Volume 3 Ed. 4 | December 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
Network Updates From the Executive Director

Time is moving quickly as we approach the holiday season and a new project year. As we close out 2019 QIAs, we would like to thank the dialysis providers who participated in the Network’s QIAs and worked hard to implement patient and family engagement at the facility level. As of October 2019, 30.8 percent of facilities in the Network 7 service area are hosting a patient support group, and 23.7 percent are engaging patients in the facility’s Quality Assessment and Performance Improvement (QAPI) program. Your hard work has also led to a reduction of 207 bloodstream infections and 184 long-term catheters across QIA facilities. Additionally, facilities included in the Transplant Coordination QIA added 361 patients to the transplant wait-list, and facilities in the Home Dialysis QIA transitioned 492 patients to home dialysis. These are real lives affected, and these improvements reflect your diligence in the work and dedication to patients. We appreciate your consistent collaboration and sharing of best practices, so keep up the great work!

In December, facilities will be notified on which QIA they will be participating in for 2020. QIA-specific information will be shared by the Network’s QIA lead and include details on orientation webinars to be held in January 2020. We look forward to continuing our collaboration with your organizations and moving together towards our shared goals. Network 7 would like to wish you and your staff a wonderful holiday season and a Happy New Year.

Helen Rose, MSW, LCSW
Executive Director
Phone: 813.865.3321 | hrose@hsag.com
Patient Services and Patient Care
Keeping Your Heart and Kidneys Healthy

The same risk factors for diabetes and high blood pressure that cause kidney disease also affect a patient’s chances of developing heart disease. The End Stage Renal Disease (ESRD) population is at a higher risk for cardiovascular disease, and over half of all ESRD dialysis deaths are cardiovascular related. Your dietitian is a valuable resource for educating patients on how to keep their kidneys and heart health on track by discussing:
  • Losing weight, if needed.
  • Keeping blood pressure and blood sugar under control.
  • Engaging in regular physical activity.
  • Diet counseling.
Visit the National Kidney Foundation (NKF) website to find patient education resources, tests to consider, treatments for heart disease, and steps for keeping a healthy heart while on dialysis.
Welcome to Medicare Visit

Medicare covers a one-time “Welcome to Medicare” visit within the first 12 months that patients have Medicare Part B. Patients do not need to have this visit to be covered for yearly "Wellness" visits. This visit helps establish a baseline for their care and is intended as a preventive service, a way of catching potentially serious health issues early. For more information visit the Medicare Interactive website .
Medicare Part B Covers Diabetes Self-Management Training (DSMT)

Diabetes management for ESRD patients is complex and can be a challenge. However, DSMT programs focus on empowering patients to better manage their blood glucose levels. DSMT programs focus on providing patients with education, tools, and support to ensure patients develop a strong skill set to keep blood glucose levels stable. Medicare Part B medical insurance covers outpatient DSMT for patients diagnosed with diabetes. Go to the Medicare.gov website to print out information on the DSMT provided under Medicare Part B and share it with your diabetic patients.
Talk to Your Patients About the Importance
of Vaccinations

Individuals with chronic diseases, such as ESRD, are immuno-compromised; and therefore, are more susceptible to developing infections and contracting communicable diseases. To help prevent disease and illness, talk to your patients about the importance of receiving the following vaccinations: influenza; tetanus; diphtheria; pertussis (Tdap); pneumococcal polysaccharide; hepatitis B; zoster; varicella; measles, mumps, and rubella (MMR). More information on vaccinating kidney dialysis patients can be found in the Centers for Disease Control and Prevention’s (CDC's)  Guidelines for Vaccinating Kidney Dialysis Patients and Patients with Chronic Kidney Disease .
Medication Reconciliation Reduces Medication Errors
Medication reconciliation reduces medication errors including, medication omissions, duplications, dosing errors, and drug interactions. According to the CDC, electronic medication reconciliation reduces medication errors by 58 percent. Medication reconciliation should be done at every transition of care to verify if existing orders have been modified or if new medications have been prescribed. To learn about effective medication management strategies, visit the Agency for Healthcare Research and Quality (AHRQ) Medication Management Strategy: Intervention webpage .
Network QIA Highlights
Network Transplant Referral Guide

The Transplant Referral Guide  is a tool developed by the Network for dialysis facilities to share with patients, staff members, medical directors, and nephrologists. This resource assists patients interested in referral for transplant by comparing the criteria for 10 transplant centers in the Network service area. Additionally, the Transplant Referral Guide offers patients and their families the opportunity to make an educated decision when choosing the transplant center that is right for their individual needs. To find this guide and other transplant resources, click on the HSAG ESRD Network 7 website .
Empowered Kidney Care

The July 24, 2019, Patient Experience of Care Learning and Action Network (PEOC LAN) webinar on Empowered Kidney Care was a big hit among Network 7’s providers this year. Empowered Kidney Care is an exciting redesign of dialysis care that was addressed in a recent New England Journal of Medicine article, entitled, " Is “'Empowered Dialysis' the Key to Better Outcomes." Visit the Network 7 PEOC QIA LAN webpage to find a link to the article. Empowered Dialysis is just one action-oriented, practical way to improve care at your facility. Please visit the Network 7  PEOC QIA LAN webpage  to view LAN webinar recordings, and improve patient and staff engagement today! Free continuing education units for dialysis technicians and nurses are available.
Data Management
Important CROWNWeb Deadlines
The Centers for Medicare & Medicaid Services (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, 2019, the CMS-2728 form should be submitted by January 11, 2019, and would be considered late after February 15, 2019. The original signed CMS-2728 is provided to the Social Security Administration (SSA) 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 .
CROWNWeb Clinical Closure Dates
Clinical Months
September 2019
October 2019
November 2019
December 2019
Date for Closure of Clinical Submissions
December 2, 2020, at 11:59 p.m. PT
January 2, 2020, at 11:59 p.m. PT
January 31, 2020, at 11:59 p.m. PT
March 2, 2020, at 11:59 p.m. PT
The ESRD Quality Incentive Program (QIP): Performance Score Certificate (PSC)
 Reminder! Each dialysis facility must post their PSC that documents the facility’s performance on the ESRD QIP, including their Total Performance Score (TPS), individual measure scores, and comparisons to national averages. Facilities must display their PSC within five business days of receiving notice from CMS that the certificate is available. The certificate must be posted for the entire year (January 1–December 31) in an area where it is easily visible to patients and their families or caregivers. These certificates must be updated and posted annually. Payment Year (PY) 2020 PSCs will be available in mid-December 2019.
Final QIP Rule for PY 2022
The ESRD QIP Final Rule for PY 2022 was published on November 8, 2019. Two new measures have been added to the QIP beginning in PY 2020. These measures include the Percentage of Prevalent Patients Waitlisted (PPPW) Care Coordination Measure and the Medication Reconciliation (Med Rec) Safety Measure. Additionally, the minimum 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 .
National Healthcare and Safety Network (NHSN)
Upcoming Deadline for NHSN Reporting
To be in compliance with the ESRD QIP, in-center dialysis facilities must follow NHSN Dialysis Event Surveillance Protocol and reporting requirements for calendar year (CY) 2019 (PY 2021). The quarterly reporting deadline for July–September 2019 data is on or before December 31, 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 is available on the NHSN website or by emailing NHSN@CDC.gov and including Dialysis in the subject line .

Remember, the CDC expects that facilities have validated data by comparing dialysis event data you collect to the dialysis event data that has been reported to NHSN. This will ensure data being reported are complete and correct. A facility-based NHSN user is expected to have access to NHSN and continue to review the data in NHSN on an ongoing basis to verify that the data reported are complete and correct. Use the 3 Steps to Review NHSN Dialysis Event Surveillance Data document to help make sure your data are correct and that you are ESRD-QIP ready!

You can also review all of the ESRD QIP requirements for PY 2021 in the Final Technical Specification document b y visiting the CMS ESRD QIP Rule of Record (PDF).
Dialysis Facility Compare (DFC)

CMS has published a summary of changes and other important information about the recent October 2019 update to the DFC website . Find the summary of changes by visiting the CMS Dialysis Facility Compare October 2019 Release Q&A (PDF).
Upcoming Events and Webinars
American Association of Kidney Patients (AAKP): 1st Annual Fun Walk
Date: Saturday, December 7, 2019
Time: 10 a.m.–12 noon PT. Registration begins at 8 a.m.
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.
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 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, and

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
Chrys Williams, BA
Data Manager
Beverly Whittet, RN, CDN, CPHQ
Special Projects Director
Melissa Johnson
Project Coordinator
Bonnie Grasso, MSW
Quality Improvement Manager
Donna DeBello, RN
Quality Improvement Director
Robert Peck, RN 
Quality Improvement Manager
Kristine Johnson, RN, MSN
Nephrology Nurse
This material was prepared by HSAG: ESRD Network 7, 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-7G091-12132019-01