Question Title

* 1. Organization type:

Question Title

* 2. Location of facilities:

Question Title

* 3. Number of dialysis treatments in Q1 (Jan- March) of each of the following years:

Question Title

* 4. How much did your organization pay in labor costs in Q1 (Jan-March) of each of the following years:
[Labor Costs = Gross Salary Expense + Contract Employee Gross Pay + Benefits (insurance, benefits, etc.)]

Question Title

* 5. What was the total of your productive and non-productive (i.e., vacation time, education time) hours plus contract labor hours in Q1 (Jan-March) of each of the following years?

Question Title

* 6. Dialysis Patient Care (nurses and technicians) - Total FTE currently unfilled:

Question Title

* 7. Dialysis Patient Care (nurses and technicians) – Total FTE filled by travel staff:

Question Title

* 8. Have you had to increase your wages since pre-pandemic (2019) in order to keep staff from leaving?

Question Title

* 9. How have staffing challenges impacted your organization? Please share any stories or experiences you’ve had in trying to hire and/or retain staff throughout the PHE.

Question Title

* 10. Please indicate how many aggregation groups received each of the following facility Performance Payment Adjustment scores for performance during MY1 (calendar year 2021):

Question Title

* 11. Under the ESRD Treatment Choices (ETC) Model, an ESRD facility’s home dialysis rate and transplant rate are aggregated to the ESRD facility’s aggregation group for performance assessment. How many aggregation groups currently include facilities from within your organization?

Question Title

* 12. Please indicate how many aggregation groups received each of the following facility Performance Payment Adjustment scores for performance during MY1 (calendar year 2021):

T