Involuntary Discharge (IVD)

An involuntary discharge is a discharge initiated by the treating dialysis facility without the patient’s agreement.

Involuntary Transfer (IVT)

An involuntary transfer occurs when the transferring facility temporarily or permanently closes due to a merger, or due to an emergency or disaster situation, or due to other circumstances, and the patient is dissatisfied with the transfer to another facility.

Failure to Place

A failure to place is defined as a situation in which no outpatient dialysis facility can be located that will accept an ESRD patient for routine dialysis treatment.

Patient Services Department

Chanell McCain, MSW
Patient Services Director
Main Line: 919-463-4523

Vanessa Talley
Community Outreach Coordinator
Main Line: 919-463-4529


Working with the ESRD Patient

The Network has resources for healthcare providers to assist in clinical practice and to deal with difficult situations. If you are having difficulty placing a patient in an outpatient dialysis facility, your first resource is Medicare's Dialysis Facility Compare to search and compare dialysis facilities in the United States and Territories. If you are still having issues placing patients in outpatient dialysis facilities, please contact Network Staff to discuss options and potential interventions for overcoming barriers to placement.

Resources for Difficult Situations

If provider staff is dealing with a situation that they feel may warrant a patient's involuntary discharge (IVD) or transfer (IVT), please be aware that the Network and State Department of Health MUST be notified when ANY notice of termination or transfer is given to a patient.

IVD/IVT places patients at extreme risk and should be considered ONLY as a last resort. IVDs and IVTs are tracked by the Network and reported to CMS monthly. In addition, patients who do not have a Health Care Proxy or Emergency Contact Person are also considered at-risk.  In many cases, we have found that early interventions have prevented discharge and we urge facility staff to identify patients who are at risk early and to contact the Network's Patient Services department for assistance.

Helpful Resources:
Decreasing Patient Provider Conflict: DPC Toolkit
Dialysis Patient Grievance Toolkit  (English|Spanish)
 Addressing Threats 
 Dialysis Facility Discharge Guidelines