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Welcome to the April 26 issue of the Quality Insights Renal Network 4 e-newsletter. In this issue, we bring you information about the new Medicare card transition, a new study on "renal rehab," patient education features, our quality improvement activities, upcoming events, National Healthcare Safety Network (NHSN) updates, CROWNWeb updates, continuing education opportunities,  resources and much more. We encourage you to  contact us with any questions, concerns or suggestions.  
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Treatment Options
We will be providing a Network 4 Patient Education Sheet each month in 2018. These documents are also located on  our website. Please provide all of your patients with this education sheet this month.   Also, we ask that you please encourage your facility's Patient  Representatives to pass out this educational information as well. 
MedicareCardnew medicare card transition has begun
The Centers for Medicare & Medicaid Services (CMS) began mailing new Medicare cards with the Medicare Beneficiary Identifier (MBI) on April 1.  The MBI on the new card is effective immediately unless the patient is new to Medicare, in which case refer to the "coverage starts" date on the card. People new to Medicare will only have a Medicare card with an MBI. Learn more.

RenalRehablocal "renal rehab" research shows promising results
A University of Delaware research team in the College of Health Sciences is combating chronic kidney disease (CKD) with exercise. More than 26 million American adults have CKD and, because of difficult-to-see warning signs, late detection is common.  The study in this article showed their exercise program improved blood vessel health and exercise capacity. Equally as important, patients reported improvements in their everyday quality of life as a result of becoming more active.  Read the full article
QIAsQuality Improvement Activities (QIAs)
Spotlight: Two of our Four Network 4 Quality Improvement Activities (QIA)
The Centers for Medicare & Medicaid Services (CMS) has set a five-year target to improve the health of all people in the United States living with End-Stage Renal Disease (ESRD).  CMS goals for two of the Network 4 Quality Improvement Activities (QIAs) are listed below. 
Transplant Waitlist
  • Increase the percentage of ESRD patients on the transplant waitlist from 18.5 percent (the 2016 national average) to 30 percent by 2023 
  • Promote early referrals to kidney transplant and assist patients and providers in improving referral patterns by addressing barriers identified as the patient moves through the waitlist process
Home Dialysis 
  • Increase the number of ESRD patients dialyzing at home from 12 percent (the 2016 national average) to 16 percent by 2023 
  • Promote referral to home dialysis modalities, identify and mitigate the barriers to timely referrals, and determine the steps patients and providers can take to improve referral patterns 

Increasing Patient Participation in network 4's quality improvement activities through Subject Matter Experts 
Many patients with kidney disease face barriers in completing the necessary steps required to be on the transplant waitlist. Studies show that peer support is effective. As a result, Network 4 - in consultation with its patient subject matter experts (SMEs) - is in the process of developing guidelines for a Patient Advocacy Initiative focused on improving the patient transplant waitlist status and home dialysis training initiations. Our goal is to build a pipeline of patients helping patients. Patient Advocates will be available for patient-to-patient sharing of experiences. The goal is to encourage/guide patients as they move through the processes of transplant evaluation and home therapy initiation. We currently have three SMEs partnering with four facilities.

Network 4 Subject Matter Experts (SMEs)

We will also be featuring our patient stories in upcoming newsletters. 

UpcomingEventsUpcoming Events

April is Organ Donation Awareness Month
Join the Renal Support Network (RSN) in encouraging your friends and family to register as organ, eye and tissue donors and to honor those who have saved lives through the gift of donation.

The Need
  • Over 118,000 people are waiting for transplants. The demand for organs far exceeds the supply.
  • More than 20 people die each day while waiting for a transplant.
  • Another person is added to the national transplant waiting list every ten minutes.
  • One organ donor can save up to eight lives.
  • Kidneys are needed more than any other organ.
The Facts
  • Anyone can become an organ donor, no matter your medical history or how old you are.
  • Organs and tissues that can be donated include: heart, kidneys, lungs, pancreas, liver, intestines, corneas, skin, tendons, bone, and heart valves.
  • After you have registered, tell your family so they understand and can communicate your decision when you cannot.
  • 95% of U.S. adults support organ donation, but only 54% have registered as donors.
Nine common myths about organ donation, accompanied by the truth. Don't let these misconceptions deter you from registering as a donor. Learn more about Organ Donation Awareness Month. 
webinar opportunity: The grievance toolkit - fostering communication and improving quality
The National Forum of ESRD Networks presents The Grievance Toolkit: Fostering Communication and Improving Quality on Wednesday, May 2. While the Toolkit was written to help guide patients
through the grievance process, it is a useful tool for both patients and providers to help improve communication. Featured presenters include Ms. Anne Pugh, Dr. Daniel Cukor and members of the Forum Kidney Patient Advisory Council (KPAC). Nursing, Social Worker and PCT CEs will be available for this webinar.  Learn more and register today
The Kidney Foundation of Central Pennsylvania (KFCP) is taking part in the annual Highmark Walk for a Healthy Community on Saturday, May 19 at the main campus of the Harrisburg Area Community College. Highmark underwrites the cost of the Walk, so each participating nonprofit organization keeps 100 percent of the funds raised by its walkers.

Proceeds from this important event help strengthen the KFCP's Patient Programs and Services. One important KFCP program in need of support this year is the Patient Emergency Assistance Fund. KFCP works closely with dialysis social workers who identify those patients in dire need of financial assistance, and temporary emergency funds are made available to help with prescription co-pays, nutritional supplements, or transportation costs to dialysis treatments. Due to fundraisers like the Highmark Walk, last year KFCP was able to assist over 350 patients when they needed it the most.

Please use this link below to make a donation or sign up to walk with the KFCP on May 19. Call (800) 762-6202 with any questions. Learn more
The Big Ask: The big Give Workshop
The Big Ask: The Big Give is a workshop on living donation coordinated by the National Kidney Foundation and Christiana Care Health System. Open to kidney patients, family members, friends, and potential living donors, the workshops provide interactive education about living donation and transplant, and teach the best, most effective strategies and tips for finding a living donor.

Sunday, May 20, 2018
John H. Ammon Medical Education Center
Christiana Hospital
4755 Ogletown-Stanton Road
Newark, DE 19718
12:00 to 4:00 p.m. ET

NHSNUpdatesNHSN Updates

cdc to present four nhsn training webinars in may
The American Nephrology Nurses Association (ANNA) has announced that the CDC will present four NHSN training webinars in May.  Introduction to the NHSN Dialysis Event Surveillance Protocol will be held May 8, 2018 and repeated May 9Advanced NHSN Dialysis Event Surveillance Reporting and Introduction to NHSN Reports will be held May 14, 2018 and repeated on May 15Learn more and register.

Reminder: Data for CMS Quality Reporting Programs Due Soon
All outpatient dialysis facilities providing in-center hemodialysis and/or a home modality should report their data to the Healthcare Patient Safety component in order to comply with the ESRD Quality Incentive Payment (QIP) requirements for reporting the clinical measure Healthcare Personnel Influenza Vaccination Reporting Measure. 

Please make sure at least one individual at your facility can access NHSN via SAMS and has been assigned appropriate user rights in NHSN so they may enter and view the facility's data. To ensure your data have been correctly entered into NHSN, please make sure to verify that: 1) your monthly reporting plans are complete, 2) you've entered appropriate summary and event data or checked the appropriate no events boxes, and 3) you've cleared all alerts from your NHSN facility homepage. For additional guidance on ensuring your data are accurately sent to CMS for Quality Reporting purposes, please visit the CDC website and navigate to the appropriate section(s) for your facility type.

As we approach the May 15 submission deadline for the 2017-2018 influenza season, CDC has outlined some guidance to help facilities check their HCP vaccination data. 

Data Verification in NHSN 

NHSN does not provide a confirmation e-mail to facilities once they have submitted their data. CDC assists with routinely verifying HCP influenza vaccination summary data during the first year of data reporting for a CMS program as a courtesy to facilities. After the first year, facilities should follow the steps below to verify data. Facilities should also maintain printed copies or screenshots of their data entry for their records. 
  1. Ensure that your facility is enrolled in NHSN as the correct facility type. You can view this information on the Facility Information page for your facility in NHSN. For example, if your facility is an ambulatory surgery center, it should only be enrolled in NHSN as "AMB-SURG - Outpatient Surgery Facility." If you have questions about your NHSN facility type, please contact for assistance. 
  2. Ensure that the correct facility CMS Certification Number (CCN) and CCN effective date have been entered into the "Facility Information" page of NHSN. View specific guidance on adding/updating the facility CCN and CCN effective date within NHSN. 
  3. Run a CMS Line Listing Report to ensure that data have been correctly entered into NHSN. Directions on how to run these reports are located by facility type under the "CMS Reporting" heading on the CDC website. This line listing shows what data for your facility will be shared with CMS. 
As long as your facility is enrolled as the correct facility type, your CCN and CCN effective date are correct, and your data appear in the CMS Line Listing for the current reporting period, no further action is required on your part. Your data will be shared with CMS following the reporting deadline established by CMS for your facility type. Also, please note that some facilities are required to report HCP influenza vaccination summary data not only to NHSN to meet CMS reporting requirements, but to other entities, such as their state or city. For non-CMS reporting requirements, facilities will need to determine if reporting through NHSN is sufficient to meet these requirements, or if data must be transmitted via another mechanism. For your reference, more information about reporting requirements, along with a data submission checklist is now available online.
Required Dialysis Event Surveillance Training
CMS requires that at least one person from each outpatient dialysis facility that is eligible to report positive blood cultures (PBC), IV antibiotic starts, and pus, redness and swelling (PRS) to the National Healthcare Safety Network (NHSN) in 2018, complete the Annual NHSN Dialysis Event Surveillance Training. Eligible facilities include:
  • Facilities that provide in-center hemodialysis to at least 11 in-center hemodialysis patients
  • Facilities that have a CMS Certification date prior to January 1, 2018 

Learn more about eligibility.

Starting in 2018, Network 4 must verify, track, and report to CMS on a monthly basis the number of facilities completing this training for 2018. Please complete the following steps as soon as possible. 

  1. Complete the training and attestation no later than September 28.
  2. Print the certificate of completion. 
  3. Attest to completion of the training.

Dialysis Event Training/Re-training is available:  

Deadline extended for re-Consent Process
The Centers for Disease Control and Prevention (CDC) announces a deadline extension for completing the online National Healthcare Safety Network (NHSN) Agreement to Participate and Consent form, referred to as the Consent in this announcement. The new deadline for completing the Consent, June 15, 2018 , applies to ALL facilities currently enrolled in NHSN regardless of their CMS participation. The deadline for Long-term Care Facilities remains June 15, 2018.

The Consent is accessible to only the NHSN Facility Administrator or Primary Contact user. The new deadline provides additional time for each facility's NHSN Facility Administrator or Primary Contact to complete the online Consent and avoid any interruptions in access to the NHSN application, including access for purposes of submitting data to meet local, state, or federal reporting requirements. Please be informed that if the Consent is not completed by the new deadline, access to NHSN will be temporarily suspended. Additionally, users will receive an error message when they attempt to log into NHSN redirecting them to the Facility Administrator or Primary Contact.

CMS quality reporting deadlines for NHSN measure reporting are not affected by this extension.
NHSN is pleased to assist with any questions or concerns you may have regarding the Consent process. Learn more on how to complete the NHSN Agreement to Participate and Consent process. You may also direct questions to
CMSUpdatesCMS Updates
April 2018 CROWNWEb Newsletter now available
The April 2018 edition of the CROWNWeb Newsletter is now available online. The CROWNWeb Newsletter focuses on user-specific topics, such as training, account management, use of the CROWNWeb system, and tips and tricks, as well as key technical aspects of CROWNWeb.

This month's featured stories include:
  • CROWNWeb and the Medicare Beneficiary Identifier (MBI)
  • Using the EDI process to submit CROWNWeb Data
  • CROWNWeb Clinical Corner
  • Clinical Closures
CEUOppsCEU Opportunities
Advanced Renal Education
This educational site provides CEU credits for anyone who completes a course. Register to gain access and complete a course.
American Kidney Fund
The American Kidney Fund offers several online courses that provide free CEs for health care professionals. Learn more
Armstrong Institute for Patient Safety and Quality
The Armstrong Institute for Patient Safety and Quality is now offering short, interactive samples of courses to get a feel for how it creates engaging learning experiences that are relevant and applicable to your work improving patient safety. Samples are now available for the following cours es:
  • Patient Safety Certificate Program
  • Human Factors for Patient Safety
  • Becoming a Patient Safety Hero
  • Foundations of CUSP
These samples will work on mobile devices; however, for the best experience use on a laptop or desktop computer. Browse the course catalog for details on all courses, including continuing education credits, learning objectives and costs.
Centers for Disease Control and Prevention (CDC)

The CDC has new free continuing education opportunities available through its Tune In for Safe Healthcare webinar series. Webinars include: 

  • Empowering Nurses to Protect Themselves and Their Patients: The Importance of Collaboration between Nurses and Environmental Services
  • Infections in Dialysis Centers: Understanding what Matters to Patients
  • Empowering Nurses for Early Sepsis Recognition
Morbidity and Mortality Weekly Report (MMWR) and Medscape
CDC's Morbidity and Mortality Weekly Report (MMWR) presents a FREE continuing education activity on the following topics:
  • Cancer and Obesity
  • Invasive Cancer
  • Recommendations on the Use of Seasonal Influenza Vaccines

In support of improving patient care, Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. If you are not a registered user on Medscape, please register for free or login without a password and get unlimited access to all continuing education activities and other Medscape features.

renal physicians association e-Learning portal offers new course
The Renal Physicians Association (RPA) has an eLearning portal that offers a wide variety of courses. The newest course, 2018 Fundamentals of Nephrology Coding and Billing, is now available online. This course will provide a better understanding of the federal and regulatory requirements for proper nephrology coding, billing and documentation. 
ESRDResourcesESRD Resources
Latest edition of KCER Watch is Now Available  
The  March 2018 issue of KCER Watch , the monthly environmental scan that provides timely and pertinent information related to emergency preparedness, is now available. The goal of KCER Watch is to facilitate the exchange of information, sharing of resources, and advancement of knowledge and expertise among ESRD and emergency management stakeholders. 
Check out the ESRD NCC Information Exchange
The ESRD Network Coordinating Center (NCC) provides centralized coordination and support for the Medicare ESRD Network program. Each month, the ESRD NCC distributes an e-newsletter, known as the Information Exchange, that compiles the most important information from numerous ListServs and publications related to renal health. To sign up to receive this informative newsletter, please contact the ESRD NCC at or visit the ESRD NCC website

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610 Freedom Business Center,  
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King of Prussia, PA 19406 
(610) 265-2418 
(800) 548-9205 (patients only) 
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This bi-weekly e-newsletter will serve as our primary method of communicating important news and updates. We encourage you to visit our Web site for the most up-to-date information or to contact us with questions, comments or suggestions.
This material was prepared by Quality Insights Renal Network 4 under contract with the Centers for Medicare & Medicaid Services (CMS). The contents do not necessarily reflect CMS policy.

Publication No. ESRD4-042518