How to make the new conditions for coverage work in your dialysis clinic: Teaching self-management: new conditions emphasize patient participation in care.

The new Conditions for Coverage1 clearly establish the importance of patients directing and participating in their own dialysis care. First, the Conditions mandate the establishment of an interdisciplinary team (IDT) with the “patient, or the patient’s designee” as a participating member. (§ 494.80). Next, the Conditions place responsibility for patient assessment (§ 494.80) and patient care planning (§ 494.90) squarely on the shoulders of that team. This strong emphasis on the patient’s role as a member of the IDT, and as an active participant in care, can be found throughout the new Conditions. It reflects CMS’ stated intention in revising the Conditions to move toward “a more patient-centered, outcome-oriented approach...” (pg. 20371). “One of the fundamental principles that guided us,” the Conditions writers note, was to “stress patient satisfaction and ongoing patient involvement in the development of the care plan and treatment” (pg. 20371). The Interpretive Guidance (IG)2 goes a step further by requiring facilities to promote patient participation. Not only do “patients have the right to know about and participate in their care and treatment to the extent that they desire,” (V456) the “facility must encourage patient participation in care planning” (V456).