Volume 4 Ed. 7 | September 2020
HSAG End Stage Renal Disease (ESRD)
Network Updates
Role of The Network: Committees and Becoming a Member 

Health Service Advisory Group (HSAG): ESRD Networks 7, 13, 15, and 17 strive to improve the delivery and quality of care provided to patients with ESRD. Renal professionals from within the healthcare and business communities play a key role in this success by serving on our boards and committees. The Network uses the services of professional and patient volunteers who serve on its Corporate Governing Body (CGB), Medical Review Board (MRB), Patient Advisory Committee (PAC), and Network Council (NC). The roles and purposes of these groups are periodically reassessed to ensure that they continue to meet current needs.

The Network is always looking for potential candidates who have demonstrated a commitment to or an interest in improving the quality and experience of care for people dealing with the complex chronic healthcare disease known as ESRD. Candidates may include individuals from within the renal community (e.g., patients of any modality, transplant recipients, caregivers/care partners, administrators, nephrologists, general surgeons with expertise in hemodialysis [HD]/peritoneal dialysis [PD] access placement, transplant surgeons, nephrology nurses, transplant nurses, social workers, registered dietitians, and patient care technicians), as well as business leaders interested in healthcare performance improvement activities. Candidates should reside and/or practice within the Network’s service area.

The involvement of patient subject matter experts or Patient SMEs serving on each of these boards and committees is also vital to the success of Network activities and to improving the quality of care and life for patients with ESRD. There are at least two Patient SMEs serving on each of these boards and committees. The PAC is comprised of a minimum of 15 patients with ESRD from each dialysis modality (in-center, home, and peritoneal), caregivers, and transplant recipients. The members represent the ethnic diversity and geographic distribution of the Network’s service area. These members are essential in incorporating the patient voice into all activities.

Providers interested in volunteering for Network boards and/or committees are encouraged to notify the Network directly. If your facility has identified a patient or caregiver who is interested in volunteering with the Network, we ask that the facility social worker assist them with contacting the Network’s Patient Services Department. Vacancies and term limits vary depending upon the existing board or committee membership.
Patient Services
Medicare Part D: Benefits and Enrollment

Open enrollment for Medicare Advantage and Medicare Prescription Drug Coverage is October 15–December 7, 2020.

What can patients do?
  • Change from Original Medicare to a Medicare Advantage Plan.
  • Change from a Medicare Advantage Plan back to Original Medicare.
  • Switch Medicare Advantage Plans.
  • Join a Medicare Prescription Drug Plan.
  • Switch from one Medicare drug plan to another Medicare drug plan.
  • Drop their Medicare prescription drug coverage completely.

How does coverage for prescription drugs work?
  • Once you become eligible for Medicare based on ESRD, your first opportunity to join a Medicare drug plan will be during the 7month period that begins 3 months before the month you are eligible for Medicare and ends 3 months after the first month you are eligible for Medicare. 
  • Your prescription drug coverage will start the same time your Medicare coverage begins, or the first month after you make your request, whichever is later.
  • Medicare Part B covers transplant drugs after a covered transplant, and most of the drugs you get for dialysis. However, Part B does not cover prescription drugs for other health conditions you may have, like high blood pressure. Medicare offers prescription drug coverage (Part D) to help you with the costs of your drugs not covered by Part B. 

When can patients apply for Part D?You can apply when you are first eligible for Medicare or during open enrollment.

Including Patients in QAPI During the COVID-19 Pandemic 

It is an unusual time. Dialysis continues as before, but with more demands, including wearing extra (hot) layers of personal protective gear, masks that make it hard to communicate among each other and with our patients, and the added stress and worry of not knowing if we will ever be or feel safe again. Both staff and patients worry about contracting Coronavirus 2019 (COVID-19) and bringing it home to possibly spread to others.

Enlisting patient input is an excellent way to better understand how staff are communicating with patients and what improvements could be made to keep everyone safe. Patients spend a lot of time sitting in their dialysis chairs observing treatment operations and listening to what is going on around them. The facility can incorporate their perspective by:
  • Reviewing the Nothing About Me Without Me resource.
  • This resource outlines the steps a facility can take to incorporate patients and families into the Quality Assurance and Performance Improvement (QAPI) Program or governing body in a way that promotes the patient’s voice in facility activities.
  • Inviting patients to attend the QAPI meeting via phone or other electronic platform, like Zoom or Facetime.
  • Asking patients for feedback on any issues prior to the meeting, and then bringing the feedback and their ideas to the QAPI meeting.
  • Patients can use this QAPI Patient and Family Meeting Notes tool to organize their thoughts and give it to staff prior to the meeting.
  • It is important that the facility staff circle back with the patient(s) and describe how things went during the QAPI meeting so that they feel appreciated and part of the process.
Clinical Topics
Smoking CessationIncreased Focus During COVID-19

On May 11, 2020, the World Health Organization (WHO) released a statement on Tobacco Use and COVID-19: https://www.who.int/news-room/detail/11-05-2020-who-statement-tobacco-use-and-covid-19. The statement identifies COVID-19 as an infectious disease that primarily attacks the lungs. Considering that tobacco smoking is a known risk factor for respiratory infections, smokers are more likely to develop severe disease with COVID-19 as compared to non-smokers. This is a great reason to quit! The WHO recommends that smokers take immediate steps to quit by using toll-free quit lines, mobile text-messaging programs, and nicotine replacement therapies.  

Available Resources
The National Cancer Institute (NCI) in partnership with the U.S. Department of Health and Human Services (HHS) and the National Institutes of Health (NIH) created a website, Smokefree.gov, to reduce smoking rates in the United States. The website provides information and resources for those who want to quit, or to help others quit smoking. There are tools and tips, answers to frequently asked questions, and information geared toward specific populations, including teens, women, people age 60+, Spanish speakers, and military veterans. They also have included a spotlight on COVID-19 and associated resources. For more information, visit the website at https://smokefree.gov/quit-smoking/smoking-and-covid19.
Diabetic Foot Checks

According to the Centers for Disease Control and Prevention (CDC), approximately 1 in 3 adults with diabetes has chronic kidney disease (CKD). So, diabetic foot checks should be a priority for dialysis personnel. This could be accomplished during physician/physician extender rounding on a monthly basis. Patient education regarding diabetes control and management is an important component to prevent limb amputation. Make sure you are talking to your patients about the following information:

  • Checking blood sugars and taking prescribed insulin, if ordered.
  • Keeping their hemoglobin A1C level below 7.0.
  • Encouraging those who smoke to stop or get assistance. Nicotine is a vasoconstrictor and reduces the amount of blood flow to extremities.
  • Checking their feet every day for signs of redness; blisters; cuts; skin breakdown; black spots; and swellingthey can use a mirror to check the soles of their feet.
  • Wearing shoes and socks, even in the house.

The CDC has a resource page, Diabetes and Your Feet, that discusses nerve damage, tips for healthy feet, and when to see a doctor. More resources are available at the websites below.

Sources:
Vaccinations (Influenza, Pneumococcal Pneumonia) During the COVID-19 Era

According to the CDC, vaccinations should not be delayed during the COVID-19 global pandemic. It is more important than ever to educate patients that getting a flu shot is one of the best strategies to prevent illness, disease, and hospitalization, during the flu season. Review the CDC handout, titled Addressing Common Questions about Influenza Vaccination for Adults, with your patients to better inform them about the seasonal flu vaccine. Additional guidance about vaccinations during the COVID-19 pandemic can be found on the CDC website at https://www.cdc.gov/vaccines/pandemic-guidance/index.html.

Vaccination for pneumococcal pneumonia is just as important as the annual flu shot. COVID-19 affects your respiratory system, so prevention of pneumonia and hospitalization is a top priority. Educating patients about the two pneumococcal vaccines (i.e., 13-Valent Pneumococcal Conjugate Vaccine [PCV13] and/or the 23-Valent Pneumococcal Polysaccharide Vaccine [PPSV23]) and having them available for patients at the dialysis unit will assure they are protected during this COVID-19 pandemic. 
Data Management
Important CROWNWeb Deadlines

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 United States and its territories. The CMS-2728 Form is completed and submitted directly to CMS via CROWNWeb. The CMS-2728 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 January 1, 2020, the CMS-2728 Form should be submitted by January 11, 2020, and would be considered late after February 15, 2020. The original signed CMS-2728 is provided to the Social Security Administration (SSA) by the dialysis facility if the patient is applying for ESRD Medicare benefits.

Additionally, the CMS-2746 ESRD Death Notification Form is completed when a patient dies. The CMS-2746 Form is due in CROWNWeb within 14 days of the patient’s date of death. Copies of the printed and signed CMS-2728 and CMS-2746 forms should be kept in the patient’s medical record. Required CROWNWeb deadlines are available in the Data Management Guidelines.
ESRD Quality Incentive Program (QIP) One-Stop Shop 

ESRD facilities now have a one-stop shop to access QIP information. The new QualityNet website allows facilities to view, download, and use the following ESRD QIP resources, information and tools:

Sign up to receive QIP email notifications or go directly to the Notifications section of the QualityNet website to stay informed about everything QIP related.
National Healthcare Safety Network (NHSN) Enrollment

Dialysis Event information, which includes positive blood cultures, intravenous antimicrobial starts, and signs of vascular access infection must be entered in NHSN. 
Here are links to assist you with accurate reporting:

Communication Updates, NHSN news, and developments can be found at https://www.cdc.gov/nhsn/commup/index.html. Contact the NHSN Helpdesk at nhsn@cdc.gov with subject line “Dialysis” if you have any questions.
Dialysis Facility Compare (DFC)

Did you know that CMS created the Dialysis Facility Compare (DFC) as a resource for patients and families to compare all Medicare-certified facilities? The website compares the services and quality of care, and provides resources related to dialysis and chronic kidney disease. It also hosts links with details on how people with ESRD are covered by Medicare. You may explore the DFC website here.

A resource for patients and their families titled, DFC Patient Education Handout, was created through a collaboration between the ESRD Networks, the National Forum of ESRD Networks and CMS. The resource is available in English and Spanish to assist patients and their families with a better understanding of how to use the DFC website. The resource includes step-by-step instructions on how to navigate the website to compare dialysis facilities in their area. Please print the resource and share it with your patients, staff and community partners. 
Upcoming Events
  • The American Society of Nephrology (ASN) has been presenting a series of COVID-19 webinars and podcasts. To view previously recorded webinars and slides, or podcasts, visit the ASN webinars website.
  • The HSAG Networks invite all dialysis facilities and transplant centers to attend the National Coordinating Centers’ COVID-19 Webinar Events. For a calendar of events and registration, visit the NCC webpage.    
  • The CDC’s Keep Learning with Emergency Partners Information Connection (EPIC) conference calls and webinars can be found at its website
Important Links
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UNOS
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.
This material was prepared by HSAG: ESRD Network 7, 13, 15, and 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: FL-ESRD-7G091-09032020-01