Volume 3 Ed. 3| September 2019
In This Issue
  • Network Updates
  • Patient Services and Patient Care
  • Network Quality Improvement Activity (QIA) Highlights
  • Data Management
  • Upcoming Events and Webinars
  • Important Links
  • Network Staff Directory
From the Executive Director
Amazing! We are three quarters of the way through 2019 and the Network projects have come so far! Highlights include the Transplant Coordination Quality Improvement Activity (QIA) facilities adding 223 patients to the transplant waitlist, and the Home Dialysis QIA facilities transitioning 319 in-center hemodialysis patients to a home dialysis modality .

The Network extends its appreciation for all your hard work and collaboration this year. Together we’ve achieved great success with our QIAs and hope to keep the momentum going! We encourage you to visit the Network website at https://www.hsag.com/en/esrd-networks/esrd-network-17/ to find new and exciting resources, including the How I took the Road Home video that can be used to encourage patients to explore home dialysis. The website also includes Learning and Action Network (LAN) best practices and updated patient and family engagement resources. 

Please feel free to contact any of the Network staff regarding comments or questions you may have. 

Helen Rose, MSW, LCSW
Executive Director
Phone: 813.865.3321 | hrose@hsag.com
Network Updates
Role of the Network: Clinical Guidelines and Standards of Care
A primary goal of the Network is to improve the quality of healthcare services provided to end stage renal disease (ESRD) patients. To that end, the Network, with the assistance of the Medical Review Board, annually reviews and updates the Clinical Performance Guidelines and Standards of Care, which provide guidance for dialysis care providers.
Guidelines are developed in partnership with the Centers for Medicare & Medicaid Services (CMS) and clinics in the service area. The Network then uses a federally-mandated Standards of Care rubric to ensure appropriate care and facility requirements and clinical outcome goals are met. This combination of guidelines and standards assists your facility to provide high-quality treatment to all ESRD patients.  

The Clinical Guidelines and Standards of Care are posted on the Network’s website at: https://www.hsag.com/contentassets/341f7f3256594ff482b030a0f1b6fd82/nw17clinicalstandardsofcare508.pdf .
Patient Services and Patient Care
Help Patients With Medicare Part D Benefit Review and Open Enrollment
Understanding Medicare coverage can be confusing for your patients, especially figuring out what treatments and medications are covered by which part. Medicare open enrollment is just around the corner (October 15–December 7, 2019). Take just a few moments to review the available Medicare options with your ESRD patients, especially their Part D benefits, before they have to make their Medicare plan decisions during the open enrollment period.
It is important that your ESRD patients understand that making the right choice is critical; they may not be able to change their insurance plan as easily (or perhaps, not at all) as Medicare beneficiaries who don’t have ESRD. 
Resources to help inform your patients are available. To learn more about Medicare Part D Coverage, how to choose a plan, and where to find more answers, direct patients to  the Medicare website about Part D . For additional information about insurance options for people with ESRD, review the National Kidney Foundation's A to Z Health Guide with patients, or see Medicare.gov for additional questions or information. 
The Importance of the Influenza Vaccination for Patients and Staff
People with ESRD have decreased immunity due to their kidney disease and are, therefore, at higher risk for contracting influenza (the flu) than the general population. Your ESRD patients are also more likely to develop serious complications from the flu, such as infections, dehydration, pneumonia, and even sepsis. Encourage all of your ESRD patients to get the vaccinated.
Then, turn your attention to your facility staff, both for their protection and the protection of your patients. The Advisory Committee on Immunization Practices (ACIP) recommends that all healthcare personnel (HCP) be vaccinated annually against influenza. And, you must report on immunizations for healthcare personnel at the facility-level in the National Healthcare Safety Network (NHSN). The reporting period for immunization of healthcare personnel for the 2019–2020 flu season is 10/1/2019–3/31/2020.
Find out more about Surveillance for Dialysis Healthcare Personnel Vaccination at https://www.cdc.gov/nhsn/dialysis/hcp-vaccination/index.html ; General FAQs and CMS Reporting Requirements at https://www.cdc.gov/nhsn/pdfs/hps-manual/vaccination/General-FAQs.pdf ; and the Centers for Disease Control and Prevention (CDC) vaccination recommendations for dialysis patients in Guidelines for Vaccinating Kidney Dialysis Patients and Patients with Chronic Kidney Disease at https://www.cdc.gov/vaccines/pubs/downloads/dialysis-guide-2012.pdf .
Network Quality Improvement Activity Highlights
Bloodstream Infection (BSI) Reduction: Days Since Last Bloom Poster
The Days Since Last Bloodstream Infection Poster, developed by the CDC, is designed to raise awareness about infections for direct patient care staff, patients, and patient family members. The poster was created to help reduce BSIs by tracking the days that have passed since the last BSI in a clinic. Use the poster to start discussions and provide education about the importance of preventing BSIs.
Locate the CDC Days Since Last Bloodstream Infection Poster at: https://www.cdc.gov/dialysis/coalition/resource.html .

If you are interested in learning more about other tools and resources from the CDC, visit the Making Dialysis Safer for Patients Coaltion (https://www.cdc.gov/dialysis/coalition/index.html) .
Treatment Options and New ESRD Technologies: Transitional Care Units
Transitional care units offer patient-centered, four-week educational programs for all patients initiating dialysis who may be candidates for other treatment modalities. During transitional care, patients learn about all aspects of renal replacement therapy, including modality selection, access information, transplant options, as well as the impact of the nutritional and psychosocial aspects of the disease. This program enables patients to make truly informed decisions regarding their care.
For additional information on transitional care, visit NXStage, Fresenius Medical Care, at: https://www.nxstage.com/administrators/transitional-dialysis-care/
Learning and Action Network Highlight: Transplant Best Practices
The ESRD National Coordination Center (ESRD NCC) has held three QIA Learning and Action Network (LAN) calls on the topic of Transplant in calendar year 2019. During these LAN calls, the following interventions were identified as LAN best practices:
  • Use a transplant tracker to monitor patients through the transplant process.
  • Develop a communication process/relationship with the transplant centers.
  • Refer patients to more than one transplant center.
  • Provide patient education regarding the steps to transplant including details of what to expect at each step.
  • While educating patients, listen to why they are not interested in transplant and talk about their concerns and possible misconceptions.
  • Continue to educate patients at their level of readiness and re-educate existing patients that may not have been ready when educated in the past. 
  • Hold a lobby day that includes peer support and mentorship from a previously transplanted patient.
Mark your calendar to join the ESRD NCC, the Networks, and other ESRD professionals for the upcoming transplant LAN calls on:
  • September 17, 2019
  • November 19, 2019
Find copies of the slides used to support previous LAN discussions, as well as recordings of the events on the ESRD NCC QIA LAN webpage at https://esrdncc.org/en/qia/ .
Data Management
CROWNWeb CMS-2728 and 2746 Forms
The CMS 2728 ESRD Patient Medicare Entitlement and/or Patient Registration form serves as the Medicare enrollment and patient registry form for all ESRD and kidney transplant patients in the U.S. and U.S. territories. The forms are completed and submitted directly to CMS via CROWNWeb and should be submitted within 10 business days, but no later than 45 days from the first chronic treatment at an outpatient dialysis facility. For example, if a patient started chronic dialysis treatments on 1/1/2019, the CMS-2728 form should be submitted by 1/11/2019 and would be considered late after 2/15/2019. The original signed CMS-2728 is provided to the Social Security Administration (SSA) if a patient is applying for ESRD Medicare benefits.
The CMS-2746 ESRD Death Notification form must be completed when a patient passes away. It is due in CROWNWeb within 14 days of a patient’s date of death.
Copies of a patient’s printed and signed CMS-2728 form, as well as the printed CMS-2746 form, as appropriate, should be kept in the patient’s medical record. 
CROWNWeb Clinical Closure Dates
Clinical Months
June 2019
July 2019
August 2019
September 2019
Date for Closure of Clinical Submissions
September 3, 2019 at 11:59 p.m. PT
September 30, 2019 at 11:59 p.m. PT
October 31, 2019 at 11:59 p.m. PT
December 2, 2019 at 11:59 p.m. PT
National Healthcare and Safety Network (NHSN)—Quarterly Data Checks
Upcoming Deadline for NHSN Reporting
Facilities must follow NHSN Dialysis Event Surveillance Protocol and reporting requirements for CY 2019/Payment Year (PY) 2021 for compliance with the ESRD Quality Incentive Program (QIP). The quarterly reporting deadline for April–June 2019 data is on or before September 30, 2019.  
Use this link to review your facility’s NHSN data and compliance with the ESRD QIP: https://www.cdc.gov/nhsn/pdfs/dialysis/3-steps-to-review-de-data-2014.pdf
More assistance and information are available on the NHSN website at https://www.cdc.gov/nhsn/dialysis/index.html , or by emailing NHSN@CDc.gov with “Dialysis” in the subject line .
You can also review all of the ESRD QIP requirements for PY 2021 in the Final Technical Specification document at : https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/Downloads/PY-2021-Final-Technical-Specifications-ESRD.pdf .
CMS provides several resources to ensure you understand and can comply with all of the ESRD QIP requirements. Find what you need to know for CY 2019/PY 2021 in:
  • The ESRD QIP Q&A Tool, which provides immediate answers to commonly asked questions and has a robust search engine that allows users to quickly locate information based on keywords or phrases and provides a convenient summary of relevant answers. There is an overview of the tool in the right-hand “Resources” menu on the ESRD QIP QualityNet home page.
There is also a brief tutorial, found at ESRD QIP Q&A Tool tutorial, that guides users to create an account within the tool, which will enable CMS to communicate directly with them.
Dialysis Facility Compare (DFC)
Dialysis Facility Compare, https://www.medicare.gov/dialysisfacilitycompare/ , is a Medicare website that provides patients and ESRD professionals with information on more than 7,000 dialysis facilities throughout the country. It is a tool that can be used to compare characteristics, services, and performance on quality measures among dialysis facilities.
Facilities have the opportunity to review their performance data before it is posted on DFC via their Quarterly Dialysis Facility Compare (QDFC) Reports on dialysisdata.org during established preview periods. Dialysisdata.org also contains a list of frequently asked questions found at:   https://www.dialysisdata.org/content/faq .
More information on the QDFC report timeline can be found at: https://www.dialysisdata.org/sites/default/files/content/FAQs/Timeline_010419.pdf .
Information on the methodology used for the QDFC reports can be found at: https://www.dialysisdata.org/content/dfcmethodology .
Upcoming Events and Webinars
Reducing Bloodstream Infection LAN Event
Date: September 3, 2019               
Time: Noon–1 p.m. PT
Bay Area Association of Kidney Patients (BAAKP): Kidney Support Group Meeting
Date: September 8, 2019
Time: 1–3 p.m. PT
For more information: http://www.baakp.org/calendar.html
Increasing Rates of Patients Dialysis at Home LAN Event
Date: September 10, 2019
Time: Noon–1 p.m. PT

Increasing Rate of Patients on a Transplant Waitlist LAN Event
Date: September 17, 2019
Time: Noon–1 p.m. PT
Patient Experience of Care (PEOC) LAN Event
Date: September 25, 2019
Time: 11 a.m.–Noon PT
DPC: Diabetes and Kidney Disease
Date: September 26, 2019
Time: 11 a.m.–Noon PT

51st Annual Medical Symposium
Date: September 27, 2019
Time: 8:00 a.m.–4:30 p.m. PT
Location: CROWN Plaza, Foster City, CA

DPC: Decisions You Need to Make About Your Transplant Choice
Date: October 17, 2019
Time: 11 a.m.–Noon PT
Important Links
Please give us your feedback!
As part of our ongoing efforts to give you the information that you need at the time that you need it, we request that you complete this short survey about our Provider eNewsletter.
Find patient transplant resources on the United Network for Organ Sharing (UNOS) website.
Visit the In-Center Hemodialysis Consumer Assessment of Providers and Systems (ICH CAHPS) website for up-to-date information on his important patient survey.
CROWNWeb Online Help
Learn about CROWNWeb and its implementations, resources, terminology, and requirements.
Track bloodstream infections and important healthcare process measures, such as healthcare personnel influenza vaccine status and infection control adherence rates.
Dialysis Facility Compare Compare dialysis facilities based on the quality of patient care they provide.
Patient and Family Engagement
The Network's patient and Family Engagement web page provides resources that will help all participants on the healthcare team to fully engage in the process of care for end stage renal disease (ESRD) patients.
National Coordinating Center (NCC)
The ESRD NCC provides resources for patients and providers that support:
Better care for the individual through beneficiary and family centered care.

Better health for the ESRD population.

Reducing costs of ESRD care by improving care.
Kidney Community Emergency Response (KCER) Program
KCER Provides technical assistance to the kidney community to ensure timely and efficient disaster preparedness, response, and recovery in the event of disaster. 
Network Staff Directory
Helen Rose, MSW, LCSW
Executive Director
Jane Wilson, MSN, RN, CNN, RD
Quality Improvement Director
Beverly Whittet, RN, CDN, CPHQ
Special Projects Director
Anne Pugh, MSW, LCSW
Patient Services Manager
Riquelen Ngumezi, MSW, LCSW
Patient Services Manager
Bonnie Grasso, MSW
Quality Improvement Manager
Robert Peck, RN 
Quality Improvement Manager
Kristine Johnson, RN, MSN
Nephrology Nurse
Rosa Rincon
Data Manager
Melissa Johnson
Project Coordinator
This material was prepared by HSAG: ESRD Network 17, 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. Publication Number: CA-ESRD-17G024-08302019-01