ESRD NETWORK 6 2011 ANNUAL REPORT

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