Volume 4 Ed. 5 | March 2020
HSAG ESRD Network COVID-19 Response Activities
The HSAG End Stage Renal Disease (ESRD) Networks are closely monitoring preparedness and response activities related to COVID-19. The Networks are working with the Centers for Medicare & Medicaid Services (CMS) and appropriate stakeholders to bring you the most up-to-date information as timely as possible. The latest updates and resources are below. 

CMS has announced expansion of payment for Medicare and Medicaid Telehealth services to help deal with the COVID-19 pandemic :

The National Consortium of Telehealth Resource Centers will present a webinar, Telehealth and COVID-19 on March 19, 2020. For details and registration: https://www.telehealthresourcecenter.org/event/nctrc-webinar-telehealth-and-covid-19/

SAVE THE DATE: Stakeholder Call, April 7, 2020 : CMS invites you to participate in a series of stakeholder calls focused on information about published guidance and other topics related to the ESRD Quality Incentive Program (QIP). These sessions are intended for key industry leaders and provide a chance to interact with ESRD QIP officials. Our next call is scheduled for Tuesday, April 7, 2020 from 1 to 2 p.m. Eastern Time (ET). Meeting details and an agenda will be sent to participants one week prior to the call.

For the latest COVID-19 information and resources visit : https://www.kcercoalition.com/en/covid-19/

CDC features a COVID-19 FAQ webpage that can answer many questions you may have, a COVID-19 webpage that contains updated information and guidance as they become available, and ways to manage anxiety and stress https://www.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html

Visit your local State Department of Health website for additional local information:

Network 7
Call Center: 1.866.779.6121 Email: COVID-19@flhealth.gov  
Dashboard: COVID-19 dashboard

Network 13
COVID-19 Call Center: 800.803.7847
Outbreak Response: 501.537.8969 (Monday–Friday, 8:00 a.m. to 4:30 p.m.)
800.554.5738 (After hours and weekends)                          
COVID-19 Call Center: 800.256.2748

COVID-19 Call Center: 405.271.4060 or 405.425.4437
Community Hotline: 877.215.8336

Network 15
Call Center: 1.844.542.8201

Call center: 303.389.1687 or 1.877.462.2911

New Mexico: https://cv.nmhealth.org/  
Call center: 1.855.600.3453 
For non-health related COVID-19 questions: 1.855.600.3453 
Call center: 1.844.442.5224

Call center: 307.777.7656 or 866.571.0944

Network 17:

Oahu (Disease Reporting Line)……............................. 808.586.4586
Maui District Health Office............................................ 808.984.8213
Kauai District Health Office........................................... 808.241.3563
Big Island District Health Office (Hilo)........................... 808.933.0912
Big Island District Health Office (Kona)......................... 808.322.4877
After hours on Oahu...................................................... 808.600.3625
After hours on neighbor islands..................................... 800.360.2575 (toll-free)

DPHSS Hotline Numbers for Medical-related questions only: 671.480.7859 or 671.480.6760 or 671.480.6763 or 671.480.7889

Commonwealth of the Northern Mariana Islands (CNMI): https://www.chcc.gov.mp/coronavirusinformation.php
COVID-19 Infolines: 670.285.1542 or 670.285.1672 or 670.285.1352 or 670.285.1854

In This Issue
  • Network Updates
  • Patient Services and Patient Care
  • Clinical Topics
  • Data Management
  • Upcoming Events and Webinars
  • Important Links
  • Network Staff Directory
Network Updates
The Role of the Network in Facilitating Access to Dialysis Care
We must all work together to ensure that every patient with ESRD has access to dialysis care in an outpatient facility. When an ESRD patient, a patient’s family/caregiver, hospital discharge coordinator, and/or dialysis facility notifies the Network about a patient that wants to dialyze in an outpatient facility but cannot find placement, the Network:
  • Determines what the patient and family’s preferences are.
  • Reviews the steps that have already been taken to locate a dialysis facility that will accept the patient.
  • Determines, with the involved parties, if the patient’s medical status is legitimately outside of any facility’s ability to provide treatment in-center or at home.
  • Reviews the reason(s) given by any facility that has refused to admit the patient.
  • Reviews the facilities’ admission policies to make sure they are being followed.
  • Identifies if any dialysis corporation has “locked out” a patient who has a history of noncompliance, behavioral problems, or a history of filing grievances.
  • Reviews the documentation being provided to potential accepting facilities.
  • Communicates as needed with physicians, social workers, or other staff members at the potential treatment facilities until a determination has been made for placement.
  • Provides support, resources, or information to anyone involved in coordinating the placement of a patient.
  • Encourages the patient to self-advocate to a physician or facility.
The Access to Care resource, Information and Recommendations for Challenging Dialysis Placements , is available on the For Providers/IVD section of your HSAG ESRD Network website.
Patient Services and Patient Care
The Grievance Process is a Patient’s Right, and the Right Thing to Do
The need for a robust and actionable grievance process may seem obvious for a dialysis facility, but many patients, while acknowledging they know they can complain or file a grievance, often choose not to out of a fear of retaliation. It falls to you, as the provider, to create and sustain a culture of addressing all grievances in a professional and ethical way so all patients can discuss concerns about their care. When the facility addresses grievances in a thoughtful and productive way, it can eliminate the fear of retaliation and build trust between staff members and patients. To encourage open communication and ensure the best outcomes for patients and the facility, here is a brief review of what should be included in the facility’s grievance process:
  • Vtag 467 (Patient’s Rights) from the Conditions for Coverage (CfC) states that every patient has the right to:
  • Be informed of his or her right to file internal grievances, external grievances, or both without reprisal or denial of services.
  • File a grievance personally, anonymously or through a representative of the patient’s choosing.
  • A robust facility grievance process includes the following provisions:
  • Any staff member may start the facility grievance process on behalf of a patient.
  • Documentation--including the date of incident, name(s) of involved staff members, a description of the incident, and the name of any witness(es).
  • Education for the patient regarding the patients' right to file a grievance either internally with the facility, externally with the regulatory agencies, or the Network.
  • Information on how a grievance can be submitted anonymously or by a representative of the patient’s/family’s/caregiver’s choice.

To learn more about how to address patient grievances, click here for the webinar recording, Anonymous Grievances: How to Improve the Process for All. (Includes 1.0 no cost continuing education unit (CEU) for registered nurses (RNs) and Certified Hemodialysis Technicians (CHTs).
Patient and Family Engagement (PFE) at the Facility Level

For the third year in a row, the CMS is asking all dialysis facilities to heighten their focus on patient and family centered care, aiming to help staff optimize customer satisfaction and improve clinical outcomes. All 18 ESRD Networks throughout the United States are working with providers to help them meet the three CMS PFE expectations, which are to:

  1. Establish patient councils, patient- and family-support groups, and/or new patient-adjustment groups
  2. Incorporate patient, family, and caregiver participation into the Quality Assurance & Performance Improvement (QAPI) program and governing body of the facility
  3. Demonstrate patient, family, and caregiver participation in the patient’s care (e.g., patient, family member, and caregiver involvement in the development of the individualized Plan of Care [POC] and/or Care Plan meetings)

To support these PFE expectations, Networks are working with facilities to establish network and/or facility patient representative programs (also known as NPRs or FPRs) to work with staff and their fellow patients at the facility level. The patient representatives (NPRs or FPRs) serve as patient peer mentors and are the link between patients and facility staff. Visit your HSAG Network website for more information on how to recruit and engage a patient representative at your facility and for educational/outreach resources related to the CMS PFE expectations. 
Vocational Rehabilitation and the Ticket to Work Program
HSAG ESRD Networks are collaborating with facilities in the Networks' service area to improve patient quality of life (QOL) by supporting gainful employment in the dialysis patient population. The Networks have heard directly from many patients who were not provided with employment resources or who struggle to find employment while on dialysis. Please use the resources below to support patients in the facility with seeking job opportunities.

Ticket to Work Connects Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) beneficiaries in the 18- to 64-year-old age group with no-cost employment services offered by authorized service providers. Beneficiaries who decide to participate receive services such as career counseling, vocational rehabilitation (VR), job placement, and training.

To learn more about the Ticket to Work program and how it works, watch this helpful Work Incentive Seminar Event (WISE) titled, Understanding Ticket to Work: How to Help Your Clients and the People You Serve, by clicking here . You can also visit the Ticket to Work website here to download resources for your patients.

State VR Agencies help patients who want to return to work but need services such as training, career counseling, rehabilitation services, or vehicle modifications. VR agencies are Ticket to Work-authorized service providers. To find the VR offices in your state, click the VR State Agency Contacts Tab here.
Clinical Topics
Multi-listing for Kidney Transplant and High Kidney Donor Profile Index (KDPI) Score
Have you had questions from patients about how they can shorten the wait time for kidney transplant? Getting on a waitlist at more than one transplant center (multi-listing) and/or accepting a kidney with a higher KDPI score may be options for some patients. Some studies suggest that listing at multiple transplant centers can reduce wait times by a few months. Patients may also ask what is involved in multiple-listing and if there are any restrictions. Answers to these and other questions regarding patients listing at more than one kidney transplant center can be found here .

Additionally, each donated kidney receives a KDPI score. This score ranges from 0100, and measures how long the kidney is likely to work. While a kidney with a lower KDPI is expected to last longer, high KDPI kidneys are often a good fit for the patient and typically last 710 years. These kidneys can function well and patients who are open to receiving kidneys with higher KDPI scores may get transplanted sooner too. Only the patient and doctor can determine if a kidney is right for him or her. Additional information, including what a KDPI score is based on, can be found here .
New Resource: Let’s Talk Home Dialysis Conversation Starter Cards
Modality education frequently consists of staff members asking patients: “Are you interested in home dialysis?” If the patient answers “no,” the conversation often ends, and is documented as “educated/not interested.”
To assist staff members in initiating dialogue with patients to establish interest about home dialysis treatment options, the ESRD National Coordinating Center (NCC) Home Dialysis Patient Affinity Group developed the Let’s Talk: Home Dialysis Conversation Starter Cards to address the topics of Quality of Life, Family, Schedule Flexibly, Travel, and Diet— when discussing home dialysis. There is also a Discussion Notes resource for patients to record their thoughts on these topics for follow-up discussions with their family and healthcare team.
To access this resource for use during patient education, click here .
Vascular Access Procedures: Keeping Grafts and Fistulas Viable
Keeping permanent accesses for dialysis viable is one of the most challenging areas you will encounter in your practice. Flow rates through the fistula or graft must be enough to keep the access patent and useable for dialysis. Staff members should have good assessment and cannulation skills to prevent damage and/or loss of the access. Patients should be taught to feel their access several times a day to ensure patency. When flow rates begin to drop, referral to a vascular access center or surgeon should occur sooner rather than later. Procedures may include:
  • Angioplasty—inserting a balloon to open a stenosis.
  • Stent placement—for damaged accesses such as aneurysm or pseudoaneurysm formation.
  • Jump graft—inserting a piece of graft material into or around a damaged piece of vessel.
  • Surgical revision—this could be a re-anastomosis procedure or a re-routing of the vessels.
Just like a car, all access types will need to be tuned up periodically to keep them performing at their best. Recognizing vascular access problems early can save a lifeline for years to come. Click here for more information on Vascular Access for Hemodialysis: What You Need to Know.
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 would be provided to the Social Security Administration (SSA) by the facility social worker or the patient 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
CROWNWeb Clinical Closure Dates
Clinical Months
January 2020
February 2020
March 2020
Date for Closure of Clinical Submissions
March 31, 2020, at 11:59 p.m. PT
April 30, 2020, at 11:59 p.m. PT
 June 1, 2020, at 11:59 p.m. PT
Final ESRD Quality Incentive Program (QIP) Rule for Calendar Year (CY)/Payment Year (PY) 2022
The ESRD QIP Final Rule for CY 2020/PY 2022 was published on November 8, 2019. Two new measures have been added to the QIP beginning in CY 2020/PY 2022. These measures include the Percentage of Prevalent Patients Waitlisted (PPPW) Care Coordination Measure and the Medication Reconciliation (Med Rec) Safety Measure. Additionally, the minimum Total Performance Score (TPS) to avoid a Medicare payment reduction in PY 2022 has been finalized at a score below 54, reduced from 56 points in PY 2021. To view the entire Final Rule and the comments submitted by stakeholders, visit the Federal Register
Dialysis Facility Compare (DFC) Updates
The release and comment period dates for the Quarterly Update of the Fiscal Year (FY) 2020 Dialysis Facility Reports for State Surveyors were shared with providers earlier in the year. This new report provides more recent summaries of select measures from the FY 2020 Dialysis Facility Report (DFR) and will be utilized by each state’s surveying agency as a resource during the survey and certification process. 
A detailed timeline for the upcoming quarterly updates of the FY 2020 DFRs for State Surveyors is posted on the dialysis data website: ( https://dialysisdata.org/sites/default/files/content/Timeline_102419.pdf ) and important dates are listed below.
Authorized users may submit comments about the report on the dialysis data secure website by using the comment form: “DFR: Comments on DFR for UM-KECC” or “DFR: Comments on DFR for State Surveyor”. Please do not include questions for The University of Michigan Kidney and Epidemiology Cost Center (UM-KECC) in comments intended for the state surveyors. You can contact the Dialysis Data Helpdesk directly at: 1.855.764.2885 or DialysisData@umich.edu
National Healthcare Safety Network (NHSN) Enrollment
CMS strongly encourages all facilities to report in NHSN to receive full reimbursement through the ESRD Quality Incentive Program (QIP). NHSN provides facilities, states, regions, and the nation with data needed to identify problem areas, measure progress of prevention efforts, and ultimately eliminate healthcare-associated infections. In addition, NHSN allows healthcare facilities to track blood safety errors and important healthcare process measures such as healthcare personnel influenza vaccine status and infection control adherence rates. For additional information please see FAQs about NHSN and the CMS ESRD QIP Rule .

For complete detailed enrollment instructions please download the NHSN Facility Administrator Enrollment Guide March 2018. Cdc-pdf[PDF – 797K]  . 

To be taken directly to the 5 Step Enrollment for Outpatient Dialysis Facilities- CMS QIP, click here: https://www.cdc.gov/nhsn/dialysis/enroll.html .
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.
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: NW-ESRD-XN-03182020-01