January 23, 2017
     
 
Do You Know?
ESRD Facilities Receive Coverage and Payment For AKI
Beginning January 1, 2017, End Stage Renal Disease (ESRD) facilities are able to furnish dialysis services to acute kidney injury (AKI) patients. The provision allows for Medicare coverage and payment to both hospital based and freestanding ESRD facilites for renal dialysis services furnished to beneficiaries with AKI.  Medicare will pay ESRD faciliteis for the dialysis treatment using the ESRD Prospective Payment System (PPS) base rate adjusted by the wage index.  In addition to the dialysis treatment, the ESRD PPS base rate pays ESRD facilities for the items and services that are renal dialysis services and there will be no separate payment for those services.  Specifically, this includes renal dialysis drugs, biologicals, laboratory services, and supplies that are included int he ESRD PPS base rate when furnished by an ESRD facility to an individual with AKI.

Drugs, biologicals, laboratory services, and supplies that ESRD facilities are certified to furnish, but that are neither ESRD renal dialysis services, nor AKI-related dialysis services may be paid for separately when furnished to individuals with AKI 
 
This regulation pertains to coverage and payment only.  AKI patients should not be entered in the CROWNWeb system which is currently the National  ESRD Patient Registry.  CMS decisions have not yet been made regarding how AKI patient data will be obtained from the ESRD dialysis facility.

Interested in Joining or Nominating Someone for a Technical Expert Panel?
ESRD Patient-Reported Outcomes (PRO) Technical Expert Panel

The University of Michigan Kidney Epidemiology and Cost Center (UM-KECC), through its contract with CMS, will convene a technical expert panel (TEP) to evaluate and make recommendations regarding the development of patient-reported outcome (PRO) measures.

TEP members will:
(1) review the current "quality of life and recovery time" measure concepts; 
(2) provide recommendations on their potential development; and
(3) review and provide recommendations on the Patient-Reported Outcome Measurement Information System (PROMIS) and potentially other PRO measures or measure concepts identified by the TEP. 

The TEP nomination period closes on  February 10, 2017. Please submit all nomination materials by the closing date.

Click here for The TEP Charter and Nomination form.  For more information, please visit cms.gov
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Emergency Preparedness & Alerts
Is Your Facility Ready?
Don't Let a Natural Disaster Keep Patients from Treatment
Many dialysis patients depend on public transportation to get to and from dialysis treatment. However, public transportation may be limited during a disaster situation; patients may be forced to either delay dialysis or skip treatment, putting their health at risk; or they may have to go to a hospital for treatment. This Kidney Community Emergency Response (KCER) Coalition study takes a look at the barriers and possible solutions to the transportation needs of dialysis patients during a natural disaster or major community emergency.
 

Click here to continue reading the full article in KCER Watch .
 
Alerts and Recalls

 Please visit http://kcercoalition.com/en/alerts-recalls/ for up-to-date alerts and recalls.


 
Data Management
Pain Assessment Reporting Due in CROWNWeb  by February 1, 2017
Conditions covering the second six months of the performance period (July 1, 2016-December 31, 2016) must be reported in CROWNWeb before February 1, 2017. Conditions include:
  1. Pain assessment using a standardized tool documented as positive and a follow-up plan is documented
  2. Pain assessment documented as positive, a follow-up plan is not documented, and the facility possesses documentation that the patient is not eligible
  3. Pain assessment documented as positive using a standardized tool, a follow-up plan is not documented, and no reason is given
  4. Pain assessment using a standardized tool documented as negative, and no follow-up plan required
  5. No documentation of pain assessment, and the facility possesses documentation that the patient is not eligible for a pain assessment using a standardized tool
  6. No documentation of pain assessment, and no reason is given 
Reporting Exclusions Criteria:
  • Patients who are younger than 18 years
  • Patients treated at the facility for fewer than 90 days
  • Facilities with a CCN open date after July 1, 2016
  • Facilities treating fewer than 11 qualifying patients during the performance period
If you have any questions about the reporting requirement, please contact Jaya Bhargava, PhD, CPHQ, Operations Manager at the Network.
Dialysis Event Surveillance Training
At least one staff member at every dialysis facility must  complete Dialysis Event Surveillance protocol training for the National Healthcare Safety Network (NHSN) on an annual basis. Please complete the training as soon as possible.  

The Network will track each facility's completion of the training and will contact leadership at those facilities that do not complete  this CDC requirement.


If you have any questions, please contact Krystle Gonzalez, Sr. Data Coordinator.
Use the Network Data Knowledge Base and Customer Portal
With the increase in data that must be submitted, as well as systems through which the data is collected, there are multiple ways in which you can reach the Network Data Support Team for help. 
*Please remember that you should NEVER include any patient-specific information such as Name, Date of Birth, Social Security Number, Medicare Claim Number, etc. The only patient identifier that can safely be communicated is the Unique Patient Identifier (UPI) from CROWNWeb.*
 
Educational Webinars
Patient Experience
Patient & Provider Engagement: Continuing the Discussion, Answering Your Questions

January 25, 2017, 2:00 PM ET
Click here to register.

The National Forum of ESRD Networks is continuing its Patient Experience Webinar series with Webinar #4, which focuses on two topics that received the most comments and questions:
  • Breaking down barriers to engaging professionals, administration and patients
  • How to get started: Peer Mentoring & Patient Advocacy
CDC Safe Healthcare Practices
 
Tune in to Safe Healthcare: Reducing Infection in the Outpatient Dialysis Facility - Results of the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative

January 31, 2017, 3:00 PM ET
Click here to register
 
CDC, in collaboration with other clinical partners, presents the webinar series,  Tune in to Safe Healthcare.   This series highlights a variety of infection control and prevention topics and features CDC external experts.  A valuable tool for educating healthcare providers on best practices to improve patient safety, these webinars are offered free of charge and provide opportunities to earn continuing education credits.  
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Quality Improvement Activities (QIAs)
Evaluate and Resolve Grievances QIA

The Network will soon launch a campaign to draw attention to the importance of establishing an effective and efficient grievance process that allows patients to feel comfortable sharing their interpersonal, operational, and environmental concerns with facility staff. As part of our efforts,  the Network has created resources and tools aimed at improving patient and provider communications with a proactive approach to prevent grievances before they occur.
This activity will focus on:
  • Improving utilization of the grievance process
  • Classifying and ranking grievances based on area of concern
  • Decreasing facility's average score  
Please contact the QIA lead, Brittney Jackson, LMSW, MBA, Patient Services Director with any questions about this project.
In Center Hemodialysis-Consumer Assessment Healthcare Providers and Systems (ICH CAHPS) QIA

Beginning in 2014, administration of the ICH CAHPS survey has been required at all dialysis facilities that served 30 or more eligible patients in the prior calendar year. The purpose of the ICH CAHPS survey is to gain facility- specific data on patient satisfaction and experience of care. Data is then used by CMS as a measure in the ESRD QIP (Quality Incentive Program), which means that a portion of facility reimbursement is related in part to these scores.

The Network is developing a quality improvement project aimed at improving communication between patients and staff, and improving scores on the ICH CHAPS survey for questions 10-18. In order to achieve this goal, the Network will work with targeted facilities to promote processes that are designed to create a systematic method for identifying and including patient-driven goals in patients' care plans. 

Please contact the QIA lead, Brittney Jackson, LMSW, MBA, Patient Services Director, with any questions about this project.
Vaccinations QIA: Hepatitis B and Pneumococcal Pneumonia

The Network is working with a group of facilities to increase rates of pneumococcal pneumonia and hepatitis B vaccinations at the facility level.  Facilities will be provided with root cause analysis (RCA) templates that the Network will review with the project lead to develop a Plan Do Study Act (PDSA) Plan for improving rates of pneumococcal pneumonia and hepatitis B vaccinations.  
  
Participating facilities are required to increase their vaccination rates by a minimum of three percent for both types of vaccinations by August 2017. Facilities that do not reach a minimum vaccination rate of 60% will be required to continue to participate in the project during the next calendar year (2018).

Please contact the QIA lead, Brittney Jackson, LMSW, MBA, Patient Services Director, with any questions about this project.

Improving your Transplant Coordination QIA 

The Network will be working with facilities on Population Health Focused Pilot Project (PHFPP) to increase the frequency of transplant coordination.  This project will focus on improving transplant referrals while decreasing an identified disparity.  The disparity identified with the Network's service area is based on gender, specifically females with ESRD.
 
Target facilities will be notified by email of their participation January 31.
 
Please contact the QIA lead, Sarah Keehner, RN, BSN, Quality Improvement Director with any questions about this project.
Healthcare Associated Infections (HAI) Bloodstream Infections (BSI) QIA
 
The Network will also be working with a group of facilities to reduce the rates of dialysis events (DE). This activity will focus on healthcare associated infections (HAIs), more specifically bloodstream infections (BSIs) that are classified as a dialysis event per the National Health and Safety Network (NHSN).  

The project will be conducted from January through September 2017.  
 
This project will include performing audits in participating facilities, identifying a root cause for facility infections, and implementing a plan to address the root cause using resources from the Centers for Disease Control and Prevention (CDC).
 
Please contact the QIA lead, Sarah Keehner, RN, BSN, Quality Improvement Director with any questions about this project.
Quality Incentive Program (QIP) QIA

Network staff will soon begin implementing activities to support improvement on two clinical measures for the ESRD QIP performance year 2017, payment year 2019.  The Network has identified a group of facilities that have the potential to achieve improvement on performance scores related to the hypercalcemia and Kt/V clinical measures.  

Target facilities will be notified by email of their participation in this QIA no later than January 31. 
 
Please contact the QIA lead, Sarah Keehner, RN, BSN, Quality Improvement Director, with any questions about this project.

Vascular Access (VA) Long-Term Catheter (LTC) Reduction QIA

Network staff is launching the long-term catheter (LTC) QIA, with a goal to reduce LTC in use rates from January through August 2017. Facilities with a greater than 10% LTC rate as of September 2016 are required to participate in this QIA.

Two quality goals have been set for dialysis facilities to achieve during the quality improvement activity (QIA) period :                                                              
  • Each hemodialysis facility's LTC rate should be less than or equal to 10% (Network QIA Focus)
  • Each hemodialysis facility's AVF rate should be equal to or greater than 68%
Target facilities have already been notified of their participation in this QIA. . 
 
Please contact the QIA lead, Sarah Keehner, RN, BSN , Quality Improvement Director, with any questions about this project.

National Healthcare Safety Network (NHSN) Data Quality QIA

Previous data quality evaluation activities performed by the CDC, ESRD Networks, and others have identified a substantial gap in reporting of blood stream infection (BSI) by dialysis facilities.  Dialysis facilities are frequently unaware of patient BSIs, because the infections are diagnosed after the patient is admitted to a hospital. Insufficient information transfer from hospitals to outpatient dialysis facilities is a concern for both surveillance of BSIs and quality of care for patients.

The Network is conducting a QIA with three cohorts of facilities, with a goal to increase facility reporting of BSIs that are identified within one calendar day following a dialysis patient's hospital admission. For each cohort, the QIA includes one year of planning followed by one year of implementation, and up to three years of monitoring results.

Target facilities have already been notified of their participation in this QIA.  

Please contact the QIA lead, Jaya Bargava, PhD, CPHQ, Operations Director, with any questions about this project


IPRO End-Stage Renal Disease Network of New England, the ESRD Organization for Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont, prepared this material under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. CMS Contract Number: HHSM-500-2016-00019C.