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PITTSBURGH OFFICE CLOSING

As you may know, it has been a very tumultuous time for the staff in our Pittsburgh office for nearly a full year. Since the creation of the ESRD Network program in 1977, the staff of ESRD Network 4 has served the renal communities of Pennsylvania and Delaware to ensure quality care for individuals receiving renal replacement therapy. On June 15, 2012, Centers for Medicare & Medicaid Services (CMS) announced that nine ESRD Network contracts would be competed, including Network 4. After submitting several proposals and revisions, TRN was informed on April 10th that the Network 4 contract was awarded to Quality Insights Renal Network (QIRN).

Please make a note that the Network 4 office located in Pittsburgh will be closing. The Network 4 contract will be managed by QIRN effective June 10, 2013 at their location:

QUALITY INSIGHTS RENAL NETWORK 4
630 Freedom Business Center, Suite 116, King of Prussia, PA 19406

We recommend that you do not mail or fax anything to the Pittsburgh office location after Friday, May 24, 2013. The fax machines and telecommunication equipment need to be properly boxed for transport to King of Prussia, Pennsylvania. The patient-only toll free number for Network 4 (1-800-548-9205) will continue to be supported throughout and beyond this transition period. You will receive information from QIRN regarding staff and contact information in the near future.

During the transition, we wish to celebrate several notable achievements. Utilizing a peer-review model, a collegial approach, and a multitude of volunteers on the Board of Trustees, Medical Review Board, Patient Advisory Committee and other committees, we accomplished:

We thank you for your dedicated service and hope we will work together again one day.

With Warm Regards -- The Staff of TRN: ESRD Network 4 in Pittsburgh

NAME	TITLE	YEARS OF SERVICE
Judi Persichetti, BA	Office Manager	35.5
Rhonda Lockett	Data Operations Director	33.1
Debra Tarrant	Secretary	15.2
Laura Kanchy	Information Specialist	14.4
Shane Perry	Project Director	14.3
David Moskovitz, RN, BA	Quality Improvement Coordinator	12.4
Amanda Topeck	Patient Services Operational Coordinator	10.7
Albert Dean Morris, MSSA, LSW	Patient Services Director	9.7
Suzanne M. Kirschbaum, RN, CNN	Quality Improvement Director	6.5
Bonnie Freshly, MEd, CMP	Community Outreach Director	0.9
Jeff Rohay, PhD, MSIS	Director of Information Services and Statistical Analysis	0.7

Patient Resources

We encourage patients to be well informed on their treatment options. You should also be aware of other things that affect your quality of life. Consult the resources listed on this page, and don't be afraid to ask your health care team questions about your care. The more involved you are in managing your condition, the better you will feel.

There are many resources available to patients searching for information and services related to kidney disease. The list below is just a handful of items we have selected. This should not be thought of being complete. Try using an Internet search engine to find information on subjects that interest you.

Looking for a Dialysis Unit?

There are several internet based search engines that may help you find a dialysis unit. Click one of the links below. If you are in need of services, you will need to make arrangements with the unit. The Network does not have the power to force any unit or physician to treat any individual. Your involvement in your care is a critical component to ensure you have access to the quality care you should have.

Patient Rights and Responsibilities

ESRD Network #4 presents this statement of patient rights and responsibilities, an important part of a patient's care, with the expectation that observance of them will contribute to more effective care and greater satisfaction for both patients and facility personnel without regard to sex, cultural, economic, educational, religious background, sexual orientation, or to the source of payment for his/her care. Network #4 serves Pennsylvania and Delaware.

RESPECT, PRIVACY AND CONFIDENTIALITY

Rights: It is your right to be treated with respect, dignity, and consideration of your rights as an individual by everyone involved in your care; and, to have as much privacy in treatment as possible. Case discussion, consultation, examination and treatment are confidential and should be conducted in a manner, which protects these rights for you.

It is your right to expect all communications and records of your care to be treated as confidential. You may approve or refuse to release your records to any individual outside the facility, except if you transfer to another health care institution, or as required by federal, state, or local laws.

Responsibilities: It is your responsibility to treat the staff with the same respect and individual consideration as you expect for yourself. This includes the responsibility to be honest and direct about everything that relates to you as a patient, to respect the personal rights and private property of other patients, and see that your visitors are considerate as well.

INFORMATION, EDUCATION, AND COUNSELING

Rights: It is your right to be told, in terms, which you can understand, all about your disease and its treatment. This includes diagnosis, medical procedures, tests to be done, equipment to be used, your progress, your future prospects, the risks involved, and the treatment choices and locations where treatment is available. You also have the right to know the person responsible for the procedures and/or treatment. It is your right to seek your own nephrologist and treatment facility and to participate in the planning of your medical care.

You have the right to education on the various treatment choices, including hemodialysis, peritoneal dialysis (CAPD/CCPD), and transplantation. However, be advised that not everyone is a suitable candidate for every treatment method; but those who are not have the right to be told by their physician why they are not.

You have the right to assistance which deals with specific problems or special needs that include (but are not limited to) blindness, hearing loss, language barrier, limited mental capacity, financial restrictions, etc., that may limit your ability to comprehend your condition or carry out your treatment plan.

It is your right to have access to qualified social work and dietary counseling.

Responsibilities: It is your responsibility to understand the nature and treatment of your kidney disease to the best of your ability. An important part of the success of the treatment plan is your understanding of your health problems. You should help make and carry out the prescribed treatment program as much as you can. You are encouraged to ask questions of staff members to obtain further instruction if you do not understand or are unable to follow your treatment plan. Following your treatment plan closely can directly affect how you feel.

It is your responsibility to contact the staff about any medical, psychological, social, dietary, or financial problem with which you want assistance.

INFORMED CONSENT, TRANSFER, AND REFUSAL OF TREATMENT

Rights: It is your right to receive information necessary for you to give "informed consent" prior to any new procedure or treatment (meaning that you agree to things only after you understand them).

It is your right to be transferred or discharged only for medical reasons, for your own welfare, for the welfare of other patients, or for willful nonpayment of services provided to you (except as prohibited by the Social Security Act). You must be given reasonable advance notice of any transfer or discharge except in the case of an emergency as determined by the professional staff.

It is your right to refuse to allow a staff member undergoing training to provide treatment unless a competent and fully trained staff member is present and directly supervising the trainee.

It is your right to refuse treatment to the extent permitted by law, and to be informed of the medical consequences of your actions. (In other words, most patients can refuse treatments, but they need to know that doing so can bring about great harm and even death in certain circumstances).

Documents called "advance directives" can protect your right to refuse or limit future medical treatment if you ever become unable to communicate your wishes. This is done by writing them down ahead of time using documents such as Living Wills and Medical Durable Powers of Attorney. Ask your treatment facility staff about information on "advance directives" if you are interested.

Responsibilities: It is your responsibility to decide whether or not the information you get from your caregivers is enough for you to feel comfortable in agreeing to undergo new procedures.

If you transfer to a new facility, it is your responsibility to secure the services of a nephrologist to provide your medical management at that facility.

It is your responsibility to notify the medical staff if you intend to not follow your prescribed medical treatment plan.

It is your responsibility to understand what will happen if you do not follow your treatment plan and to explain your reasons for your refusal to the medical staff. Also, you must sign any forms required by the facility to document your actions.

If you have chosen to use "advance directives" (Living Will or Medical Durable Power of Attorney), it is your responsibility to furnish your facility with complete, current documents.

KNOWLEDGE OF FACILITY SERVICES

Rights: It is your right to be dialyzed at the hours most convenient and desirable to you, as the facility schedule permits. Furthermore, it is your right to expect the facility to provide treatment at your regularly scheduled times, except in unusual circumstances.

It is your right to receive, upon request, information about facilities available to visiting patients and to receive assistance in arranging for dialysis when you plan to travel away from home.

It is your right to know all costs of your care, including costs for any consultants, if used, and to have access to individuals who know about Medicare and other potential sources of financial assistance, and to be told about charges for services not covered by Medicare or other insurance.

Responsibilities: It is your responsibility to make every effort to keep all scheduled appointments and dialysis treatments and to be on time. If an appointment needs to be canceled or delayed, a call to the unit should be made in advance. You should recognize the possibility of having to reschedule if you are late.

It is your responsibility, when dialyzing away from your usual facility, to plan your travel far enough in advance that arrangements can be made. You will need to confirm financial arrangements. Medical information should be available to the visited facility and medical reports should be sent back to your "home" facility. When dialyzing away you have a particular responsibility for being knowledgeable about care and treatment, to ensure you receive appropriate care.

It is your responsibility to know the costs of treatment and provide accurate and complete information about your Medicare eligibility and other necessary financial matters. You are responsible for payment of all services provided to you and you should be aware of those services covered by insurance and those for which you must pay yourself. If you have any change in insurance coverage, it is your responsibility to immediately notify your facility.

EMERGENCY CARE

Rights: It is your right to expect emergency medical care to be available at all times and to be given to you without unnecessary delay.

It is your right to be told exactly what to do and/or whom to call by your physician or other caregiver, in case of medical emergencies such as access bleeding, clotting, or other situations which may happen for which there may be some advance action plan (fire, power outage, low water pressure, natural disasters, etc.)

Responsibilities: It is your responsibility to recognize what constitutes an emergency and what actions you, or someone acting on your behalf, need to take to appropriately deal with the emergency situation.

GRIEVANCE MECHANISM

Rights: If you feel that there is a problem with the care you receive or arrangements you have at your facility, then it is your right to try to correct the situation by talking to the staff to voice a complaint or to suggest changes in policies or services. It is your right to do that, or have someone else do it in your behalf, without fear of punishment or negative actions toward you. If, after talking to the appropriate facility personnel the problem still continues, you may file a formal complaint called a grievance with the facility, which is required by law to have a Grievance Procedure to help resolve the matter. If that process is not satisfactory to you (and the problem pertains to a quality of medical care issue) you can contact ESRD Network #4 for further information and/or assistance, which might include filing a formal grievance with the Network. Upon request your name can be held confidential.

Responsibilities: It is your responsibility to know and to follow your facility's posted rules and regulations. If a problem arises for you we suggest that you try to settle any disagreements informally with the appropriate personnel. If the problem cannot be solved in that way, it is your responsibility to know the proper Grievance Procedure in your treatment center and we then suggest that you use that procedure. If, at that point, the grievance remains unresolved and pertains to a quality of care issue, you are encouraged to use the ESRD Network #4 Grievance Protocol. You may contact the Network by writing ESRD Network #4, 40 24th Street, Suite 410, Pittsburgh, PA 15222 or by calling the following toll-free phone number: 1-800-548-9205.

A FINAL WORD TO PATIENTS

Please remember that you have choices. As a dialysis patient, you have both rights and responsibilities. Under Federal rules and regulation, all Medicare-approved dialysis treatment centers must have written policies regarding the rights and responsibilities of patients in their care. These policies should be given to you when you begin treatment at the dialysis unit.

If you have any questions or concerns about these rights and responsibilities or the policies issued by your dialysis center, speak with your doctor or the staff members of the dialysis unit (nurse manager, social worker, and administrator).

Derechos Y Responsabilidades Del Paciente

Network 4 (La Red #4) presenta esta declaración de derechos y responsabilidades, una parte importante del cuidado del paciente. Hay la expectación que la observancia de los derechos y las responsabilidades contribuyan en forma más efectiva al cuidado y mayor satisfacción de los pacientes y el personal de la clínica sin importar sexo, cultura, educación, religión, orientación sexual, o estado económico o resursos monetarios para pagar por el cuidado del paciente. Network 4 (La Red #4) sirve a los residentes de Pennsylvania y Delaware.

RESPETO, PRIVACIDAD, Y CONFIDENCIALIDAD

Derechos: Tiene el derecho de ser tratado con respeto, dignidad, y en consideración de sus derechos como individuo por todos que lo atiendan; y de ser tratado en privado durante su tratamiento. Discusión de caso, consoltas, exámenes y tratamiento son confidenciales y deben ser conducidos en una manera que protejen estos derechos.

Tiene el derecho de saber que toda comunicación y los datos de su cuidado sean tratados confidencialmente. Puede aprobar o declinar que su expediente sea proveido a cualquiera persona fuera de la clínica, excepto si usted se translada a otra institución de tratamiento o que sea requerido por las leyes federales, estatales, o locales.

Responsabilidades: Es su responsabilidad de tratar al personal con el mismo respeto y consideración que espera para usted misno. Esto incluye la responsabilidad de ser honesto y directo acerca de todo lo que se relaciona con usted como paciente, de respetar los derechos personales y propiedad privada de otros pacientes, y asegurar que sus visitantes traten a otros igualmente.

INFORMACIÓN, EDUCACIÓN, Y SERVICIOS CONSEJALES

Derechos: Es su derecho que se le diga en terminología que usted pueda entender todo lo que se relaciona a su enfermedad y su tratamiento. Esto incluye diagnóstico, procedimientos médicos, exámenes que se le hagan, equipo utilizado, su progreso, su futuro médico, los riesgos que puedan ocurrir, y los distintos tratamientos y lugares adonde se tratamiento pueda llevarse a cabo. Es su derecho de conocer la persona que es responsable hacer los procedimientos y/o el tratamiento. Es su derecho de escoger su nefrólogo y el lugar donde quiera recibir su tratamiento y de participar en planear su cuidado médico.

Tiene el derecho de recibir educación sobre los varios tratamientos incluyendo hemodiálisis, diàlisis peritoneal (CAPD/CCPD), y transplante de órganos. Sin embargo, se le advierte que no todos pueden ser candidatos para todo tipo de tratamiento; pero la persona que no califique tiene el derecho de que su médico le de una explicación.

Es su derecho que se le asista con problemas específicos o necesidades especiales que incluyen (pero no se limita) ceguera, pérdida de oir, comunicación de idioma, limitaciones financieras, etc., que puedan limitar su abilidad para entender su condición o llevar a cabo su tratamiento.

Tiene el derecho de servicios de trabajador social y de consultas dietarias.

Responsabilidades: Es su responsabilidad de entender su enfermedad y el tratamiento de su enfermedad renal. Una parte importante para tener éxito con su tratamiento es que usted enienda bien sus problemas de salud. Debe involucrarse lo más posible en su tratamiento prescrito. Asi cumple con su tratamiento en forma directa como se siente. Debe hacer preguntas al personal para obtener más instrucciones si no entiende o no puede seguir el plan de su tratamiento.

Es su responsabilidad de comunicarse con el personal acerca de problemas medicales, emocionales, sociales, dietarios o financieros cuando necesite asistencia o ayuda.

CONSENTIMIENTO INFORMADO, TRANSLADACIÓN Y REHUSAR DE TRATAMIENTO

Derechos: Es su derecho de recibir la información necesaria para que de "consentimiento informado" antes de recibir angún tratamiento o procedimiento muevo (esto quiere decir que usted está de acuerdo con acciones solamente si usted las entiende).

Es su derecho de ser transferido o terminado de servicios solo por razones médicas, para su bienestar, para el bienestar de otros pacientes, o por falta intencionada de pago de los servicios proveidos a usted (menos cuando sea prohibido por la ley de Seguro Social). Se le debe dar suficiente noticia antes du su translada o terminación de servicios o dado de alta, excepto en caso de emergencia que sea determinada por el personal profesional.

Es su derecho de rehusar tratamiento por personal que esté en entrenamiento, salvo que esté supervisado por un miembro completamente entrenado del personal y que este supervisor esté presente dirijiendolo directamente.

Es su derecho do rehusar tratamiento hasta el punto permitido por la ley, y ser informado de las consecuencias médicas por su acción. (En otras palabras, la mayoría de los pacientes pueden rehusar tratamiento, pero necesitan saber que su decisión le puede causar gran daño incluyendo la muerte en ciertas circunstancias.)

Documentos llamados "directivas anticipadas" pueden proteger su derecho de rehusar o limitar el tratamiento médico en el futuro, si usted llega al punto de no poder comunicar sus deseos. Esto se hace por escrito adelantemente usando documentos como Ponder de Cuidado de Salud y Testamiento en Vivo. Si se interesa, pregunte al personal de la clínica por información sobre "directivas anticipadas".

Responsabilidades: Es su responsabilidad a decidir si la información proveida por el personal que lo cuida es suficiente para que se sienta cómodo de someter a nuevos procedimientos.

Si se traslada a uno clínica nueva, es su responsabilidad de obtener los servicios de un nefrólogo que maneje sus servicios médicos en esa clínica.

Es su responsabilidad de notificar al personal de la clínica si no intenta seguir el plan de tratamiento recetado para usted.

Es su responsabilidad entender que pueda pasarle si no sigue el plan de tratamiento y de expresar sus razones de rehuso al personal de la clínica. También, debe firmar las formas requeridas por la clínica para documentar sus acciones.

Si usted ha escogido usar "directivas anticipadas", (el Poder de Cuidado de Salud o Testamiento en Vivo), es su responsabilidad de proveer a la clínica una copia de sus documentos completos.

CONOCIMIENTO DE SERVICIOS DE CLÍNICA

Derechos: Es su derecho recibir diálisis a las horas más convenientes y deseables para usted, siempre que el horario de la clínica le provea tratamiento en forma regular a la hora establecida, excepto en circunstancias imprevistas.

Es su derecho de recibir, si lo pide, información cerca de facilidades que son disponibles para recibir pacientes que están visitando, y de recibir ayuda para arreglar los tratamientos de diálisis cuando hay oportunidad de viajar fuera de su casa.

Es su derecho de saber todo el costo de su cuidado, incluyendo el costo de consultas especiales y de tener acceso a personas que sepan de Medicare y otras posibilidades de asistencia monetaria, y de habérsele dicho de cargos por servicios que no están cubiertos por Medicare u otro seguro.

Responsabilidades: Es su responsabilidad hacer todo lo posible para mantener el horario de sus citas de diálisis y llegar a tiempo. Si alguna cita necesita ser cancelada o demorada, una llamada a la clínica debe hacerse con anticipación. Debe reconocer la posibilidad de tener que obtener otra cita si llega tarde.

Es su responsabilidad, cuando se vaya a dializar fuera de su clínica regular, de planear su viaje con tiempo para que los arreglos se puedan hacer con anticipación. Usted necesitará los arreglos monetarios. Información médica debe ser proveida a la clínica regular. Cuando está dializandose fuera de su clínica regular, tiene la responsabilidad especial de estar familiarizado con su cuido y tratamiento para asegurarse de recibir el tratamiento propio.

Es su responsabilidad saber el costo de su tratamiento y de proveer información correcta y completa de su elegibilidad de Medicare y otra elegibilidad monetaria. Es responsable para pagar todos los servicios proveidos y debe de estar enterado de los servicios que están cubiertos por seguros y los que tenga que pagar usted. Si tiene cualquier cambio en su aseguranza, es su responsabilidad de notificar a su clínica inmediatamente.

SERVICIOS DE EMERGENCIA

Derechos: Es su derecho de poder recibir cuidados de emergencia médica disponible a todos tiempos sin demora irracionalmente.

Es su derecho que su médico (o la persona que le esté cuidando) le diga que hacer o a quien llamar en caso de emergencia médica, como sangrar de la fístula, coagularse u otros situaciones que sucedan las cuales hayan un plan de acción (en caso de fuego, pérdida de electricidad, baja presión de agua desastres naturales, etc.).

Responsabilidades: Es su responsabilidad reconocer lo que constituye una emergencia y la acción que usted debe tomar, o quien esté actuando por usted, para que se maneje la emergencia apropiamente.

MECANISMO PARA QUEJAS

Derechos: Si cree que hay un problema con su cuidado o con los arreglos que se han hecho para usted en la clínica, tiene el derecho de tratar de corregir la situación hablando con el personal o sugiriendo cambios en polizas o servicios. Tiene el derecho de hacer eso, o que alguien lo haga en su nombre, sin tener miedo de que sea juzgado en contra de usted. Si después de hablar con el personal apropiado su problema continua, puede someter una queja formal con la clínica. Por ley las clénicas son requeridas de tener ciertas reglas para resolver problemas.

Si ese proceso no es satisfactorio para usted (y el problema es relacionado con la calidad de servicio médico), puedo comunicarse con La Red (Network #4) para más información o ayuda con su queja, lo cual quizas requiera una queja formal con la Red. Si usted lo pide, su nombre puede ser mantenido en forma confidencial.

Responsabilidades: Es su responsabilidad saber y seguir las reglas y regulaciones promulgadas por su clínica. Si algún problema surge le gugerimos que intente resolverlo informalmente con el personal. Si el problema no se resuelve de esa manera, entonces es su responsabilidad saber los propios pasos de seguir con su clínica y le animamos que use ese proceso mencionado. Si al hacerlo su queja continua sin resolverse y es directamente relacionada con su tratamiento, use la Red (Network #4) para poner su queja. Puede hacerlo escribiendo a ESRD Network 4, 40 24th Street, Suite 410, Pittsburgh, PA 15222, o llame al 1-800-548-9205.

UNA PALABRA FINAL A LOS PACIENTES

Por favor recuerde que tiene opciones. Como un paciente de diálisis, usted tiene ambos derechos y responsabilidades. Bajo reglas y regulaciones federales, todas las clínicas de tratamiento de diálisis que son aprobadas por Medicare tienen que tener pólizas encritas cobre los derechos y las responsabilidades de los pacientes bajo del cuidado de ellos. Estas pólizas se le deben dar a usted cuando usted empieza a recibir su tratamiento en la clínica de diálisis.

Si tiene algunas preguntas o algunos asuntos sobre estos derechos y estas responsabilidades o las pólizas de su clínica de diálisis, hable con su médico o el personal de su clínica de diálisis (enfermero manejero, trabajador social, y administrador).

DISASTER PREPAREDNESS AND RESPONSE

It is important to be aware that disasters can take on many forms and can strike at any time. Although nothing can prepare us for every possible problem, we should all do our best to be as prepared as we can be. This page offers resources and information on preparing for emergencies.

As emergencies occur, you may have questions or may be in need of information. Please review this information, and if you have any questions you should contact the Network office: (412) 325-2250.

Emergency Plans and Resources

1.) To encourage provider preparedness for an emergency/disaster, the Network will:

2.) During an emergency/disaster the Network will:

3.) To ensure maximum preparedness for an emergency/disaster, the provider will:

4.) During an emergnecy/disaster the provider MUST:

Crush Injuries Can Be Deceptively Dangerous

by Madison Park, CNN -- http://www.cnn.com/2010/HEALTH/01/21/haiti.rhabdomyolysis.crush.injury/?hpt=C1
January 21, 2010 2:25 p.m. EST
This article explains how crush injuries to muscle tissue affect your kidneys.

"Where can a patient get assistance in obtaining dialysis services?"

There are several dialysis corporations that are known to provide dialysis services to over 80 percent of the overall dialysis patient population. Each organization has emergency procedures in place to assist patients in obtaining dialysis services and can often assist with locating transportation services for dialysis, obtaining dialysis supplies, and obtaining renal medications. It is advisable that patients contact the organization where their traditional facility was affiliated because they will be able to access information from their medical record. However, if a patient is unsure of the affiliation, or was receiving services from an independent facility, they can contact any organization and will receive the same level of service.

There are also several community and federal based organizations that may help as well.

READY.GOV website

This is an excellent government website and provides a number of pages and resources to help you plan for emergencies of all types:

KCER is Available to Help!

Network 4 is a member of the national Kidney Community Emergency Response Coalition (KCER) which was established to provider technical assistance to ESRD Networks, CMS organizations, and other groups to ensure timely and efficient emergency preparedness, response, and recovery. Refter to their website www.kcercoalition.com for tools and resources.

Medicare Publication -- "Preparing for Emergencies: A Guide for People on Dialysis"

Medicare Publication -- Preparing for Emergencies: A Guide for People on Dialysis (external link, format: PDF, size: 144 kb)

The hyperlink above will take you to a Medicare publication located outside the Network's website. Please let us know if the link doesn't work. Like what the title says, this is a guide for people on dailysis.

Pandemic Flu Preparedness

It is critical that we all consider the impact that a Pandemic Flu Outbreak may have on our patient population. The following links contain information from the CDC and from the state Departments of Health for Pennsylvania and Delaware.