Volume 3 Ed. 2| June 2019
In This Issue
  • Network Updates
  • Patient and Family Engagement
  • Patient Services and Patient Care
  • Network Quality Improvement Highlights
  • Data Management
  • Upcoming Events and Webinars
  • Important Links
  • Network Staff Directory
From the Executive Director
On April 16, 2019, CMS hosted its first annual National Care Transitions Awareness (NCTA) Day. As we all know, patients on dialysis are very complex. Between dialysis treatments, transplant work-ups, access appointments, and managing co-morbid conditions, there are many opportunities to miss out on the vital communication needed to ensure seamless care transitions. Implementing a process for care transitions and using checklists and communication logs are best practices for transferring patients and their critical medical information in a safe, timely and efficient manner. I encourage you and your team to review and implement the attached resources to create safe transitions for your patients.

Helen Rose, MSW, LCSW
Executive Director
Phone: 813.865.3321 | hrose@hsag.com
Network Updates
The Network Needs Your Help!
ESRD Network 17 strives to improve the quality of care provided to dialysis and transplant patients. To successfully achieve this objective, we need professionals from the end stage renal disease (ESRD) community to play key roles in the Network; we are looking for candidates to serve as volunteers on the following Network committees:

  • Board of Directors (BOD)
  • Medical Review Board (MRB)
  • Network Council (NC).

You are a potential candidate if you work within the Network's service area and are a:
  • Facility administrator
  • Nephrologist
  • Vascular surgeon
  • Transplant surgeon
  • Nephrology nurse
  • Transplant nurse
  • Social worker
  • Registered dietitian
  • Patient care technician

If you are interested in serving on a Network committee, you can find more information on the Network website or contact Jane Wilson at JWilson@nw17.esrd.net

Note: Vacancies and term limits vary depending on the committee and existing membership. 

Emergency Preparedness
Emergency Preparedness is a community effort that requires everyone at your facility to be on board. It is important for all staff and administration to understand your facility’s emergency plan. Additionally, the plan must be tested and updated at least annually, more frequently as needed.

What Can You Do Today to be Prepared for an Emergency?

W hat Can You Tell Patients?
When speaking to patients about being prepared for an emergency, tell them:

  • Plan now!
  • Plan to evacuate!
  • Provide them with shelter information.
  • Explain that “riding out” storms is getting more dangerous and that they need to know in advance where they will go.
  • There is limited support after an event to get patients to treatment and they should have:
  • Their emergency 3-day meal plan up-to-date.
  • Important papers, medications, contact lists at the ready.
  • The facility will be calling them after a disaster, so please answer the phone.
  • Who they can call:
  • Facility back-up phone number.
  • Dialysis organization 1-800 numbers.
  • The ESRD Network Patient Line: 800.232.3773.

E mergency Preparedness Resources
Patient and Family Engagement (PFE)
PFE in the Facility Quality Assessment and Performance Improvement (QAPI) Meetings
I ncluding a patient in your facility’s QAPI meetings can assist facility staff to better understand patients' needs and to improve patients' experience of care. Sometimes, however, patient participation can be challenging. Following are some common facility-identified barriers to incorporating patients, family, and caregivers in QAPI and some strategies for overcoming those barriers.

“Patients and their families do not care about the QAPI meeting.”

Recommended Strategy for Overcoming the Barrier:
Facility staff should highlight the benefits of attending QAPI. Let them know that patients who attend QAPI meetings:
  • Have the opportunity to bring their concerns to the entire interdisciplinary team (IDT).
  • Can get immediate feedback from the IDT on any topic on their mind.
  • Can gain a deeper understanding of the clinical process.

Barrier: “Patients do not want or are unable to come to the clinic outside of their dialysis schedule.”

Recommended Strategy for Overcoming the Barrier:
Facilities can help to overcome this barrier by making arrangements to accommodate the patients schedule, including:
  • Offering patients a way to join the meeting via webinar or conference call.
  • Assisting patients in changing their treatment schedule for that day.
  • Scheduling the meeting at a convenient time for the patient.
  • Assisting patients with transportation arrangements.

Barrier: “QAPI meetings may include Personal Health Information (PHI) that would be a HIPAA violation.”

Recommended Strategy for Overcoming the Barrier:
Facilities can break the meeting into two parts, one with the patient and the second without. Invite the patient to the first 15–20 minutes of the meeting when general facility topics are discussed. Then, thank the patient for his or her time and invite them to leave. Save the second half of the meeting for any discussions of personal patient information.

To get started with implementing PFE activities at your facility, visit the Network PFE web page   today. PATIENT SERVICES AND PATIENT CARE
Patient Services and Patient Care
Network Grievance Process: Use the Network as Your Resource
The Network can assist dialysis facilities and patients with turning grievances into opportunities for improvement. Here's how the process works. Once a patient contacts the Network with a grievance the Network representative will :
  • Log the grievance and contact the facility to begin an investigation.
  • Often interview the facility administrator to discuss the grievance.
  • Request medical records and/or policies and procedures as part of the investigation.
  • Review the records and contact the appropriate facility staff to work on improving the situation, before following back up with the patient.

The goal of the grievance process is for the Network and the facility to work toward a mutually beneficial outcome for both the patient and the facility. Working together through a grievance allows the facility a chance to grow and gives patients a chance to feel heard.

Facilities can provide patients with a copy of the Patient Grievance Toolkit , developed by The National Forum of ESRD Networks, to help them understand the grievance process. The Toolkit was designed by patients for patients who are working through the grievance process.

Role of the Network for Access to Dialysis Care Concerns
To the greatest extent possible, we must all work together to ensure that every patient with ESRD has access to dialysis care in an outpatient facility. The CFCs Interpretive Guidance state that “involuntary discharge or transfer should be rare and preceded by a demonstrated effort on the part of the interdisciplinary team to address the problem in a mutually beneficial way.” Network 17 would like to be contacted by facilities before involuntary discharge (IVD) is likely, in hopes of preserving access to care for the patient and to support the dialysis professionals involved.

Two new resources that can help your facility and staff with access to care issues are:

Both are now available in the IVD section of the HSAG ESRD Network 17 website.

Opioid Crisis: Combating the Opioid Crisis
To assist providers in reducing opioid misuse and improve medication management, CMS has developed a Medication Management and Opioid (MMO) Initiative Pledge . The MMO Pledge focuses on:
  • Educating ourselves and our team regarding patient referrals to appropriate resources and/or implementation of appropriate practices for opioid management.
  • Ensuring persons with opioid disorder are treated in a respectful and person-centered manner.
  • Leveraging and aligning with existing programs and initiatives to combat opioid misuse.
  • Identifying and sharing successes and best practices to spread to other ESRD providers.

Click here to sign the MMO Pledge and/or to learn more about opioid management.

Vaccination: Hepatitis B (HBV) Vaccination/Screening for Patients and Staff
Vaccinations help protect people from diseases that are serious and sometimes deadly. Patients may refuse vaccination at times, possibly due to fears of contracting the disease and/or fear of needles. Refusing vaccination places patients at risk for contracting the HBV infection and becoming a chronic HBV carrier.

Dialysis staff have the task of managing their patients' conditions while also focusing on reducing the risk of infection. The following resources provide guidance on the prevention of HBV infection in the dialysis setting:

Network Quality Improvement Activity Highlights
Home Dialysis: Home Remote Monitoring
Accurate dialysis treatment data is important for predicting dialysis-related complications and monitoring patients' adherence to treatment prescriptions. Home remote monitoring (sending real time patient health data to caregivers and providers) provides state-of-the-art tools for patients and caregivers to lower the risk of complications and improve patients' wellness and quality of life. It is expected that home remote monitoring will help to improve clinical outcomes through early recognition and correction of identified problems. 

Learn more about home remote monitoring by reading the Kidney International Reports article, Remote Patient Management for Home Dialysis Patients .

Learning and Action Network (LAN) Best Practice Highlight
The National Forum of ESRD Networks Medical Advisory Council created the Kidney Transplant Toolkit  to assist physicians and dialysis facility staff with guidance regarding eligibility requirements and the transplant referral process.

Find out more about The Kidney Transplant Toolkit here.
Data Management
(Patient Attributes and Related Treatment)
PART data is a census of patient personal information and treatment history. It is obtained from information entered on the Admit/Discharge , Patient Attributes , and Dialysis Treatment Information screens in CROWNWeb. PART data in CROWNWeb helps with verifying the accuracy of:

  • Facility patient census
  • Admit/discharge status
  • Patients’ current treatment summaries

CROWNWeb tracks data entered for each patient and presents users the ability to verify the accuracy on the PART screen. Users should verify PART data in CROWNWeb at the end of each month, and no later than the fifth business day of the following month, for all patients.

Please refer to the ESRD Systems Data Management Guidelines for CROWNWeb data entry due dates. 
CROWNWeb Clinical Closure Dates
Clinical Months
April 2019
May 2019
June 2019
July 2019
Date for Closure of Clinical Submissions
July 1, 2019 at 11:59 p.m. PT
July 31, 2019 at 11:59 p.m. PT
September 3, 2019 at 11:59 p.m. PT
September 30, 2019 at 11:59 p.m. PT
National Healthcare and Safety Network (NHSN)—Annual Training
The NHSN training course and post-assessment are required annually for all users participating in Dialysis Event Surveillance, as specified on the Centers for Disease Control and Prevention’s (CDC’s) NHSN website located at: https://www.cdc.gov/nhsn/dialysis/index.html

Facilities are also required to meet NHSN enrollment and training requirements as part of the ESRD Quality Incentive Program (QIP).

New! NHSN Help Desk Management System
 To better serve users, NHSN is now using a help desk management system for all NHSN inquiries. All messages are now being assigned a ticket number for tracking. When you contact NHSN@cdc.gov , you will receive a notification that your incident has been assigned a ticket number, and all correspondence on that subject will be tracked by that number.

QIP Requirements and the Performance Score Certificate (PSC)
Are you familiar with the ESRD QIP measures for Calendar Year (CY) 2019? Here are some links that can help:

One of the QIP requirements is that each dialysis facility must display its most current PSC that lists its Total Performance Score (TPS), as well as its performance on each of the quality measures identified for that year. Here’s a great link to terminology used in the Performance Score Report (PSR) and PSC: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/ESRDQIPGlossaryofTerms.html.
Dialysis Facility Compare (DFC)
The Quarterly Dialysis Facility Compare (QDFC) - Preview Report for July 2019 Refresh is Available. Visit the Dialysisdata.org FAQs for assistance by clicking here, or contact the Network at 415.897.2400.

Have you checked out the DFC website? Use this link to understand the information publicly available about your facility: https://www.medicare.gov/dialysisfacilitycompare/#about/dialysisfacility-info .
Upcoming Events and Webinars
Dialysis Patient Citizens (DPC): Vocational Rehabilitation Works for You and Your Quality of Life!
Date: June 27, 2019
Time: 11 a.m.–12 noon PT

Reducing Bloodstream Infection LAN Event
Date: July 2, 2019
Time: 12 noon–1 p.m. PT

Increasing Rates of Patients Dialyzing at Home LAN Event
Date: July 9, 2019
Time: 12 noon–1 p.m. PT

Increasing Rates of Patients on a Transplant Waitlist LAN Event
Date: July 16, 2019
Time: 12 noon–1 p.m. PT

DPC: A Young Man's Life Changing Experience with both Heart and Kidney Disease
Date: July 25, 2019
Time: 11 a.m.–12 noon PT

DPC Webinar presented in SPANISH!
Guia Basica de Alimentacion para Personas con Enfermedad Renal
( Basic Nutrition Guide for People with Kidney Disease )
Date: August 22, 2019
Time: 11 a.m.–12 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.–12 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-17G024-06262019-01