7 10 12 11 127 117 0 0 146 138342506 11 13 22 17 27 37 0 0 60 67342507 13 18 1 3 19 12 1 1 34 34342509 0 2 0 0 6 3 0 0 6 5342510 7 11 51 32 10 25 0 0 68 68342511 11 15 29 25 20 22 1 1 61 63342512 7 14 2 10 56 51 0 0 65 75342513 33 39 1 2 10 14 0 0 44 55342514 0 0 5 5 37 39 0 0 42 44342515 0 0 18 6 14 28 0 0 32 34342516 1 4 4 4 33 31 0 0 38 39342517 1 5 9 19 27 17 0 0 37 41342518 0 0 0 0 0 0 0 0 0 0P a g e | 114

DATA TABLE 3: Network 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON 12/31/2011Dialysis ModalityNumber of living patients by modality by dialysis facility self-care settings as of December 31, 2010and December 31, 2011Self-Care Settings - HomeHEMO CAPD CCPD IPD TOTAL2010 2011 2010 2011 2010 2011 2010 2011 2010 2011Provider342520 0 0 0 0 0 0 0 0 0 0342521 0 0 0 0 0 0 0 0 0 0342522 9 7 27 40 12 5 0 0 48 52342523 1 0 0 0 0 0 0 0 1 0342524 0 0 0 0 0 0 0 0 0 0342525 0 0 0 0 0 0 0 0 0 0342526 0 0 7 10 13 13 0 0 20 23342527 0 0 4 2 15 24 0 0 19 26342528 0 0 12 10 2 2 0 0 14 12342529 0 0 6 13 8 5 0 0 14 18342531 14 22 4 14 22 21 0 0 40 57342532 9 7 7 9 12 16 0 0 28 32342533 0 1 0 3 1 1 0 0 1 5342534 0 0 0 0 0 0 0 0 0 0342535 0 0 0 0 0 0 0 0 0 0342536 0 0 0 1 6 9 0 0 6 10342537 0 0 0 0 0 0 0 0 0 0342538 0 0 0 0 0 0 0 0 0 0342539 0 0 3 2 0 2 0 0 3 4342540 0 0 7 7 0 0 0 0 7 7342541 0 0 0 2 0 0 0 0 0 2342542 0 0 0 6 24 18 0 0 24 24342543 0 0 1 0 7 7 0 0 8 7342544 0 0 0 0 0 0 0 0 0 0342545 0 0 0 0 0 0 0 0 0 0342546 0 0 2 2 21 20 0 0 23 22342547 0 0 0 0 0 0 0 0 0 0342548 16 14 5 9 25 30 0 1 46 54342549 0 0 0 0 0 0 0 0 0 0342550 0 0 0 0 0 0 0 0 0 0342551 0 0 0 0 0 0 0 0 0 0342552 12 15 0 0 1 0 0 0 13 15342553 0 0 0 1 4 13 0 0 4 14342554 0 0 0 0 0 0 0 0 0 0342555 9 13 2 2 24 21 0 0 35 36342556 0 0 16 21 0 0 0 0 16 21342557 0 0 4 7 6 3 0 0 10 10342558 0 0 0 0 0 0 0 0 0 0342559 0 0 0 0 0 0 0 0 0 0342560 0 0 0 1 0 0 0 0 0 1P a g e | 115

DATA TABLE 3: Network 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON 12/31/2011Dialysis ModalityNumber of living patients by modality by dialysis facility self-care settings as of December 31, 2010and December 31, 2011Self-Care Settings - HomeHEMO CAPD CCPD IPD TOTAL2010 2011 2010 2011 2010 2011 2010 2011 2010 2011Provider342561 0 0 0 0 0 0 0 0 0 0342562 0 0 1 0 3 6 0 0 4 6342563 0 0 1 3 3 9 0 0 4 12342564 0 0 0 0 0 0 0 0 0 0342565 0 0 0 0 0 0 0 0 0 0342566 0 0 7 18 0 1 0 0 7 19342567 1 0 4 3 9 11 0 0 14 14342568 0 0 0 0 0 0 0 0 0 0342569 0 0 0 0 0 1 0 0 0 1342570 0 0 0 0 0 0 0 0 0 0342571 0 0 5 5 11 12 0 0 16 17342572 0 0 0 0 0 0 0 0 0 0342573 0 0 0 0 0 0 0 0 0 0342576 0 0 0 0 0 0 0 0 0 0342577 0 0 0 2 5 4 0 0 5 6342578 0 0 0 1 0 0 0 0 0 1342579 0 0 0 0 0 0 0 0 0 0342581 0 0 0 0 0 1 0 0 0 1342582 0 0 13 18 5 5 1 0 19 23342583 0 0 0 0 0 0 0 0 0 0342584 0 0 0 0 0 0 0 0 0 0342585 6 13 3 4 9 7 0 0 18 24342586 0 0 0 0 0 0 0 0 0 0342587 0 0 0 0 0 0 0 0 0 0342588 0 0 0 0 0 0 0 0 0 0342589 0 0 0 0 0 0 0 0 0 0342590 0 0 6 5 12 19 0 0 18 24342591 3 4 4 3 6 5 0 0 13 12342592 10 11 0 1 34 36 0 0 44 48342593 0 0 0 0 0 0 0 0 0 0342594 0 0 0 0 0 0 0 0 0 0342595 0 0 0 0 0 0 0 0 0 0342596 1 2 16 20 3 2 0 0 20 24342597 0 0 0 1 0 0 0 0 0 1342598 0 0 0 0 0 0 0 0 0 0342599 0 0 0 0 0 0 0 0 0 0342600 0 0 0 0 0 0 0 0 0 0342601 0 0 0 0 0 0 0 0 0 0342602 0 0 0 0 0 0 0 0 0 0342603 0 0 0 0 0 0 0 0 0 0P a g e | 116

DATA TABLE 3: Network 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON 12/31/2011Dialysis ModalityNumber of living patients by modality by dialysis facility self-care settings as of December 31, 2010and December 31, 2011Self-Care Settings - HomeHEMO CAPD CCPD IPD TOTAL2010 2011 2010 2011 2010 2011 2010 2011 2010 2011Provider342604 0 0 0 0 0 0 0 0 0 0342605 0 0 0 0 0 0 0 0 0 0342606 0 0 1 0 17 20 0 0 18 20342607 0 0 0 0 0 0 0 0 0 0342608 0 0 0 0 0 0 0 0 0 0342609 0 1 1 2 4 4 0 0 5 7342610 0 0 0 0 0 0 0 0 0 0342611 0 0 0 0 0 0 0 0 0 0342612 0 0 0 0 0 0 0 0 0 0342613 0 0 0 0 0 0 0 0 0 0342614 0 0 0 0 0 0 0 0 0 0342615 0 0 0 0 0 0 0 0 0 0342616 9 10 1 0 13 10 0 0 23 20342617 0 0 0 0 0 0 0 0 0 0342618 0 0 0 0 0 0 0 0 0342619 0 0 0 0 0 0 0 0 0342620 0 0 4 2 13 12 0 0 17 14342621 0 0 0 0 0 0 0 0 0 0342622 1 2 13 10 42 40 0 0 56 52342623 0 0 0 0 0 0 0 0 0 0342624 0 0 0 0 0 0 0 0 0 0342625 0 0 0 0 0 0 0 0 0 0342626 0 0 0 0 0 0 0 0 0 0342627 0 0 0 0 0 0 0 0 0 0342628 0 0 0 0 0 0 0 0 0 0342629 0 1 0 0 0 0 0 0 0 1342630 0 0 0 0 0 0 0 0 0 0342631 0 0 0 0 0 0 0 0 0 0342632 0 0 0 0 0 0 0 0 0 0342633 0 0 0 0 0 0 0 0 0 0342634 0 0 0 0 0 0 0 0 0 0342635 0 0 0 0 0 0 0 0 0 0342636 0 0 0 0 0 0 0 0 0 0342637 0 0 0 0 0 0 0 0 0 0342638 0 0 0 0 0 0 0 0 0 0342639 0 0 0 0 0 0 0 0 0 0342640 2 0 0 0 0 0 0 0 2 0342641 0 0 0 0 0 0 0 0 0 0342642 0 0 0 0 0 0 0 0 0 0342643 0 0 0 0 0 0 0 0 0 0P a g e | 117

DATA TABLE 3: Network 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON 12/31/2011Dialysis ModalityNumber of living patients by modality by dialysis facility self-care settings as of December 31, 2010and December 31, 2011Self-Care Settings - HomeHEMO CAPD CCPD IPD TOTAL2010 2011 2010 2011 2010 2011 2010 2011 2010 2011Provider342644 0 0 0 0 0 0 0 0 0 0342645 0 0 0 0 0 0 0 0 0 0342646 0 0 0 0 0 0 0 0 0 0342647 0 0 0 0 0 0 0 0 0 0342648 0 0 0 0 0 0 0 0 0 0342649 0 0 0 0 0 0 0 0 0 0342650 0 0 0 0 0 0 0 0 0 0342651 0 0 0 0 0 0 0 0 0 0342652 0 1 0 0 0 0 0 0 0 1342653 0 0 0 0 0 0 0 0 0 0342654 0 0 2 2 6 11 0 0 8 13342655 0 0 1 0 12 8 0 0 13 8342656 0 0 0 0 5 6 0 0 5 6342657 0 0 3 2 13 14 0 0 16 16342658 0 0 0 0 0 0 0 0 0 0342659 0 0 0 0 0 0 0 0 0 0342660 0 0 0 0 0 0 0 0 0 0342661 0 0 0 0 0 0 0 0 0 0342662 0 0 0 0 0 0 0 0 0 0342663 0 0 0 0 0 0 0 0 0 0342664 0 0 0 0 0 0 0 0 0 0342665 0 0 0 0 16 19 0 0 16 19342666 0 0 0 0 0 0 0 0 0 0342667 0 0 0 0 0 0 0 0 0 0342668 0 0 0 0 1 1 0 0 1 1342669 0 0 0 0 0 0 0 0 0 0342670 0 0 0 0 0 0 0 0 0 0342671 0 0 0 0 0 0 0 0 0 0342672 0 0 0 0 0 0 0 0 0 0342673 0 0 0 0 0 0 0 0 0 0342674 0 0 1 1 15 14 0 0 16 15342675 0 0 1 1 1 2 0 0 2 3342676 0 0 0 0 0 0 0 0 0 0342677 0 0 0 0 0 0 0 0 0 0342678 0 0 0 0 0 0 0 0 0 0342679 0 0 0 0 0 0 0 0 0 0342680 0 0 0 0 0 0 0 0 0 0342681# 0 2 0 0 0 0 0 0 0 2342682# 0 0 0 0 0 0 0 0 0 0342683# 0 0 0 0 0 0 0 0 0 0P a g e | 118

DATA TABLE 3: Network 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON 12/31/2011Dialysis ModalityNumber of living patients by modality by dialysis facility self-care settings as of December 31, 2010and December 31, 2011Self-Care Settings - HomeHEMO CAPD CCPD IPD TOTAL2010 2011 2010 2011 2010 2011 2010 2011 2010 2011Provider342684# 0 0 0 0 0 0 0 0 0 0342686# 0 0 0 0 0 1 0 0 0 1343504 0 0 1 3 13 14 0 0 14 17NC Total 217 290 378 428 972 996 3 3 1570 171742011F 0 0 0 0 0 0 0 0 0 042029F 0 0 0 0 0 0 0 0 0 0422503 4 4 1 6 15 21 0 0 20 31422504 0 0 0 0 0 0 0 0 0 0422505 0 0 0 0 0 0 0 0 0 0422506 2 3 7 6 0 4 0 0 9 13422508 1 3 0 4 0 24 0 0 1 31422509 0 0 0 1 0 0 0 0 0 1422510 7 6 10 15 4 3 0 0 21 24422511 0 0 0 0 0 0 0 0 0 0422512 2 1 0 2 1 2 0 0 3 5422513 0 0 0 0 0 0 0 0 0 0422514 0 0 2 2 0 0 0 0 2 2422515 0 0 18 17 16 16 0 0 34 33422516 0 0 0 0 0 0 0 0 0 0422517 1 0 0 0 0 0 0 0 1 0422518 0 0 0 0 0 0 0 0 0 0422519 3 3 3 3 1 2 0 0 7 8422520 0 0 0 0 0 0 0 0 0 0422521 0 0 0 0 0 0 0 0 0 0422522 1 1 44 39 19 20 0 0 64 60422524 0 0 0 0 0 0 0 0 0 0422527 0 0 0 0 0 0 0 0 0 0422528 0 0 0 2 6 10 0 0 6 12422529 2 1 4 8 18 15 0 0 24 24422530 0 0 0 0 0 0 0 0 0 0422531 0 0 0 0 0 0 0 0 0 0422532 0 0 0 0 0 0 0 0 0 0422533 0 0 0 0 0 0 0 0 0 0422534 0 0 0 0 0 0 0 0 0 0422535 0 0 0 0 0 0 0 0 0 0422536 0 0 3 5 1 0 0 0 4 5422537 0 0 0 0 0 0 0 0 0 0422538 6 5 10 20 6 4 0 0 22 29422539 0 0 0 0 0 0 0 0 0 0422540 8 15 4 4 32 41 0 0 44 60P a g e | 119

DATA TABLE 3: Network 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON 12/31/2011Dialysis ModalityNumber of living patients by modality by dialysis facility self-care settings as of December 31, 2010and December 31, 2011Self-Care Settings - HomeHEMO CAPD CCPD IPD TOTAL2010 2011 2010 2011 2010 2011 2010 2011 2010 2011Provider422541 0 0 0 0 0 0 0 0 0 0422542 0 0 0 0 0 0 0 0 0 0422543 0 0 0 0 0 0 0 0 0 0422545 0 0 0 0 0 0 0 0 0 0422546 2 1 5 1 75 0 0 0 82 2422547 0 0 0 0 0 0 0 0 0 0422548 0 0 0 0 0 0 0 0 0 0422549 0 0 9 6 3 4 0 0 12 10422550 0 0 0 0 0 0 0 0 0 0422552 0 0 0 0 0 0 0 0 0 0422553 0 0 0 1 0 0 0 0 0 1422556 0 0 0 0 0 0 0 0 0 0422557 0 0 0 0 0 0 0 0 0 0422560 0 0 0 0 0 0 0 0 0 0422563 1 3 19 13 20 31 0 0 40 47422564 0 0 0 0 0 0 0 0 0 0422565 0 0 14 2 24 0 0 0 38 2422566 0 0 0 0 0 0 0 0 0 0422567 0 0 5 0 6 0 0 0 11 0422568 0 0 0 0 0 0 0 0 0 0422569 0 0 9 0 6 0 0 0 15 0422570 1 2 8 8 0 1 0 0 9 11422571 0 0 0 0 0 0 0 0 0 0422572 0 0 0 0 0 0 0 0 0 0422573 0 0 0 0 0 0 0 0 0 0422574 2 3 16 28 42 39 0 0 60 70422575 15 13 13 13 34 25 0 0 62 51422576 0 0 0 0 0 0 0 0 0 0422577 0 0 0 0 0 0 0 1 0 1422578 0 1 0 1 0 1 0 0 0 3422579 0 0 0 0 0 0 0 0 0 0422580 0 0 0 0 0 0 0 0 0 0422581 0 0 0 0 0 0 0 0 0 0422582 0 0 0 0 0 0 0 0 0 0422583^ 0 0 0 0 0 0 0 0 0 0422584 0 0 0 0 0 0 0 0 0 0422585 0 0 2 3 17 24 0 0 19 27422586 0 0 0 0 0 0 0 0 0 0422587 0 0 0 0 0 0 0 0 0 0422588 0 0 0 0 0 0 0 0 0 0P a g e | 120

DATA TABLE 3: Network 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON 12/31/2011Dialysis ModalityNumber of living patients by modality by dialysis facility self-care settings as of December 31, 2010and December 31, 2011Self-Care Settings - HomeHEMO CAPD CCPD IPD TOTAL2010 2011 2010 2011 2010 2011 2010 2011 2010 2011Provider422589 0 0 0 0 0 0 0 0 0 0422590 0 0 0 0 0 0 0 0 0 0422591 0 2 3 1 2 5 0 0 5 8422592 0 0 0 0 0 0 0 0 0 0422593 0 0 0 0 0 0 0 0 0 0422594 0 0 0 0 1 0 0 0 1 0422596 0 0 0 0 0 1 0 0 0 1422597 0 0 0 0 0 0 0 0 0 0422598 0 0 0 0 0 0 0 0 0 0422599 0 0 0 0 0 0 0 0 0 0422600 0 0 0 0 0 0 0 0 0 0422601 0 0 0 0 0 0 0 0 0 0422602 0 0 0 0 0 0 0 0 0 0422603 0 0 0 0 0 0 0 0 0 0422604 1 0 4 8 19 24 0 0 24 32422605 0 0 0 0 0 0 0 0 0 0422606 0 0 0 0 0 0 0 0 0 0422607 3 5 0 1 2 3 0 0 5 9422608 0 1 4 3 10 8 0 0 14 12422609 0 0 0 0 0 0 0 0 0 0422610 0 0 0 0 0 0 0 0 0 0422611 0 0 0 0 0 0 0 0 0 0422612 0 0 0 1 0 0 0 0 0 1422613 0 0 0 0 0 0 0 0 0 0422614 0 0 0 0 0 0 0 0 0 0422615 0 0 0 0 0 0 0 0 0 0422616 0 0 0 0 0 1 0 0 0 1422617 0 0 0 1 0 0 0 0 0 1422618 0 0 0 0 0 0 0 0 0 0422619 0 0 0 0 0 0 0 0 0 0422620 1 3 0 0 0 1 0 0 1 4422621 0 0 0 0 0 0 0 0 0 0422622 0 0 0 0 0 0 0 0 0 0422623 0 0 0 6 0 10 0 0 0 16422624 0 0 0 0 0 0 0 0 0 0422625 0 0 0 0 0 0 0 0 0 0422626 0 0 0 0 0 0 0 0 0 0422627 0 4 0 11 1 88 0 0 1 103422628 0 0 0 0 0 0 0 0 0 0422629# 0 0 0 0 0 1 0 0 0 1P a g e | 121

DATA TABLE 3: Network 6 HOME DIALYSIS PATIENTS MODALITY- STATUS ON 12/31/2011Dialysis ModalityNumber of living patients by modality by dialysis facility self-care settings as of December 31, 2010and December 31, 2011Self-Care Settings - HomeHEMO CAPD CCPD IPD TOTAL2010 2011 2010 2011 2010 2011 2010 2011 2010 2011Provider422630# 0 0 0 3 0 2 0 0 0 5422631# 0 1 0 0 0 1 0 0 0 2SC Total 63 81 217 245 381 432 0 1 661 759NetworkTotal565 637 1194 1345 2229 2364 5 6 3993 4352Source of Information: Facility Survey (CMS 2744) and NetworkSIMS DatabaseDate of Preparation: May 2012This table includes 10 Veterans Affairs Facility patients for 2010 and 9 Veterans AffairsFacility patients for 2011.# Provider not operational in 2010^ Provider not operational in 2011P a g e | 122

DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011DIALYSIS MODALITYNumber of living patients by modality by dialysis facility in-center as of December 31,2010 and December 31, 2011In-CenterHEMO PD TOTALTOTAL OF HOME& IN-CENTER*2010 2011 2010 2011 2010 2011 2010 2011Provider110016 90 88 0 0 90 88 104 101110038 104 110 0 0 104 110 137 146110095 108 101 2 1 110 102 121 113110104 67 71 0 0 67 71 67 71110105 69 64 0 0 69 64 69 6411029F 40 45 0 0 40 45 41 45112501 77 87 0 0 77 87 79 95112503^ 0 0 0 0 0 0 0 0112504 32 37 0 0 32 37 32 39112505 63 72 0 0 63 72 91 95112507 127 125 0 0 127 125 149 151112509 122 124 0 0 122 124 122 125112510 95 94 0 0 95 94 139 142112511 60 61 0 0 60 61 65 67112512 83 80 0 0 83 80 86 83112513 88 91 0 0 88 91 88 91112514 73 82 0 0 73 82 100 109112515 37 36 0 0 37 36 43 43112516 42 46 0 0 42 46 49 58112517 71 75 0 0 71 75 84 92112518 61 65 0 0 61 65 61 66112519 31 33 0 0 31 33 31 33112521^ 0 0 0 0 0 0 0 0112522 77 73 0 0 77 73 86 82112523 141 136 0 0 141 136 141 136112524 74 69 0 0 74 69 100 92112526 62 60 0 0 62 60 82 81112527 68 70 0 0 68 70 68 70112528 75 84 0 0 75 84 78 86112529 50 48 0 0 50 48 50 48112530 0 0 0 0 0 0 40 38112531 71 71 0 0 71 71 104 97112532 55 53 0 0 55 53 55 53112533 56 56 0 0 56 56 56 56112534 39 35 0 0 39 35 39 35112535 83 79 0 0 83 79 94 89112540 103 104 0 0 103 104 103 104112541 47 42 0 0 47 42 48 43P a g e | 123

DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011DIALYSIS MODALITYNumber of living patients by modality by dialysis facility in-center as of December 31,2010 and December 31, 2011In-CenterHEMO PD TOTALTOTAL OF HOME& IN-CENTER*2010 2011 2010 2011 2010 2011 2010 2011112544 15 18 0 0 15 18 17 19112545 68 58 0 0 68 58 68 58112546 91 82 0 0 91 82 91 82112551 28 28 0 0 28 28 33 32112553 43 42 0 0 43 42 43 42112554 57 56 0 0 57 56 57 56112555 61 59 0 0 61 59 61 59112557 65 61 0 0 65 61 81 78112558 43 40 0 0 43 40 48 46112559 55 57 0 0 55 57 55 57112561 71 78 0 0 71 78 71 78112562 57 63 0 0 57 63 57 63112563 52 46 0 0 52 46 52 46112566 67 77 0 0 67 77 113 121112567 42 49 0 0 42 49 59 59112568 82 85 0 0 82 85 90 100112569 47 45 0 0 47 45 64 57112571 55 64 0 0 55 64 56 64112573 66 46 0 0 66 46 66 46112574 62 65 0 0 62 65 62 65112576 73 74 0 0 73 74 73 74112578 42 37 0 0 42 37 76 93112579 75 74 0 0 75 74 82 78112581 55 56 0 0 55 56 55 56112582 48 39 0 0 48 39 48 41112583 65 87 0 0 65 87 65 88112584 43 50 0 0 43 50 43 50112587 83 92 0 0 83 92 83 92112588 63 60 0 0 63 60 63 60112590 77 76 0 0 77 76 91 94112591 63 57 0 0 63 57 63 57112593 21 0 0 21 0 21 0112594 49 39 0 0 49 39 49 39112596 28 29 0 0 28 29 28 29112598 22 21 0 0 22 21 22 21112599 58 64 0 0 58 64 58 64112600 130 137 0 0 130 137 130 137112601 36 35 0 0 36 35 45 43112602 91 107 0 0 91 107 104 118P a g e | 124

DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011DIALYSIS MODALITYNumber of living patients by modality by dialysis facility in-center as of December 31,2010 and December 31, 2011In-CenterHEMO PD TOTALTOTAL OF HOME& IN-CENTER*2010 2011 2010 2011 2010 2011 2010 2011112603 21 24 0 0 21 24 21 24112608 50 60 0 0 50 60 50 60112609 42 42 0 0 42 42 57 56112610 39 41 0 0 39 41 39 41112611 41 42 0 0 41 42 41 42112614^ 0 0 0 0 0 0 0 0112615 35 35 0 0 35 35 35 35112617 63 62 0 0 63 62 78 80112619 43 31 0 0 43 31 44 34112620 54 59 0 0 54 59 67 70112622 66 63 0 0 66 63 75 72112624 22 20 0 0 22 20 24 22112627 46 41 0 0 46 41 46 41112628 23 22 0 0 23 22 26 24112630 43 52 0 0 43 52 43 52112631 50 59 0 0 50 59 50 60112632 25 26 0 0 25 26 25 26112633 77 82 0 0 77 82 77 82112634 76 80 0 0 76 80 81 90112636 75 73 0 0 75 73 75 73112637 43 32 0 0 43 32 47 36112638 46 41 0 0 46 41 46 41112639 91 90 0 0 91 90 111 108112640 47 50 0 0 47 50 48 51112641 88 75 0 0 88 76 102 87112643 73 68 0 0 73 68 73 68112645 80 95 0 0 80 95 88 110112646 83 89 0 0 83 89 97 106112647 27 25 0 0 27 25 27 25112648 64 74 0 0 64 74 77 86112649 37 47 0 0 37 47 37 48112651 76 80 0 0 76 80 76 80112652 48 35 0 0 48 35 48 35112653^ 0 0 0 0 0 0 0 0112655 79 82 0 0 79 82 79 82112656 75 79 0 0 75 79 80 83112657 79 73 0 0 79 73 101 91112658 65 66 0 0 65 66 66 67112659 63 71 0 0 63 71 70 71P a g e | 125

DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011DIALYSIS MODALITYNumber of living patients by modality by dialysis facility in-center as of December 31,2010 and December 31, 2011In-CenterHEMO PD TOTALTOTAL OF HOME& IN-CENTER*2010 2011 2010 2011 2010 2011 2010 2011112660 37 36 0 0 37 36 37 36112661 40 37 0 0 40 37 40 37112664 27 25 0 0 27 25 27 25112667 27 34 0 0 27 34 27 34112668 106 109 0 0 106 109 107 115112669 71 71 0 0 71 71 71 71112670 19 15 0 0 19 15 19 15112671 58 57 0 0 58 57 58 57112672 43 49 0 0 43 49 56 62112674 69 66 0 0 69 66 69 66112675 46 50 0 0 46 50 57 60112676 55 60 0 0 55 60 57 62112677 0 0 0 0 0 0 8 8112678 20 19 0 0 20 19 20 19112679 35 33 0 0 35 33 42 43112680 40 36 0 0 40 36 50 43112681 67 47 0 0 67 47 67 47112683 47 44 0 0 47 44 47 44112685 46 40 0 0 46 40 46 40112688 84 86 0 0 84 86 87 91112689 49 47 0 0 49 47 56 53112691 40 52 0 0 40 52 44 52112692 79 77 0 0 79 77 79 77112693 57 62 0 0 57 62 74 75112694 46 43 0 0 46 43 51 46112695 75 81 0 0 75 81 79 83112696 47 53 0 0 47 53 47 53112697 40 39 0 0 40 39 40 39112698 42 47 0 0 42 47 42 47112699 70 77 0 0 70 77 70 77112700 37 29 0 0 37 29 37 35112702 86 82 0 0 86 82 86 82112703 1 0 0 0 1 0 47 12112704 125 118 0 0 125 118 125 118112705 74 83 0 0 74 83 74 83112706 74 66 0 0 74 66 90 88112707 60 70 0 0 60 70 68 76112708 78 75 0 0 78 75 91 86112709 18 25 0 0 18 25 18 25P a g e | 126

DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011DIALYSIS MODALITYNumber of living patients by modality by dialysis facility in-center as of December 31,2010 and December 31, 2011In-CenterHEMO PD TOTALTOTAL OF HOME& IN-CENTER*2010 2011 2010 2011 2010 2011 2010 2011112710 43 41 0 0 43 41 45 44112711 43 45 0 0 43 45 43 45112712 38 30 0 0 38 30 64 62112713^ 0 0 0 0 0 0 0 0112714 104 102 0 0 104 102 104 102112715 73 77 0 0 73 77 73 77112716 48 50 0 0 48 50 48 50112718 39 32 0 0 39 32 43 38112719 61 56 0 0 61 56 61 56112720 86 89 0 0 86 89 93 100112721 30 41 0 0 30 41 30 41112722 84 85 0 0 84 85 98 100112723 24 53 0 0 24 53 24 53112724 47 53 0 0 47 53 47 53112725 32 34 0 0 32 34 32 34112726 24 24 0 0 24 24 24 24112727 57 50 0 0 57 50 57 50112728 20 16 0 0 20 16 26 18112729 66 66 0 0 66 66 66 66112730 73 76 0 0 73 76 89 90112732 29 40 0 0 29 40 29 40112733 66 67 0 0 66 67 66 67112734 54 54 0 0 54 54 54 54112735 95 86 0 0 95 86 95 86112736 88 95 0 0 88 95 88 95112737 40 36 0 0 40 36 46 42112738 89 97 0 0 89 97 89 97112741 43 40 0 0 43 40 44 42112742 48 74 0 0 48 74 80 107112743 33 40 0 0 33 40 51 59112744 23 23 0 0 23 23 23 23112745 67 67 0 0 67 67 68 67112746 116 122 0 0 116 122 123 126112747 37 27 0 0 37 27 151 124112748 29 28 0 0 29 28 29 28112749 86 85 0 0 86 85 111 118112750 43 38 0 0 43 38 64 56112751 42 32 0 0 42 32 42 32112752 96 88 0 0 96 88 119 114P a g e | 127

DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011DIALYSIS MODALITYNumber of living patients by modality by dialysis facility in-center as of December 31,2010 and December 31, 2011In-CenterHEMO PD TOTALTOTAL OF HOME& IN-CENTER*2010 2011 2010 2011 2010 2011 2010 2011112753 58 62 0 0 58 62 76 75112754 88 85 0 0 88 85 124 120112755 38 37 0 0 38 37 41 39112756 8 0 0 0 8 0 8 0112757 21 20 0 0 21 20 21 20112758 72 73 0 0 72 73 98 97112759 72 90 0 0 72 90 72 94112760 49 54 0 0 49 54 59 64112761 87 93 0 0 87 93 107 120112762 89 80 0 0 89 80 104 98112763 33 29 0 0 33 29 33 32112765 54 54 0 0 54 54 71 75112766 36 42 0 0 36 42 45 50112767 23 22 0 0 23 22 23 22112768 36 35 0 0 36 35 44 45112769 42 38 0 0 42 38 43 39112770 46 48 0 0 46 48 46 48112771 66 76 0 0 66 76 66 76112772 43 42 0 0 43 42 43 46112773 49 45 0 0 49 45 50 49112774 0 0 0 0 0 0 37 31112775 116 112 0 0 116 112 116 112112776 30 27 0 0 30 27 30 27112777 31 41 0 0 31 41 31 41112778 53 50 0 0 53 50 53 52112779 32 35 0 0 32 35 54 53112780 0 0 0 0 0 8 1112781 33 44 0 0 33 44 47 61112782 37 43 0 0 37 43 37 43112783 24 22 0 0 24 22 24 22112784 60 67 0 0 60 67 60 67112785 47 55 0 0 47 55 48 55112786 26 20 0 0 26 20 26 20112787^ 0 0 0 0 0 0 0 0112788 64 73 0 0 64 73 73 89112789 40 37 0 0 40 37 46 41112790 52 50 0 0 52 50 52 50112791 24 31 0 0 24 31 24 31112792 47 47 0 0 47 47 47 47P a g e | 128

DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011DIALYSIS MODALITYNumber of living patients by modality by dialysis facility in-center as of December 31,2010 and December 31, 2011In-CenterHEMO PD TOTALTOTAL OF HOME& IN-CENTER*2010 2011 2010 2011 2010 2011 2010 2011112793 32 45 0 0 32 45 32 45112794 11 21 0 0 11 21 12 22112795 42 48 0 0 42 48 42 48112796 50 56 0 0 50 56 50 56112797 95 95 0 0 95 95 116 121112798 56 52 0 0 56 52 64 65112799 17 15 0 0 17 15 17 15112800 47 53 0 0 47 53 47 53112801 0 0 0 0 0 0 55 65112802 15 19 0 0 15 19 15 19112803 114 110 0 0 114 110 145 138112804 22 17 0 0 22 17 22 17112805 23 18 0 0 23 18 31 28112806 25 40 0 0 25 40 33 48112807 28 30 0 0 28 30 28 30112808 53 0 0 0 53 0 53 0112809 14 24 0 0 14 24 14 24112810 18 33 0 0 18 33 31 46112811 21 30 0 0 21 30 25 37112812 16 18 0 0 16 18 16 18112813 38 39 0 0 38 39 58 69112814 37 36 0 0 37 36 37 36112815 25 28 0 0 25 28 30 34112816 10 11 0 0 10 11 10 11112817 14 13 0 0 14 13 21 18112818 15 23 0 0 15 23 15 23112819 33 32 0 0 33 32 34 32112820 0 0 0 0 0 0 17 19112821 41 51 0 0 41 51 41 53112822 12 13 0 0 12 13 12 13112823 131 125 0 0 131 125 132 126112824 130 147 0 0 130 147 173 212112825 16 17 0 0 16 17 17 17112826 144 148 0 0 144 148 144 148112827 42 46 0 0 42 46 42 46112828 28 47 0 0 28 47 30 50112829 22 39 0 0 22 39 25 42112830 31 50 0 0 31 50 31 53112831 25 29 0 0 25 29 34 42P a g e | 129

DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011DIALYSIS MODALITYNumber of living patients by modality by dialysis facility in-center as of December 31,2010 and December 31, 2011In-CenterHEMO PD TOTALTOTAL OF HOME& IN-CENTER*2010 2011 2010 2011 2010 2011 2010 2011112832 16 30 0 0 16 30 16 32112833 15 26 0 0 15 26 15 26112834 16 18 0 0 16 18 16 18112835 31 42 0 0 31 42 31 42112836 16 29 0 0 16 29 18 35112837# 0 14 0 0 0 14 0 14112838 3 21 0 0 3 21 3 21112839# 0 23 0 0 0 23 0 30112840# 0 7 0 0 0 7 0 7112841# 0 24 0 0 0 24 0 24112842# 0 0 0 0 0 0 0 25112843# 0 3 0 0 0 3 0 3112844# 0 34 0 0 0 34 0 38112845# 0 1 0 0 0 1 0 2112846# 0 2 0 0 0 2 0 2113300 20 20 0 0 20 20 38 41113500 43 41 0 0 43 41 43 41113501 59 50 0 0 59 50 59 51113502 48 55 0 0 48 55 48 55113504 47 47 0 0 47 47 47 47GA Total 14529 14989 2 1 14531 14991 16293 16867340030 0 0 0 0 0 0 0 0340040 0 0 0 0 0 0 0 0340047 2 0 0 0 2 0 2 0340064 55 53 0 0 55 53 55 53340113 9 14 0 0 9 14 14 1834012F 30 38 0 0 30 38 39 4734013F# 0 40 0 0 0 40 0 4034014F# 0 42 0 0 0 42 0 42342502 133 140 0 0 133 140 210 209342503 124 120 0 0 124 120 166 165342504 155 170 0 0 155 170 185 196342505 135 129 0 0 135 129 281 267342506 152 155 0 0 152 155 212 222342507 101 113 0 0 101 113 135 147342509 87 77 0 0 87 77 93 82342510 133 122 0 0 133 122 201 190342511 195 77 0 0 195 77 256 140342512 174 152 0 0 174 152 239 227P a g e | 130

DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011DIALYSIS MODALITYNumber of living patients by modality by dialysis facility in-center as of December 31,2010 and December 31, 2011In-CenterHEMO PD TOTALTOTAL OF HOME& IN-CENTER*2010 2011 2010 2011 2010 2011 2010 2011342513 123 102 0 0 123 102 167 157342514 143 150 0 0 143 150 185 194342515 101 110 0 0 101 110 133 144342516 112 115 0 0 112 115 150 154342517 153 150 0 0 153 150 190 191342518 104 93 0 0 104 93 104 93342520 61 62 0 0 61 62 61 62342521 61 56 0 0 61 56 61 56342522 190 174 0 0 190 174 238 226342523 78 67 0 0 78 67 79 67342524 106 114 0 0 106 114 106 114342525 65 54 0 0 65 54 65 54342526 90 81 0 0 90 81 110 104342527 65 69 0 0 65 69 84 95342528 102 94 0 0 102 94 116 106342529 91 93 0 0 91 93 105 111342531 92 87 0 0 92 87 132 144342532 108 132 0 0 108 132 136 164342533 164 150 0 0 164 150 165 155342534 96 91 0 0 96 91 96 91342535 47 54 0 0 47 54 47 54342536 72 63 0 0 72 63 78 73342537 157 174 0 0 157 174 157 174342538 72 66 0 0 72 66 72 66342539 116 123 0 0 116 123 119 127342540 82 91 0 0 82 91 89 98342541 52 50 0 0 52 50 52 52342542 138 140 0 0 138 140 162 164342543 140 143 0 0 140 143 148 150342544 74 84 0 0 74 84 74 84342545 63 54 0 0 63 54 63 54342546 90 97 0 0 90 97 113 119342547 41 39 0 0 41 39 41 39342548 109 105 0 0 109 105 155 159342549 72 88 0 0 72 88 72 88342550 125 86 0 0 125 86 125 86342551 78 84 0 0 78 84 78 84342552 69 59 0 0 69 59 82 74342553 93 92 0 0 93 92 97 106P a g e | 131

DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011DIALYSIS MODALITYNumber of living patients by modality by dialysis facility in-center as of December 31,2010 and December 31, 2011In-CenterHEMO PD TOTALTOTAL OF HOME& IN-CENTER*2010 2011 2010 2011 2010 2011 2010 2011342554 80 92 0 0 80 92 80 92342555 77 71 0 0 77 71 112 107342556 38 51 0 0 38 51 54 72342557 87 90 0 0 87 90 97 100342558 67 68 0 0 67 68 67 68342559 129 124 0 0 129 124 129 124342560 40 33 0 0 40 33 40 34342561 69 79 0 0 69 79 69 79342562 97 97 0 0 97 97 101 103342563 73 73 0 0 73 73 77 85342564 83 88 0 0 83 88 83 88342565 70 67 0 0 70 67 70 67342566 88 88 0 0 88 88 95 107342567 77 88 0 0 77 88 91 102342568 73 59 0 0 73 59 73 59342569 123 120 0 0 123 120 123 121342570 85 87 0 0 85 87 85 87342571 72 69 0 0 72 69 88 86342572 76 81 0 0 76 81 76 81342573 39 32 0 0 39 32 39 32342576 24 22 0 0 24 22 24 22342577 85 84 0 0 85 84 90 90342578 71 66 0 0 71 66 71 67342579 110 102 0 0 110 102 110 102342581 109 111 0 0 109 111 109 112342582 49 46 0 0 49 46 68 69342583 52 59 0 0 52 59 52 59342584 63 64 0 0 63 64 63 64342585 79 73 0 0 79 73 97 97342586 54 47 0 0 54 47 54 47342587 71 73 0 0 71 73 71 73342588 65 62 0 0 65 62 65 62342589 90 89 0 0 90 89 90 89342590 58 56 0 0 58 56 76 80342591 122 118 0 0 122 118 135 130342592 79 64 0 0 79 65 123 113342593 116 123 0 0 116 123 116 123342594 84 96 0 0 84 96 84 96342595 45 38 0 0 45 38 45 38P a g e | 132

DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011DIALYSIS MODALITYNumber of living patients by modality by dialysis facility in-center as of December 31,2010 and December 31, 2011In-CenterHEMO PD TOTALTOTAL OF HOME& IN-CENTER*2010 2011 2010 2011 2010 2011 2010 2011342596 116 119 0 0 116 119 136 143342597 31 27 0 0 31 27 31 28342598 27 28 0 0 27 28 27 28342599 65 65 0 0 65 65 65 65342600 79 82 0 0 79 82 79 82342601 141 119 0 0 141 119 141 119342602 55 57 0 0 55 57 55 57342603 97 98 0 0 97 98 97 98342604 37 42 0 0 37 42 37 42342605 79 76 0 0 79 76 79 76342606 80 79 0 3 80 82 98 102342607 52 34 0 0 52 34 52 34342608 75 79 0 0 75 79 75 79342609 67 65 0 0 67 65 72 72342610 65 62 0 0 65 62 65 62342611 42 46 0 0 42 46 42 46342612 129 138 0 0 129 138 129 138342613 65 68 0 0 65 68 65 68342614 52 41 0 0 52 41 52 41342615 88 69 0 0 88 69 88 69342616 85 87 0 0 85 87 108 107342617 66 21 0 0 66 21 66 21342618 44 39 0 0 44 39 44 39342619 50 51 0 0 50 51 50 51342620 144 137 0 0 144 137 161 151342621 0 47 0 0 0 47 0 47342622 132 112 0 0 132 112 188 164342623 61 61 0 0 61 61 61 61342624 30 28 0 0 30 28 30 28342625 27 23 0 0 27 23 27 23342626 18 17 0 0 18 17 18 17342627 74 74 0 0 74 74 74 74342628 41 41 0 0 41 41 41 41342629 46 49 0 0 46 49 46 50342630 28 23 0 0 28 23 28 23342631 61 60 0 0 61 60 61 60342632 55 56 0 0 55 56 55 56342633 49 46 0 0 49 46 49 46342634 99 102 0 0 99 102 99 102P a g e | 133

DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011DIALYSIS MODALITYNumber of living patients by modality by dialysis facility in-center as of December 31,2010 and December 31, 2011In-CenterHEMO PD TOTALTOTAL OF HOME& IN-CENTER*2010 2011 2010 2011 2010 2011 2010 2011342635 55 59 0 0 55 59 55 59342636 60 61 0 0 60 61 60 61342637 84 92 0 0 84 92 84 92342638 47 46 0 0 47 46 47 46342639 42 53 0 0 42 53 42 53342640 60 57 0 0 60 57 62 57342641 45 51 0 0 45 51 45 51342642 94 102 0 0 94 102 94 102342643 110 114 0 0 110 114 110 114342644 25 32 0 0 25 32 25 32342645 34 40 0 0 34 40 34 40342646 99 97 0 0 99 97 99 97342647 45 55 0 0 45 55 45 55342648 49 44 0 0 49 44 49 44342649 25 23 0 0 25 23 25 23342650 51 48 0 0 51 48 51 48342651 26 22 0 0 26 22 26 22342652 42 42 0 0 42 42 42 43342653 43 53 0 0 43 53 43 53342654 0 0 0 0 0 0 8 13342655 0 0 0 0 0 0 13 8342656 0 0 0 0 0 0 5 6342657 0 0 0 0 0 0 16 16342658 39 41 0 0 39 41 39 41342659 45 50 0 0 45 50 45 50342660 20 21 0 0 20 21 20 21342661 32 32 0 0 32 32 32 32342662 35 35 0 0 35 35 35 35342663 74 95 0 0 74 95 74 95342664 45 43 0 0 45 43 45 43342665 26 27 0 0 26 27 42 46342666 25 26 0 0 25 26 25 26342667 115 113 0 0 115 113 115 113342668 0 0 0 0 0 0 1 1342669 23 35 0 0 23 35 23 35342670 51 60 0 0 51 60 51 60342671 50 63 0 0 50 63 50 63342672 41 41 0 0 41 41 41 41342673 19 26 0 0 19 26 19 26P a g e | 134

DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011DIALYSIS MODALITYNumber of living patients by modality by dialysis facility in-center as of December 31,2010 and December 31, 2011In-CenterHEMO PD TOTALTOTAL OF HOME& IN-CENTER*2010 2011 2010 2011 2010 2011 2010 2011342674 41 43 0 0 41 43 57 58342675 23 37 0 0 23 37 25 40342676 36 36 0 0 36 36 36 36342677 21 23 0 0 21 23 21 23342678 8 34 0 0 8 34 8 34342679 18 23 0 0 18 23 18 23342680 18 34 0 0 18 34 18 34342681# 0 53 0 0 0 53 0 55342682# 0 39 0 0 0 39 0 39342683# 0 40 0 0 0 40 0 40342684# 0 4 0 0 0 4 0 4342686# 0 1 0 0 0 1 0 2343504 47 45 0 0 47 45 61 62NC Total 12689 12807 0 3 12689 12811 14259 1452842011F 25 19 0 0 25 19 25 1942029F 28 27 0 0 28 27 28 27422503 136 126 0 1 136 127 156 158422504 132 132 0 0 132 132 132 132422505 110 135 0 1 110 136 110 136422506 131 132 0 0 131 132 140 145422508 72 76 0 0 72 76 73 107422509 77 76 0 0 77 76 77 77422510 191 188 0 0 191 188 212 212422511 74 78 0 0 74 78 74 78422512 78 93 0 0 78 93 81 98422513 70 76 0 0 70 76 70 76422514 63 67 0 0 63 67 65 69422515 147 123 0 0 147 123 181 156422516 49 51 0 0 49 51 49 51422517 75 74 0 0 75 74 76 74422518 58 62 0 0 58 62 58 62422519 72 69 0 0 72 69 79 77422520 78 79 0 0 78 79 78 79422521 80 86 0 0 80 86 80 86422522 99 97 0 0 99 97 163 157422524 74 66 0 0 74 66 74 66422527 47 38 0 0 47 38 47 38422528 115 113 0 0 115 113 121 125422529 99 67 0 0 99 67 123 91P a g e | 135

DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011DIALYSIS MODALITYNumber of living patients by modality by dialysis facility in-center as of December 31,2010 and December 31, 2011In-CenterHEMO PD TOTALTOTAL OF HOME& IN-CENTER*2010 2011 2010 2011 2010 2011 2010 2011422530 63 69 0 0 63 69 63 69422531 61 61 0 0 61 61 61 61422532 78 76 0 0 78 76 78 76422533 85 84 0 0 85 84 85 84422534 39 38 0 0 39 38 39 38422535 52 54 0 0 52 54 52 54422536 47 58 0 0 47 58 51 63422537 36 38 0 0 36 38 36 38422538 62 62 0 0 62 62 84 91422539 91 74 0 0 91 74 91 74422540 140 116 0 0 140 116 184 176422541 87 77 0 0 87 77 87 77422542 36 37 0 0 36 37 36 37422543 77 77 0 0 77 77 77 77422545 94 95 0 0 94 95 94 95422546 106 97 0 0 106 97 188 99422547 48 42 0 0 48 42 48 42422548 23 25 0 0 23 25 23 25422549 85 85 0 0 85 85 97 95422550 76 81 0 0 76 81 76 81422552 58 59 0 0 58 59 58 59422553 85 90 0 0 85 90 85 91422556 56 63 0 0 56 63 56 63422557 45 46 0 0 45 46 45 46422560 84 96 0 0 84 96 84 96422563 71 69 0 0 71 69 111 116422564 84 77 0 0 84 77 84 77422565 63 58 0 0 63 58 101 60422566 51 50 0 0 51 50 51 50422567 110 102 0 0 110 102 121 102422568 49 43 0 0 49 43 49 43422569 46 42 0 0 46 42 61 42422570 46 45 0 0 46 45 55 56422571 52 52 0 0 52 52 52 52422572 72 73 0 0 72 73 72 73422573 35 34 0 0 35 34 35 34422574 80 74 0 0 80 74 140 144422575 101 103 0 0 101 103 163 154422576 99 92 0 0 99 92 99 92P a g e | 136

DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011DIALYSIS MODALITYNumber of living patients by modality by dialysis facility in-center as of December 31,2010 and December 31, 2011In-CenterHEMO PD TOTALTOTAL OF HOME& IN-CENTER*2010 2011 2010 2011 2010 2011 2010 2011422577 19 24 0 0 19 24 19 25422578 94 92 0 0 94 92 94 95422579 0 49 0 0 0 49 0 49422580 44 40 0 0 44 40 44 40422581 43 45 0 0 43 45 43 45422582 68 66 0 0 68 66 68 66422583^ 0 0 0 0 0 0 0 0422584 100 76 0 0 100 76 100 76422585 52 52 0 0 52 52 71 79422586 74 74 0 0 74 74 74 74422587 57 58 0 0 57 58 57 58422588 43 0 0 0 43 0 43 0422589 66 60 0 0 66 60 66 60422590 74 61 0 0 74 61 74 61422591 67 69 0 0 67 69 72 77422592 33 31 0 0 33 31 33 31422593 51 56 0 0 51 56 51 56422594 49 84 0 0 49 84 50 84422596 49 48 0 0 49 48 49 49422597 30 30 0 0 30 30 30 30422598 57 60 0 0 57 60 57 60422599 33 32 0 0 33 32 33 32422600 34 42 0 0 34 42 34 42422601 60 50 0 0 60 50 60 50422602 35 31 0 0 35 31 35 31422603 57 52 0 0 57 52 57 52422604 47 55 0 0 47 55 71 87422605 44 40 0 0 44 40 44 40422606 47 51 0 0 47 51 47 51422607 52 58 0 0 52 58 57 67422608 61 60 0 0 61 60 75 72422609 34 37 0 0 34 37 34 37422610 60 62 0 0 60 62 60 62422611 47 69 0 0 47 69 47 69422612 44 40 0 0 44 40 44 41422613 52 51 0 0 52 51 52 51422614 78 82 0 0 78 82 78 82422615 32 34 0 0 32 34 32 34422616 19 31 0 0 19 31 19 32P a g e | 137

DATA TABLE 4: NETWORK 6 IN-CENTER DIALYSIS PATIENTS MODALITY STATUS ON 12/31/2011DIALYSIS MODALITYNumber of living patients by modality by dialysis facility in-center as of December 31,2010 and December 31, 2011In-CenterHEMO PD TOTALTOTAL OF HOME& IN-CENTER*2010 2011 2010 2011 2010 2011 2010 2011422617 75 67 0 0 75 67 75 68422618 37 37 0 0 37 37 37 37422619 48 52 0 0 48 52 48 52422620 54 59 0 0 54 59 55 63422621 29 35 0 0 29 35 29 35422622 17 18 0 0 17 18 17 18422623 24 24 0 0 24 24 24 40422624 18 23 0 0 18 23 18 23422625 24 31 0 0 24 31 24 31422626 13 29 0 0 13 29 13 29422627 0 1 0 0 0 1 1 104422628 0 37 0 0 0 37 0 37422629# 0 36 0 0 0 36 0 37422630# 0 28 0 0 0 28 0 33422631# 0 0 0 0 0 0 0 2SC Total 7098 7193 0 2 7098 7195 7759 7954NetworkTotal34316 34989 2 6 34318 34997 38311 39349Source of Information: Facility Survey (CMS 2744) and Network SIMS Database*Total from Table #3 plus total from Table #4 (for last column of report year)Date of Preparation: June 2012This table includes 123 Veterans Affairs Facility patients for 2010 and 211 Veterans Affairs Facility patients for 2011.# Provider not operational in 2010^ Provider not operational in 2011P a g e | 138

DATA TABLE 5: NETWORK 6 NUMBER OF RENAL TRANSPLANTS BY TRANSPLANT CENTER ANDSTATERenal Transplant by Transplant CenterNumber of transplants performed by transplant center calendar year 2010 and calendar year 2011TOTAL TRANSPLANTSPERFORMEDPATIENTS WAITING FORTRANSPLANT*Transplant Center 2010 2011 2010 2011110010 207 214 700 866110034 91 78 685 677110083 155 160 649 790113300 21 34 16 0GA Total 474 486340030 108 127 599 580340040 72 87 279 380340047 210 192 752 843340061 72 64 744 771340113 172 129 467 498NC Total 634 599420004 196 221 553 545SC Total 196 221NETWORK TOTAL: 1,304 1306Source of information: Network SIMS Database/CMS-2744Date of Preparation: May 2012* These numbers are not added to State or Network totals because some patients may be placed on more than one waiting list.The numbers are only accurate for each center.# Provider not operational in 2010^ Provider not operational in 2011P a g e | 139

DATA TABLE 6: NETWORK 6 NUMBER OF RENAL TRANSPLANTS BY TYPE, AGE,RACE, SEX, AND PRIMARY DIAGNOSISRenal Transplant RecipientsRenal transplant recipients by transplant type, age, race, gender and primary diagnosis forcalendar year 2011CADAVERICLIVINGRELATEDLIVINGUNRELATEDTotalAge Group00-04 5 4 1 1005-09 9 6 1 1610-14 10 2 1 1315-19 25 8 1 3420-24 8 8 5 2125-29 26 7 6 3930-34 44 10 5 5935-39 70 20 12 10240-44 116 15 17 14845-49 108 13 14 13550-54 120 25 26 17155-59 131 14 27 17260-64 122 18 22 16265-69 121 8 12 14170-74 44 8 6 5875-79 22 2 1 2580-84 2 0 0 2>=85 1 0 0 1Missing 0 0 0 0Total 984 168 157 1309GenderFemale 419 76 51 546Male 565 92 106 763Missing 0 0 0 0Total 984 168 157 1309RaceAmerican Indian/AlaskaNative9 1 1 11Asian 12 4 0 16Black or African American 545 45 31 621More than one race selected 3 1 2 6Native Hawaiian or OtherPacific Islander4 0 0 4White 408 117 119 644Missing 3 0 4 7Total 984 168 157 1309P a g e | 140

DATA TABLE 6: Network 6 NUMBER OF RENAL TRANSPLANTS BY TYPE, AGE,RACE, SEX, AND PRIMARY DIAGNOSISRenal Transplant RecipientsRenal transplant recipients by transplant type, age, race, gender and primary diagnosisfor calendar year 2011CADAVERICLIVINGRELATEDLIVINGUNRELATEDTotalPrimary DiagnosisCystic Kidney 76 14 26 116Diabetes 275 25 27 327Glomerulonephritis 159 42 45 246Hypertension 276 32 18 326Other 159 45 33 237Other Urologic 12 1 3 16Missing 3 0 5 8Unknown 24 9 0 33Total 984 168 157 1309Source of information: Network SIMS DatabaseDate of Preparation: May 2012Race: The categories are from the CMS-2728 Form.Diagnosis: Categories are from the CMS-2728. A diagnosis of 'unknown' is ICD-9 code7999.This table includes 0 patients receiving treatment at VA facilities.P a g e | 141

DATA TABLE 7: NETWORK 6 DIALYSIS DEATHSDIALYSIS DEATHSDeaths of dialysis patients by state of residence, age, race, gender, primary diagnosis andcause of death for calendar year 2011Age Group GA NC SC Other Total00-04 0 2 0 0 205-09 0 1 0 0 110-14 2 0 0 0 215-19 2 0 0 0 220-24 6 3 6 1 1625-29 21 17 3 0 4130-34 19 29 19 1 6835-39 49 36 10 1 9640-44 67 49 34 1 15145-49 119 121 61 2 30350-54 207 143 97 5 45255-59 251 249 139 6 64560-64 360 319 179 8 86665-69 422 346 215 4 98770-74 394 362 207 5 96875-79 359 349 189 4 90180-84 303 292 139 10 744>=85 259 194 108 4 565Missing 0 0 0 0 0Total 2840 2512 1406 52 6810Female 1371 1140 707 24 3242Male 1469 1372 699 28 3568Missing 0 0 0 0 0Total 2840 2512 1406 52 6810Female 1371 1140 707 24 3242RaceAmerican Indian/Alaska Native 10 25 4 0 39Asian 23 11 8 0 42Black or African American 1526 1237 852 22 3637More than one race selected 8 4 0 0 12Native Hawaiian or Other Pacific Islander 6 2 2 0 10White 1266 1232 539 28 3065Missing 1 1 1 2 5Total 2840 2512 1406 52 6810P a g e | 142

DATA TABLE 7 Network 6 DIALYSIS DEATHSDIALYSIS DEATHSDeaths of dialysis patients by state of residence, age, race, gender, primary diagnosis andcause of death for calendar year 2011Primary DiagnosisCystic Kidney 38 28 17 3 86Diabetes 1254 1209 647 22 3132Glomerulonephritis 120 162 77 4 363Hypertension 1011 695 509 16 2231Other 295 283 113 4 695Other Urologic 30 32 10 1 73Missing 1 1 3 0 5Unknown 91 102 30 2 225Total 2840 2512 1406 52 6810Primary Cause of DeathCardiac 1177 937 591 26 2731Gastro Intestinal 19 24 12 1 56Infection 230 284 146 4 664Liver Disease 21 22 17 1 61Vascular 97 131 65 0 293Missing 79 36 34 2 151Other 532 723 287 13 1555Unknown 685 355 254 5 1299Total 2840 2512 1406 52 6810Source of information: Network SIMS DatabaseDate of Preparation: May 2012Race: The categories are from the CMS-2728 Form.Diagnosis: Categories are from the CMS-2728. A diagnosis of 'unknown' is ICD-9 code 7999.This table cannot be compared to the CMS Facility Survey because the CMS Facility Survey is limited to thosedeaths reported by only Medicare-approved facilities.This table includes 31 patients receiving treatment at VA facilities.P a g e | 143

DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATIONVOCATIONAL REHABILITATIONBEGINNING THROUGH END OF SURVEY PERIOD 2011FACILITIESREPORTINGAGED 18THROUGH 54(as of Dec 31)PATIENTSRECEIVINGSERVICESFROM VOCREHABPATIENTSEMPLOYEDFULL-TIMEORPART_TIMEPATIENTSATTENDINGSCHOOLFULL TIMESHIFTAFTER 5PMGEORGIA110010 0 0 0 0 N110016 39 0 7 1 N110034 0 0 0 0 N110038 56 2 10 4 N110083 0 0 0 0 N110095 31 1 7 2 N110104 23 0 0 0 N110105 22 0 7 0 N11029F 12 0 1 0 N112501 34 0 0 0 Y112504 19 0 0 0 N112505 35 2 9 0 Y112507 53 0 0 0 N112509 37 0 3 2 N112510 61 1 26 8 N112511 25 0 16 1 N112512 30 0 4 0 N112513 29 0 0 0 N112514 38 0 0 0 N112515 13 0 0 0 N112516 24 0 0 0 N112517 40 0 0 0 N112518 24 0 1 3 N112519 12 0 3 0 N112522 30 2 3 2 N112523 57 0 12 0 N112524 41 0 2 0 N112526 43 3 13 2 N112527 20 0 0 0 N112528 31 2 2 3 N112529 19 0 1 0 N112530 17 1 9 0 N112531 35 0 11 1 N112532 16 0 0 0 N112533 15 0 0 0 N112534 8 0 0 0 N112535 35 0 2 1 N112540 36 0 5 0 N112541 17 0 2 0 NP a g e | 144

DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATIONVOCATIONAL REHABILITATIONBEGINNING THROUGH END OF SURVEY PERIOD 2011FACILITIESREPORTINGAGED 18THROUGH 54(as of Dec 31)PATIENTSRECEIVINGSERVICESFROM VOCREHABPATIENTSEMPLOYEDFULL-TIMEORPART_TIMEPATIENTSATTENDINGSCHOOLFULL TIMESHIFTAFTER 5PM112544 2 0 1 0 N112545 13 0 1 1 N112546 15 0 1 0 N112551 12 2 1 0 N112553 22 0 2 1 N112554 21 0 3 4 N112555 16 0 1 0 N112557 40 0 3 2 N112558 14 0 0 0 N112559 18 0 3 1 N112561 23 0 2 0 N112562 37 3 6 1 N112563 15 6 15 1 N112566 73 0 0 0 N112567 18 0 0 0 N112568 39 0 9 1 N112569 21 0 0 0 N112571 19 0 3 2 N112573 14 0 0 0 N112574 20 0 1 0 N112576 27 0 2 1 N112578 48 4 25 1 Y112579 24 0 2 3 N112581 14 0 0 0 N112582 18 5 7 2 N112583 39 0 0 0 N112584 13 0 1 1 N112587 34 0 3 3 N112588 23 0 0 0 N112590 19 0 9 1 N112591 26 2 3 0 N112593 0 0 0 0 N112594 13 0 2 1 N112596 18 0 0 0 N112598 8 2 2 0 N112599 25 1 7 1 N112600 45 2 6 0 N112601 15 0 4 0 N112602 35 1 1 2 N112603 11 0 2 0 NP a g e | 145

DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATIONVOCATIONAL REHABILITATIONBEGINNING THROUGH END OF SURVEY PERIOD 2011FACILITIESREPORTINGAGED 18THROUGH 54(as of Dec 31)PATIENTSRECEIVINGSERVICESFROM VOCREHABPATIENTSEMPLOYEDFULL-TIMEORPART_TIMEPATIENTSATTENDINGSCHOOLFULL TIMESHIFTAFTER 5PM112608 18 0 3 0 N112609 16 0 0 1 N112610 13 0 0 0 N112611 19 0 0 0 N112615 19 1 3 0 N112617 32 0 0 0 N112619 11 0 3 0 N112620 33 0 5 2 N112622 32 4 3 0 N112624 6 0 0 0 N112627 8 0 5 2 N112628 11 0 0 0 N112630 22 0 0 0 N112631 22 5 8 2 N112632 12 0 0 0 N112633 31 0 10 0 Y112634 25 2 8 0 N112636 18 0 3 0 N112637 10 0 4 0 N112638 13 0 0 0 N112639 41 1 6 3 N112640 22 0 0 0 N112641 29 0 0 0 N112643 23 8 0 1 N112645 56 5 7 4 N112646 49 0 11 0 N112647 6 0 0 0 N112648 22 2 11 2 N112649 17 0 0 0 N112651 24 0 6 0 N112652 9 0 0 0 N112655 40 0 0 0 N112656 32 0 0 0 N112657 29 1 10 2 N112658 17 0 0 1 N112659 28 1 10 2 N112660 16 0 4 0 N112661 3 0 0 0 N112664 8 0 0 0 N112667 9 0 1 0 NP a g e | 146

DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATIONVOCATIONAL REHABILITATIONBEGINNING THROUGH END OF SURVEY PERIOD 2011FACILITIESREPORTINGAGED 18THROUGH 54(as of Dec 31)PATIENTSRECEIVINGSERVICESFROM VOCREHABPATIENTSEMPLOYEDFULL-TIMEORPART_TIMEPATIENTSATTENDINGSCHOOLFULL TIMESHIFTAFTER 5PM112668 46 0 0 0 N112669 23 0 1 0 N112670 6 0 0 0 N112671 19 0 0 0 N112672 28 0 0 0 N112674 21 0 2 1 N112675 16 0 1 0 N112676 20 1 5 3 N112677 4 0 2 0 N112678 7 0 1 0 N112679 11 0 0 0 N112680 11 0 1 0 N112681 13 1 4 5 N112683 12 0 1 0 N112685 13 0 0 0 N112688 30 0 0 0 N112689 18 0 0 0 N112691 17 0 0 0 N112692 36 0 0 0 N112693 20 0 0 0 N112694 22 0 0 0 N112695 28 0 21 1 N112696 14 0 2 0 N112697 17 0 0 0 N112698 14 2 6 2 N112699 27 0 3 0 N112700 16 0 0 0 N112702 43 0 39 4 N112703 6 1 0 1 N112704 44 0 14 1 N112705 44 1 9 1 N112706 42 0 18 18 N112707 20 0 3 0 N112708 22 2 5 1 N112709 3 0 0 0 N112710 20 1 4 2 N112711 20 0 1 0 N112712 23 0 0 0 N112714 25 5 4 0 N112715 19 0 3 0 NP a g e | 147

DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATIONVOCATIONAL REHABILITATIONBEGINNING THROUGH END OF SURVEY PERIOD 2011FACILITIESREPORTINGAGED 18THROUGH 54(as of Dec 31)PATIENTSRECEIVINGSERVICESFROM VOCREHABPATIENTSEMPLOYEDFULL-TIMEORPART_TIMEPATIENTSATTENDINGSCHOOLFULL TIMESHIFTAFTER 5PM112716 13 0 0 0 N112718 14 0 2 0 N112719 27 0 0 0 N112720 44 5 8 2 N112721 13 0 0 0 N112722 31 1 11 2 Y112723 16 0 3 0 N112724 19 2 4 0 N112725 8 0 0 0 N112726 1 0 0 0 N112727 18 0 7 0 N112728 6 0 1 0 N112729 18 0 3 2 N112730 31 1 3 2 N112732 14 1 0 1 N112733 22 0 1 1 N112734 14 0 2 0 N112735 29 0 4 2 Y112736 27 0 3 1 N112737 19 0 0 0 N112738 35 3 6 2 N112741 10 0 2 1 N112742 47 1 9 3 N112743 20 0 7 0 N112744 7 0 0 0 N112745 33 0 12 2 N112746 57 0 12 3 Y112747 51 0 16 4 N112748 5 0 2 0 N112749 46 0 0 0 N112750 24 0 1 0 N112751 12 0 0 0 N112752 30 1 5 1 N112753 26 0 4 0 N112754 58 2 17 4 N112755 9 0 0 0 N112756 0 0 0 0 N112757 6 0 0 0 N112758 41 2 15 1 N112759 43 0 0 0 NP a g e | 148

DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATIONVOCATIONAL REHABILITATIONBEGINNING THROUGH END OF SURVEY PERIOD 2011FACILITIESREPORTINGAGED 18THROUGH 54(as of Dec 31)PATIENTSRECEIVINGSERVICESFROM VOCREHABPATIENTSEMPLOYEDFULL-TIMEORPART_TIMEPATIENTSATTENDINGSCHOOLFULL TIMESHIFTAFTER 5PM112760 18 0 0 0 N112761 53 1 26 3 Y112762 41 0 8 1 N112763 7 1 2 0 N112765 21 0 0 0 N112766 18 0 0 0 N112767 5 0 2 1 N112768 12 0 0 0 N112769 10 2 1 0 Y112770 14 0 0 0 N112771 26 0 3 0 N112772 13 0 0 0 N112773 22 0 4 1 N112774 20 1 8 3 N112775 37 1 2 2 N112776 8 0 1 0 N112777 16 1 2 1 N112778 25 0 0 0 Y112779 22 1 9 1 N112780 1 0 0 0 N112781 19 0 0 0 N112782 16 2 9 0 N112783 6 0 3 2 N112784 29 0 4 0 N112785 16 0 0 0 Y112786 5 1 1 1 N112788 37 2 10 2 N112789 13 0 0 0 N112790 14 0 1 1 N112791 14 0 3 0 N112792 13 0 1 1 N112793 21 1 5 1 N112794 11 0 0 1 N112795 8 0 0 0 N112796 18 0 3 0 N112797 31 0 7 1 N112798 22 0 2 0 N112799 5 0 1 0 N112800 12 0 4 0 N112801 31 0 15 6 NP a g e | 149

DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATIONVOCATIONAL REHABILITATIONBEGINNING THROUGH END OF SURVEY PERIOD 2011FACILITIESREPORTINGAGED 18THROUGH 54(as of Dec 31)PATIENTSRECEIVINGSERVICESFROM VOCREHABPATIENTSEMPLOYEDFULL-TIMEORPART_TIMEPATIENTSATTENDINGSCHOOLFULL TIMESHIFTAFTER 5PM112802 5 0 1 0 N112803 45 2 9 2 N112804 7 0 0 0 N112805 8 0 2 0 N112806 18 0 0 0 N112807 12 0 0 0 N112808 0 0 0 0 N112809 11 0 0 0 N112810 25 2 6 2 N112811 7 0 0 0 N112812 4 0 0 0 N112813 29 0 2 1 N112814 5 0 0 0 N112815 3 0 0 0 N112816 4 0 0 0 N112817 8 0 0 1 N112818 6 0 0 0 N112819 10 0 1 0 N112820 8 0 6 0 N112821 16 3 9 0 N112822 3 0 0 0 N112823 44 0 0 0 N112824 113 4 35 6 N112825 6 0 1 0 N112826 51 0 7 3 N112827 13 0 0 0 N112828 28 0 3 0 N112829 17 2 2 1 N112830 14 0 0 0 N112831 13 0 0 0 N112832 10 0 1 0 N112833 11 0 1 0 N112834 6 0 1 0 N112835 8 1 3 2 N112836 19 0 8 1 N112837 8 0 0 0 N112838 9 0 3 0 N112839 14 3 2 1 N112840 4 0 0 0 N112841 11 0 1 0 NP a g e | 150

DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATIONVOCATIONAL REHABILITATIONBEGINNING THROUGH END OF SURVEY PERIOD 2011FACILITIESREPORTINGAGED 18THROUGH 54(as of Dec 31)PATIENTSRECEIVINGSERVICESFROM VOCREHABPATIENTSEMPLOYEDFULL-TIMEORPART_TIMEPATIENTSATTENDINGSCHOOLFULL TIMESHIFTAFTER 5PM112842 17 1 13 2 N112843 2 0 0 0 N112844 11 0 1 0 N112845 1 0 0 0 N112846 0 0 0 0 N113300 6 0 0 0 N113500 12 0 0 0 N113501 11 0 3 0 N113502 11 0 0 1 N113504 19 0 1 0 NGEORGIASTATETOTAL6,072 137 974 208NORTHCAROLINA340030 0 0 0 0 N340040 0 0 0 0 N340047 0 0 0 0 N340061 0 0 0 0 N340064 13 0 2 1 N340113 1 0 0 0 N34012F 9 0 0 0 N34013F 8 0 3 0 N34014F 11 0 1 0 N342502 74 0 16 2 Y342503 80 13 16 7 Y342504 83 2 21 9 N342505 99 3 32 7 N342506 78 0 0 0 Y342507 55 1 3 0 N342509 34 0 3 0 N342510 84 0 22 0 N342511 56 0 0 0 N342512 99 5 26 3 N342513 68 0 17 5 N342514 65 0 11 4 N342515 39 0 8 1 N342516 45 7 10 0 N342517 65 2 11 2 N342518 30 1 5 0 NP a g e | 151

DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATIONVOCATIONAL REHABILITATIONBEGINNING THROUGH END OF SURVEY PERIOD 2011FACILITIESREPORTINGAGED 18THROUGH 54(as of Dec 31)PATIENTSRECEIVINGSERVICESFROM VOCREHABPATIENTSEMPLOYEDFULL-TIMEORPART_TIMEPATIENTSATTENDINGSCHOOLFULL TIMESHIFTAFTER 5PM342520 15 0 0 0 N342521 12 0 1 0 N342522 89 12 48 8 N342523 15 0 5 1 N342524 36 0 10 3 N342525 14 1 4 0 N342526 38 0 1 1 N342527 30 0 6 2 N342528 39 1 5 1 N342529 33 0 0 0 N342531 61 0 0 0 N342532 49 4 3 3 N342533 51 0 8 2 N342534 19 0 4 0 N342535 12 2 3 1 N342536 24 1 5 1 N342537 57 1 1 3 N342538 15 0 0 0 N342539 30 0 0 0 N342540 32 0 2 0 N342541 16 0 0 0 N342542 43 3 2 4 N342543 54 3 11 2 N342544 30 0 7 1 Y342545 16 0 0 1 N342546 37 0 5 2 N342547 15 0 0 2 N342548 74 3 30 4 N342549 38 0 0 0 N342550 38 1 14 1 N342551 19 0 4 0 N342552 26 1 10 1 N342553 32 1 4 0 N342554 36 0 0 0 N342555 28 0 0 0 Y342556 17 0 7 1 N342557 32 0 3 0 N342558 14 0 0 0 Y342559 32 3 3 1 N342560 18 0 1 0 NP a g e | 152

DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATIONVOCATIONAL REHABILITATIONBEGINNING THROUGH END OF SURVEY PERIOD 2011FACILITIESREPORTINGAGED 18THROUGH 54(as of Dec 31)PATIENTSRECEIVINGSERVICESFROM VOCREHABPATIENTSEMPLOYEDFULL-TIMEORPART_TIMEPATIENTSATTENDINGSCHOOLFULL TIMESHIFTAFTER 5PM342561 23 1 1 3 N342562 37 0 5 0 N342563 29 1 2 1 N342564 15 0 0 0 N342565 23 0 1 0 N342566 31 0 0 0 N342567 34 1 9 1 N342568 19 0 0 0 N342569 34 0 4 2 N342570 28 1 2 1 N342571 29 3 5 0 N342572 28 0 0 0 N342573 6 1 3 0 N342576 6 0 1 0 N342577 31 5 1 2 N342578 16 0 0 0 N342579 29 0 5 0 N342581 34 0 0 0 N342582 23 17 23 4 N342583 25 0 1 1 N342584 16 0 4 0 N342585 31 0 0 0 N342586 10 1 0 0 N342587 26 2 4 1 N342588 12 0 4 1 N342589 31 0 4 0 Y342590 26 5 11 2 N342591 50 1 18 4 N342592 43 0 3 3 N342593 44 2 1 2 N342594 57 0 12 1 Y342595 15 0 4 1 N342596 64 1 3 3 N342597 7 0 0 0 N342598 6 0 2 0 N342599 27 0 2 2 N342600 25 1 1 3 N342601 38 0 0 0 Y342602 28 0 4 0 N342603 32 0 8 2 NP a g e | 153

DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATIONVOCATIONAL REHABILITATIONBEGINNING THROUGH END OF SURVEY PERIOD 2011FACILITIESREPORTINGAGED 18THROUGH 54(as of Dec 31)PATIENTSRECEIVINGSERVICESFROM VOCREHABPATIENTSEMPLOYEDFULL-TIMEORPART_TIMEPATIENTSATTENDINGSCHOOLFULL TIMESHIFTAFTER 5PM342604 7 0 2 0 Y342605 38 0 11 2 N342606 22 0 0 0 N342607 13 0 0 0 N342608 23 0 5 0 N342609 24 0 5 11 N342610 23 1 4 0 N342611 12 0 0 0 N342612 47 0 19 11 N342613 22 0 8 2 N342614 8 0 1 0 N342615 25 0 8 0 Y342616 44 5 12 6 Y342617 2 0 0 0 N342618 12 0 1 0 N342619 12 1 1 1 N342620 57 0 4 2 N342621 18 0 0 0 N342622 68 5 13 2 N342623 18 1 1 1 N342624 7 0 1 0 N342625 7 0 0 0 N342626 3 0 0 0 N342627 33 0 0 0 N342628 16 0 2 0 N342629 10 1 2 0 N342630 10 0 3 1 N342631 19 2 0 1 N342632 11 0 2 2 N342633 3 0 0 0 N342634 38 0 0 0 N342635 24 2 3 0 N342636 22 2 3 1 N342637 25 0 3 2 N342638 14 0 0 0 N342639 19 0 3 0 N342640 17 0 3 1 N342641 13 0 4 0 N342642 34 0 10 1 N342643 39 0 4 4 NP a g e | 154

DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATIONVOCATIONAL REHABILITATIONBEGINNING THROUGH END OF SURVEY PERIOD 2011FACILITIESREPORTINGAGED 18THROUGH 54(as of Dec 31)PATIENTSRECEIVINGSERVICESFROM VOCREHABPATIENTSEMPLOYEDFULL-TIMEORPART_TIMEPATIENTSATTENDINGSCHOOLFULL TIMESHIFTAFTER 5PM342644 8 0 2 0 N342645 18 1 1 0 N342646 47 6 22 2 N342647 17 0 1 0 N342648 17 0 1 0 N342649 3 0 0 0 N342650 8 0 4 1 N342651 8 0 5 0 Y342652 8 0 0 0 N342653 19 0 0 0 N342654 9 1 6 0 N342655 5 2 1 1 N342656 2 0 1 0 N342657 8 1 0 0 N342658 8 0 1 0 N342659 8 1 0 1 N342660 8 0 1 0 N342661 11 0 0 0 N342662 11 0 0 1 N342663 38 0 13 1 N342664 8 0 0 0 N342665 12 0 1 0 N342666 4 0 0 0 N342667 32 0 1 4 N342668 0 0 0 0 N342669 6 0 0 1 N342670 19 0 4 2 N342671 25 0 4 0 N342672 9 0 4 0 N342673 7 0 1 0 N342674 11 0 6 1 N342675 17 0 1 1 N342676 17 0 0 0 N342677 7 0 0 0 N342678 9 0 4 1 N342679 8 0 0 0 N342680 8 1 1 0 N342681 15 0 11 0 N342682 11 0 1 0 N342683 14 0 4 0 NP a g e | 155

DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATIONVOCATIONAL REHABILITATIONBEGINNING THROUGH END OF SURVEY PERIOD 2011FACILITIESREPORTINGAGED 18THROUGH 54(as of Dec 31)PATIENTSRECEIVINGSERVICESFROM VOCREHABPATIENTSEMPLOYEDFULL-TIMEORPART_TIMEPATIENTSATTENDINGSCHOOLFULL TIMESHIFTAFTER 5PM342684 1 0 0 0 N342686 0 0 0 0 N343504 28 5 12 8 NNORTHCAROLINASTATETOTAL4,858 152 814 203SOUTHCAROLINA420004 0 0 0 0 N42011F 4 0 2 1 N42029F 3 0 1 1 N422503 61 0 8 1 Y422504 56 0 2 0 N422505 34 0 0 0 N422506 45 1 23 4 N422508 36 0 0 1 N422509 27 0 8 0 N422510 74 0 7 6 N422511 33 3 5 3 N422512 37 1 6 1 N422513 40 0 11 0 N422514 26 0 1 0 N422515 46 1 3 0 N422516 19 5 2 0 N422517 23 0 5 2 N422518 17 0 1 0 N422519 29 0 0 0 N422520 28 2 3 0 N422521 23 1 3 1 N422522 56 0 12 4 N422524 22 0 1 1 N422527 13 0 1 0 N422528 27 0 4 3 N422529 34 1 3 0 N422530 16 0 1 0 N422531 10 0 0 0 N422532 24 2 0 2 N422533 22 0 3 0 N422534 12 0 0 0 NP a g e | 156

DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATIONVOCATIONAL REHABILITATIONBEGINNING THROUGH END OF SURVEY PERIOD 2011FACILITIESREPORTINGAGED 18THROUGH 54(as of Dec 31)PATIENTSRECEIVINGSERVICESFROM VOCREHABPATIENTSEMPLOYEDFULL-TIMEORPART_TIMEPATIENTSATTENDINGSCHOOLFULL TIMESHIFTAFTER 5PM422535 12 0 1 0 N422536 18 0 0 0 N422537 14 0 0 0 N422538 38 0 5 2 N422539 22 0 3 1 N422540 63 0 0 0 N422541 15 0 3 1 N422542 10 2 1 0 N422543 24 2 1 0 N422545 36 0 0 0 N422546 39 0 0 0 Y422547 10 0 0 0 N422548 8 0 0 0 N422549 27 0 3 0 N422550 25 1 5 0 N422552 17 0 2 2 N422553 33 4 6 0 N422556 15 6 2 0 N422557 14 0 2 1 N422560 39 1 8 0 N422563 52 2 12 3 N422564 23 2 8 1 N422565 17 1 2 0 N422566 15 0 1 0 N422567 38 2 0 0 Y422568 14 0 0 0 N422569 12 0 6 0 N422570 18 0 5 0 N422571 10 0 1 1 N422572 24 0 5 1 N422573 7 0 0 1 N422574 61 14 21 4 N422575 51 0 9 1 N422576 32 0 2 1 N422577 5 2 2 0 N422578 32 0 0 1 N422579 20 0 3 1 N422580 15 0 0 1 N422581 16 0 0 0 N422582 26 1 7 1 NP a g e | 157

DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATIONVOCATIONAL REHABILITATIONBEGINNING THROUGH END OF SURVEY PERIOD 2011FACILITIESREPORTINGAGED 18THROUGH 54(as of Dec 31)PATIENTSRECEIVINGSERVICESFROM VOCREHABPATIENTSEMPLOYEDFULL-TIMEORPART_TIMEPATIENTSATTENDINGSCHOOLFULL TIMESHIFTAFTER 5PM422584 28 0 0 0 N422585 24 0 0 0 N422586 22 0 3 2 N422587 14 1 6 0 N422588 0 0 0 0 N422589 22 4 1 1 N422590 13 0 3 0 N422591 33 0 0 0 N422592 9 0 2 0 N422593 14 0 2 0 N422594 30 0 2 0 N422596 10 0 1 2 N422597 13 1 1 2 N422598 18 0 5 0 N422599 14 0 0 0 N422600 11 0 4 1 N422601 21 0 3 2 N422602 8 0 0 0 N422603 17 0 0 0 N422604 32 1 4 0 N422605 10 0 0 0 N422606 18 0 3 1 N422607 29 6 1 0 N422608 24 0 18 2 N422609 12 0 0 0 N422610 13 0 5 0 N422611 28 0 0 0 N422612 23 0 5 1 N422613 21 0 0 0 N422614 25 1 2 1 N422615 11 0 0 1 N422616 11 0 2 1 N422617 22 0 3 0 N422618 9 0 0 0 N422619 13 0 1 0 N422620 22 0 5 0 N422621 15 0 0 0 N422622 5 0 2 0 N422623 14 0 1 0 N422624 6 0 0 0 NP a g e | 158

DATA TABLE 8: NETWORK 6 VOCATIONAL REHABILITATIONVOCATIONAL REHABILITATIONBEGINNING THROUGH END OF SURVEY PERIOD 2011FACILITIESREPORTINGAGED 18THROUGH 54(as of Dec 31)PATIENTSRECEIVINGSERVICESFROM VOCREHABPATIENTSEMPLOYEDFULL-TIMEORPART_TIMEPATIENTSATTENDINGSCHOOLFULL TIMESHIFTAFTER 5PM422625 10 0 0 0 N422626 8 0 0 0 N422627 43 0 0 0 N422628 19 4 3 2 N422629 12 1 3 1 N422630 6 0 0 0 N422631 0 0 0 0 NSOUTHCAROLINATotal2,646 76 333 75NetworkTotal13,576 365 2,121 486P a g e | 159

P a g e | 160