BMM
At what phosphorus level is a binder recommended?
5.5, but earlier/proactive initiation is better when taking into consideration new KDIGO guidelines recommending a phos goal more toward normal range (2.5-4.5)
What % of HTN is fluid Related?
85-90%
How long does the QIP hypercalcemia impact a facility?
1 calendar year even after patient is not at facility it effects the numerator.
Can ONSP be provided per physician order only?
No, the patient is required to have met the criteria of 3.5 or lower
How often is a new FRx KPI report available?
Weekly
At what PTH level on the new CMAB 2.0 algorithm, should vitamin D (hectorol or calcitriol) be initiated?
150
Where can resources be found for staff and patients regarding fluid?
Fluid Management Playbook (either the icon on your desktop or through Clinical Quality on the FMC4me intranet)
How many updates does an Action plan have and how often should it be updated?
3 and every month
Pending insurance coverage, name two companies that will deliver protein supplements to a patients home.
Crosbys, Lincare, Coram
What has to be provided to FRx for a patient to receive medications shipped to the unit?
Signed Agent Designation Form
What is the maximum dose for Calcitriol and Hectorol?
8 for calcitriol, 18 for Hectorol
Name 3 root causes of high IDWG?
Missing treatments, Diet, increased thirst d/t elevated A1C, Shortened treatments, psychosocial issues, Increased sodium intake.
Will a patient with PTH <150 be considered an outlier on eQUIP?
Only if they remain on vitamin D for the month
Name 3 "non-nutritional" causes of hypoalbuminemia
-hospitalizations, fluid overload, missed/shortened tx's, infection/inflammation, advanced age
How often does a BMM assessment need completed on a patient?
Every 90 days, as long as the patient is flagging AND/OR a patient who has hit for Parsabiv de-escalation
At what TSAT level and/or Ferritin level should a physician be consulted when a patient is on Auryxia per the CMAB hyperphosphatemia algorithm 1.0?
TSAT >30%, Ferritin >1000ng/mL
What causes a patient to be in action group 1 on the fluid dashboard?
– Post bp >140 and IDWG >4% of EDW or Post bp >140 and Missed / Shortened Tx’s
What are the 2 key attributes for an Action Plan?
Measurable and achievable
When should the CMAB Recommended Evaluation and Management of Hypoalbuminemia Version 1.0 algorithm be initiated?
When a patients albumin is less than or equal to 3.9
What are the parameters for Parsabiv de-escalation? ie: what % improvement must been achieved in what timeframe, for the drug to NOT be considered "futile use"?
30% improvement within 90 days of initiation
What MUST be completed in the FERA/P&T system for an appeal to be considered?
The additional comments section (in addition to the prompts above the additional comments section)
How often should the Fluid Dashboard be addressed?
Weekly
What are the 3 components of an Action Plan?
Findings (summary of outliers), Goals (analysis of findings/ root cause), and Actions Planned/Time Frame/Person Responsible
How many steps are there in the CMAB Recommended Evaluation and Management of Hypoalbuminemia (in center) Version 1.0
8:
-Evaluate for fluid overload
-Evalute for HD adequacy
-Evaluate for Metabolic Acidosis
-Evaluate for Vitamin D 25 (OH) insufficeincy
-Recent hospitalization
-Evaluate for Infection/Inflammation
-RD to evaluate nutritional intake
-finally, Indications for Treatment
What are the "3 pillars" of the new 2022 BMM Incentive Program, and what needs to be completed to avoid your award amount being pro-rated
Quality (Phosphorus and Calcium), reduction of clinically at risk patients (<10% in flag 1 on MM020), and Etecalcetide Review (review of and BMM assessment completion patients flagged for parsabiv de-escalation on MM020).
Must complete 100% of BMM assessment for award to not be pro-rated