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Welcome to the December 21 issue of the Quality Insights Renal Network 4 e-newsletter. In this issue, we bring you information about identifying phosphates in packaged foods, NHSN updates, CMS updates, continuing education opportunities, patient education features, ESRD events, resources and much more. We encourage you to  contact us with any questions, concerns or suggestions.  
FeedbackPlease provide us with your feedback on last month's Facility-LED PATIENT EDUCATION
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esrd qip performance score certificates
We will be providing a Network 4 Patient Education Sheet each month in 2017. 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. 

PackagedFood Identifying added phosphates in packaged food 
Phosphorus is a concern for anyone with kidney disease.  Before blood serum levels become elevated in later stages of kidney disease, experts believe that phosphates in the food supply are impacting bone health and calcification processes.  Check out this article from that shows both foods with phosphate additives and substitutes.

National Healthcare Safety Network (NHSN) user responses on the NHSN Education and Training Needs Assessment survey indicated a need for increased navigability and more streamlined access to training activities and materials. This feedback has been incorporated into updates on the  NHSN Training websiteView a summaryof the most notable changes to the NHSN Training website. Keep an eye out for the updated website to go live in early 2018. Please direct any questions to

NHSNReleaseNotesNHSN version 8.8 released 
The latest National Healthcare Safety Network (NHSN) release notes include several items related dialysis. See below for details.  

Annual Survey Updates
There are updates to the annual surveys for the following components:
  1. Patient Safety - includes LTAC and Rehab surveys - a new section has been added to all Patient Safety surveys to collect information about healthcare facilities water management practices and policies. This section will include a total of three (3) optional questions about current water management systems that impact the spread and control of Legionella. The format of the questions found in this section do not differ from other sections found on the Patient Safety surveys.
  2. Long Term Care - New section added to collect information about healthcare facilities water management practices and policies. This section will include a total of three (3) optional questions about current water management systems that impact the spread and control of Legionella. The format of the questions found in this section do not differ from other sections found on the survey. 
  3. Dialysis 
  4. HPS - Home Dialysis Survey
Changes to Patient Safety Component (Events)
1. BSI event - request for two new optional fields (optional until CDA catches up)
a. Extracorporeal life support present (e.g. ECMO): with a Yes/No dropdown
b. Ventricular access device (VAD) present: o with a Yes/No dropdown
2. SSI Event and GI Event - Specific Event Criteria business rules
a. Updated IAB specific criteria definitions. Refer to IDM for specific rule changes
b. Updated GIT specific criteria definitions. Refer to IDM for specific rule changes
3. For ICU/other summary, SCA summary, and the VAE event, the "APRV" field will changed from Conditional to Optional

Changes to the Dialysis Component
  • Dialysis Event - Dialysis-numerator - Implemented new CDA for Dialysis-num using 'R3-D1.1 IG'; Dialysis Events with event dates => 2018 MUST use the R3-D1.1 version of the IG
1. "If new antimicrobial start = "Yes", then "was a blood sample collected for culture" is required. (code = 2339-0)
2. Added location for acute kidney injury (AKI) patients in outpatient hemodialysis centers
  • Monthly Reporting Plan - A comment box has been added to Dialysis Monthly Reporting Plans
  • Analysis and Reporting - TAP Reports for Groups are available. Targeted Assessment for Prevention is a strategy that identifies facilities with a high burden of excess infections. Groups can generate a report that ranks facilities in descending order by their burden of
    excess infections, which allows groups to target facilities for infection prevention purposes.
    Facilities O the existing facility-level Bloodstream Infection (BSI) SIR report has been modified to allow facilities to view their number of excess infections.
AKI AKI Patients to be Included in Dialysis Event Surveillance Beginning January 1
Beginning January 1, 2018, dialysis facilities should include acute kidney injury (AKI) patients in National Healthcare Safety Network (NHSN) Dialysis Event Surveillance. Reporting AKI patient data to a new, separate NHSN location will enable CDC to exclude AKI patient data from NHSN Bloodstream Infection (BSI) information shared with CMS for purposes of the ESRD Quality Incentive Program (QIP).

The "Acute Kidney Injury (AKI) Location" should be used to report Dialysis Events, and denominator data, for patients who have acute kidney injury and do not have an end-stage renal disease (ESRD) diagnosis at the time of the Event, or denominator data collection.

The "Acute Kidney Injury Location" will be released as part of the NHSN version 8.8 update. Instructions for using the "Acute Kidney Injury Location" are forthcoming.

Among patients included in the NHSN Dialysis Event Surveillance population, the following criteria should be used to identify patients who have acute kidney injury:

1. No diagnosis of "End Stage Renal Disease" or "ESRD" in the patient medical record, or through the ESRD Medical Evidence Form (Form CMS-2728-U3).


2. Physician-diagnosis of "Acute Kidney Injury" or "AKI" listed in the patient medical record (e.g., nephrologist consult or referral form).


3. The event date, or date of denominator data collection, is not more than 6 months after the date the patient initiated outpatient hemodialysis.

NewNHSNNew NHSN Agreement to Participate
The Consent Form: What is New?
  • Submission will be done electronically through the NHSN application rather than a paper copy that is mailed, scanned, or faxed.
  • A facility's primary contact will accept the new consent form instead of requiring signature from a facility executive
  • NHSN data access is being extended to local health departments for surveillance and prevention purposes-as is currently done for state health departments
  • Some purposes of NHSN have been updated to reflect current data reporting relationship with CMS
  • CDC plans to introduce the new, online NHSN Agreement to Participate and Consent form in December 2017
The NHSN Re-consent Process
  • Primary Contacts for each component will be able to review and accept the new consent form in the NHSN application in December 2017.
  • All NHSN users will need to accept the new Agreement to Participate and Consent (or "re-consent") by February 24th, 2018.
  • If a dialysis facility fails to re-consent by the deadline, its NHSN functionality will be suspended until the consent form is accepted by the primary contact.
  • CDC will make every effort to communicate with users before and during the re-consent process to minimize any disruption to reporting.
If you have questions on this new form or the process, please contact and put "Dialysis" in the subject line.

CMSUpdatesCMS Updates
CMS Announces Release and Availability of PY 2018 ESRD QIP Final Performance Score Reports
The Centers for Medicare and Medicaid Services (CMS) announces the release and availability of the Payment Year (PY) 2018 End-Stage Renal Disease Quality Incentive Program (ESRD QIP) Final Performance Score Reports (PSR) and PY 2018 ESRD QIP Performance Score Certificates (PSC). You are encouraged to download and save these documents from the ESRD QIP system as soon as possible.
  • PY 2018 Final Performance Score Reports (PSR)  - The PY 2018 Final PSR documents your facility's performance during CY 2016 and any payment reduction that may result. It also reflects any revisions to your facility's performance scores from the Preview Period. We encourage facilities to save an electronic copy of their PSRs for reference and reprinting. Please note that PY 2018 PSRs will be available in the ESRD QIP system until the PY 2019 Preview Period begins next summer 2018 
  • PY 2018 Performance Score Certificates (PSC) - As a reminder, each facility is required to download, print, and post both the English and Spanish versions of the PSC in a prominent patient area within fifteen (15) business days of their availability, and ensure that these documents remain posted throughout Calendar Year (CY) 2018. 

We also encourage facilities to save an electronic copy of their PSCs for reference, reprinting, and reposting throughout the year as the need arises. Please note that PY 2018 PSCs will be available in the ESRD QIP system until the PY 2019 Preview Period begins next summer 2018. After that point, facilities will need to contact the QualityNet Help Desk to acquire the document.

Please allow some time for your reports to process. If you do not receive your report within 24 hours, please submit a help desk ticket to the QualityNet Helpdesk at or (866) 288-8912. If you have any questions about the information in this memorandum, please contact the ESRD QIP Team at

Emergency Preparedness Rule Reminder
If your facility has activated its emergency plan due to a disaster this year, the facility is exempt from one full-scale exercise for the year following the event. The secondary requirement for a table-top exercise or exercise of choice still applies. Please see the CMS Emergency Preparedness Final Rule language below:

An actual emergency event or response of sufficient magnitude that requires activation of the relevant emergency plans meets the Full Scale annual exercise requirement and exempts the facility for engaging in the required exercise for one year following the actual event. Facility's must be able to demonstrate this through written documentation and the facility is responsible for documenting their compliance and ensuring that this information is available for review at any time, for a period of no less than three (3) years. Facilities should also document the lessons learned following their tabletop and full-scale exercises and real-life emergencies and demonstrate that they have incorporated any necessary improvements in their emergency preparedness program. Facilities may complete an after action review process to help them develop an actionable after action report (AAR). The process includes a roundtable discussion that includes leadership, department leads and critical staff who can identify and document lessons learned and necessary improvements in an official AAR. The AAR, at a minimum, should determine 1) what was supposed to happen; 2) what occurred; 3) what went well; 4) what the facility can do differently or improve upon; and 5) a plan with timelines for incorporating necessary improvement.

Surveyor Procedures:
  • Ask to see documentation of the annual tabletop and full scale exercises (which may include, but is not limited to, the exercise plan, the AAR, and any additional documentation used by the facility to support the exercise.
  • Ask to see the documentation of the facility's efforts to identify a full-scale community based exercise if they did not participate in one (i.e. date and personnel and agencies contacted and the reasons for the inability to participate in a community based exercise).
  • Request documentation of the facility's analysis and response and how the facility updated its emergency program based on this analysis.
Please visit the KCER website for additional resources. 

Update on CMS PPS and AKI for Calendar Year 2018
CMS has published an update to Publication 100-02, Medicare Benefit Policy Manual, Chapter 11, section 50, on "Implementation of Changes in the ESRD PPS and Payment for Dialysis Furnished for AKI in ESRD Facilities for CY2018," dated November 3, 2017.  Learn more

Tentative Data Collection Schedule for the 2018 ICH CAHPS Spring Survey
The tentative data collection schedule and the dates for some key activities related to the 2018 In-Center Hemodialysis CAHPS (ICH CAHPS) Spring Survey are shown below. Please note that these dates are subject to change. Should a schedule change occur, an announcement will be posted.
  • 2018 Introduction to the ICH CAHPS Survey Webinar Training - 2/14/2018
  • 2018 ICH CAHPS Survey Vendor Update Training Session - 2/15/2018
  • Submit New Facility-Specific Questions to CMS 1/31/2018
  • Deadline for Authorizing a Vendor for 2018 Spring Survey - 2/28/2018 
  • Deadline for Submitting a 2018 Facility Non-Participation Form 2/28/2018
  • Deadline for Submitting the Quality Assurance Plan - 3/31/2018
  • Sampling Window - 7/1/2017 to 9/30/2017
  • Sample Files Uploaded on ICH CAHPS Website - 3/30/2018
  • Vendors Attest to Receipt of Sample File - 4/3/2018
  • Mail Prenotification Letter - 4/20/2018
  • Mail 1st Questionnaire (mail only and mixed mode)/Begin Telephone data collection (phone only mode) - 5/4/2018
  • Mail 2nd Questionnaire (mail only)/Begin phone follow-up (mixed mode) - 6/1/2018
  • Data Collection Ends - 7/13/2018
  • Vendors Clean/Process Final Data and Construct XML File - 7/16/2018 to 7/25/2018
  • Deadline for Submitting XML Data File to ICH Data Center - 7/25/2018

UpcomingEventsUpcoming events

Registration Now Open for the RPA's Billing and Coding Conference
Knowing and understanding the rules of the game are the keys to proper billing, coding and documentation. The Renal Physicians Association (RPA) Billing and Coding conference is scheduled for March 15, 2018 in Orlando, Florida and can help physicians, practice managers and coders gain greater understanding around office, hospital and dialysis coding. Jeffery Giullian, MD , Rob Blaser and Leland Garrett, MD will be presenting for this dynamic, fundamental, interactive workshop. Registration is now open.

2018 National Kidney Foundation Spring Clinical Meetings
The 2018 National Kidney Foundation Spring Clinical Meetings (SCM) will be held in Austin, TX on April 10-14, 2018.  The SCM website features a comprehensive preliminary program, a call for abstracts, a sign-up area for news and a link to the NKF Professional Education Resource Center (PERC) that will have many free-to-members courses based on the 2017 SCM.  SCM includes separate pre-conference workshops and conference tracks for physicians, pharmacists, advanced practitioners, nurses, technicians, dietitians, social workers, and transplant professionals.  Registration is now open, and discounted advance registration closes January 26, 2018. Learn more

freeCEUsCEU 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 courses:
  • 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.

California State University Institute for Palliative Care
The California State University Institute for Palliative Care sponsors a series of webinars called What Every... Needs to Know About Palliative Care.  It is a series of self-paced, online courses that enables organizations to ensure that everyone understands the fundamentals about palliative care, including how it differs from hospice care.  Since palliative care can benefit patients at every stage of life, it is important for every person working in an organization to understand what it is, for whom it is appropriate, and how to connect patients and families to available palliative care services. Learn more

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 MMWR presents a FREE continuing education activity on U.S. pregnant women and infants with recent Zika virus exposure. Continuing Medical Education (CME), American Board of Internal Medicine Maintenance of Certification (ABIM MOC), and Continuing Education (CE) credits are all available for this activity - Vital Signs: Update on Zika Virus - Associated Birth Defects and Evaluation of All U.S. Infants with Congenital Zika Virus Exposure - U.S. Zika Pregnancy Registry, 2016. This activity is intended for infectious disease clinicians, obstetricians/gynecologists, family medicine practitioners, internists, nurses, public health officials, pediatricians, and other clinicians who treat and manage women of reproductive age who may be exposed to Zika virus and risk for birth defects in their offspring.
ESRDResourcesESRD resources 

Quality Insights' Latest e-Bulletin Offers Flu Vaccination Resources and Tools
The latest e-bulletin from Quality Insights Quality Innovation Network offers a wealth of information, tools and resources about influenza. Check it out.

Looking for a Patient Support Group?
Sometimes it's helpful to talk about your journey to kidney health with peers that understand what you're going through. Check out our website periodically for information about local support groups near you, including upcoming meeting dates as they become available. 
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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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. ESRD4-122017