ESRD Networks: past, present, and challenges for the future.

Established by Federal law in 1978, the ESRD Networks are regional nonprofit organizations that contract with the Centers for Medicare and Medicaid Services to provide quality oversight services to chronic dialysis facilities. The governing bodies and medical review boards of each network are populated by volunteer professionals and patients. The medical review boards drive the quality agenda for each network, addressing specific local barriers to improvement. The network contract deliverables are defined by the Centers for Medicare and Medicaid Services in a scope of work document (SOW) that is generally revised with each 3-year contracting cycle. The current SOW has not been revised since the implementation of the new Conditions for Coverage for dialysis facilities in 2008 or the implementation of a bundled payment system and quality incentive program for dialysis providers in 2011. The future success of the ESRD Network Program will depend upon adequate funding, data accessibility to drive rapid-cycle quality improvement efforts, and partnerships with other stakeholder groups to address the continuum of care of patients with CKD. The Forum of ESRD Networks has developed a strategic plan that aligns the priorities of the networks with the National Quality Strategy. The integration of these objectives into the next SOW will augment the relevance of the network program to the ESRD stakeholder community as the networks move from a task-oriented approach to a system-improvement approach to quality oversight.