Introduction

Comprehensive Kidney Care Contracting (CKCC) is a new CMS program intended to improve outcomes for CKD patients while cutting costs to deliver the care needed. This type of revenue share payment model increases financial risk to practices caring for these patients. The CKCC case management module is intended to aid practices by improving visibility and tracking of CKCC patients.

Highlights

• Create visibility by creating a CKCC case in the Case Management section of Patient Setup
• Active enrolled CKCC patients will display the new blue kidney icon in the patient header
• Inactive CKCC patients will display a grayed out kidney icon (inactive occurs when a CKCC patient is set to a status other than enrolled)
• The kidney icon hover text allows users to see CKCC notes, CKCC status, and CKCC Custom Practice Group field entries
• Add CKCC specific notes, where the most recent note entry displays when hovering over kidney icon
• Create up to 4 custom practice groups with custom drop-down lists for more robust tracking and sharing of CKCC information (these 4 items display when hovering over kidney icon)
• Report export allows practices to generate an excel export detailing pertinent CKCC patient details for CMS and/or other third parties
• This new module is designed with consideration to allow future capabilities where practices can receive and consume digital updates that CMS may provide on patient statuses. 

First Steps to enable CKCC for your practice:  

1. Open the EMR, access any patient account and open the Patient Setup screen, then click on the Window Settings icon
2. Choose Setup
3. Choose Miscellaneous
4. Search/Select CKCC Status a
5. Set Selection to CKCC Status and make sure Usage is check-marked, then Save

There are some additional custom practice defined lists to configure, but it is important to understand how your practice will use these CKCC features before configuring these 4 optional - but permanent - practice lists. The reason is that once the list is created, it cannot be deleted (only disabled). This is necessary to preserve historically associated patient data. It is best practice to configure these optional list(s) after a thorough internal review to make determinations on how you are best served utilizing these 4 available custom lists.

CKCC Case Management  

1. Open the EMR, access any patient account and open the Patient Setup screen (Patient Index Card), then choose Case Management
2. Choose New icon

-- Incomplete - will be updated soon

Visibility of CKCC Patients

 Practices engaging with CKCC patients need to take extra care to ensure all aspects of patient care are considered, therefore, visibility of these contracted patients is essential for practitioners and ancillary medical staff. Only after a patient has the CKCC module added under their Case Management area of the Patient's Setup will any of the following visibility items display, as follows:

Blue Kidney Icon - Active CKCC Enrolled Patient

Grayed Out Kidney Icon - Previously Enrolled but no longer active CKCC patient for various reasons

Kidney Icon Hover Text - helpful information that is customized by the practice

Mobile Visibility of CKCC Patients

 Practices engaging with patients using OfficeEMR mobile can now see the CKCC icon carried over onto our mobile display where accessing patients on Rounds and Dialysis schedules, the red kidney indicator is set up to display when a patient is actively enrolled in the CKCC program. When viewing from your practice Schedule, you can see the Kidney icon in the patient header based on the patients CKCC status. This release is expected during the 23.11 release cycle.

CKCC Practice Defined Options:

To give practices some flexibility on visibility and tracking fields, we have included 4 practice-defined drop down list items that can be created for practice tracking related to CKCC. For example, a practice could set up one of the 4 fields to have a list of Dialysis Locations, or a Disease Level (e.g., CKD 3, CKD 4, etc.). Setting up these Practice Defined fields is as shown below.

Important Note: You only have 4 user defined drop-down lists that can be created, and it is important to understand how your practice will use these CKCC features before configuring these 4 optional - but permanent - practice lists. The reason is that once the list is created, it cannot be deleted (only disabled). This is necessary to preserve historically associated patient data. 

It is best practice to configure these optional list(s) after a thorough internal review to make determinations on how your practice is best served utilizing these 4 available custom lists. If, in the future, you decide they are no longer needed in the future, they must be inactivated but cannot be deleted to preserve historical data. When you are ready to proceed, the steps to build these custom lists is noted below. Consider building only 1 list to begin with, and reserve the remaining 3 lists for future use (after you have had an opportunity to use the CKCC module, you will likely determine the best use case for your practice workflows). 

1. Access the Setup portal
2. Choose CKCC Groups under the new CKCC Setup header
3. Select new icon to add your first practice CKCC practice-defined Group Description label for a new drop-down list to be used in documenting CKCC patients.
4. Input your desired Group Description label name, then save, then check active and save again
5. You should see your new CKCC Group label displayed with a Group ID#, the description you chose, and the Active column should be set to ‘Y’ if you want this accessible to system users.
6. With a CKCC Group Description label created, access CKCC Dropdowns under the CKCC Setup header
7. Use the same series of steps to create your drop-down items to be associated with the CKCC Group Description label you created in step 4, but note for this step you will need to identify the Group Number. Notice how can add your desired list of items to be available in the drop-down list for the specified Group Number.
8. The result of creating the CKCC Group Description label and the CKCC Dropdowns list will be as you see in the image label #8 below
9. Repeat these steps to build each of the Group/Dropdown lists that you need (with a maximum of 4 practice defined lists).

CKCC Essential Fields Report

A CKCC focused connect report that contains fields that can be exported to excel for use with third-party systems and/or CMS. There are no filters for this report, it is building a list of CKCC Case Management patients to provide CKCC status and other details for reporting and submission to third-party vendors. The report fields cover data areas like:

• Patient Chart
• Patient Demographics (general patient demographic and contact fields)
• Patient Case Management details
• Upcoming Appointment (next appointment date, time, type, location, provider)
• Last Appointment (last checked-in or completed appointment date and time)
• Last Claim Rending Provider Details (including Tax ID, NPI, rendering provider, claim date) 
• Dialysis Schedule (Most recent active dialysis schedule including Event Description, Modality, Days, Shift, Location)

Report Example:

You will see all of the data fields included in this image below: