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Welcome to the February 15 issue of the Quality Insights Renal Network 4 e-newsletter. In this issue, we bring you information about a summary of a new budget law expanding use of home dialysis, National Healthcare Safety Network (NHSN) updates, Centers for Medicare & Medicaid Services (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
Please take this short survey to let us know what you thought about last month's facility-led patient education topics
Hemodialysis Vascular Access Lifeline
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. 
NetworkGoals2018 Network Goals: Attestation Link Available
Quality Insights Renal Network 4 is providing Network facilities with 2018 Network 4 Goals. We ask that you attest in the following site after you receive and review these goals. If you oversee more than one facility, please add all of the CCNs in one attestation. Access the attestation here.  
BudgetLawkidney care partners offers summary of new budget law expanding use of home dialysis 
Kidney Care Partners has summarized the ESRD-related provisions of the new budget law, H.R.1892 - Bipartisan Budget Act of 2018.  The Act will expand the use of home dialysis therapy through use of telehealth services, expedite patient access to quality dialysis care at newly certified facilities, and extend authority for Special Needs Plans (C-SNPs) without interruption in care. In addition, payments for non-emergency ambulance use are reduced. While the legislation as passed and signed may not be effective until converted to administrative law, more detailed information can be found below. 
UpcomingEventsUpcoming Events

registration now open for Spring meeting of the Eastern Pennsylvania and Delaware cnsw Chapter 
Registration for the spring meeting of the Eastern Pennsylvania and Delaware Council of Nephrology Social Workers (CNSW) chapter is now open. The meeting will take place on Thursday, March 1

The agenda will include:

8:30 - 9:00 a.m. - Registration, Breakfast and Exhibits
9:00 a.m. - 12:00 p.m.  - Ethics in Social Work with Madhan Kris Srinivasan MD, MBA, MHSE
12:00 - 1:00 p.m.  - Lunch and Exhibits
1:00 - 3:00 p.m.  - Intimacy for the Aging with Katie Starrantino LSW, M.Ed
3:00 - 3:15 p.m. - CNSW Updates

Register today by visiting the chapter page of the National Kidney Foundation website or 

Registration Now Open for 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.

Registration Now Open for the Latest National Kidney Foundation Patient & Community Education Seminar
Registration is now open for the National Kidney Foundation's latest Patient & Community Education Seminar, Everyday Heroes Living with Kidney Disease. The seminar will take place on Sunday, March 25, 2018 from 1:30 to 5:30 p.m. at the South Philadelphia Community Health and Literacy Center located at 1700 South Broad Street, Philadelphia, PA 19145. The National Kidney Foundation invites kidney patients from early stages of kidney disease to dialysis or transplantation and their caregivers to come together, learn and become empowered through this Patient Education Program. To register, contact Eleanor at (215) 923-8611 ext. 743 or email This seminar is sponsored by Pentec Health.

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
NHSNUpdatesNHSN Updates
New Instructional Guidance on the Re-consent Process
The National Healthcare Safety Network (NHSN) team has published some informational guidance on our website to assist users with completion of the updated NHSN Agreement to Participate and Consent. A 5-minute video informs users of the new Consent purposes and the simple process for accepting the Consent electronically. Furthermore, a step-by-step guidance document provides detailed instructions and screen shots for what Facility Administrators and Primary Contacts can expect to see when they begin the re-consent process in the NHSN application. A link to the video and the guidance document can both be found in the FAQs About NHSN's Agreement to Participate and Consent. As a reminder, the deadline for accepting the updated Consent is April 14, 2018, for all components except Long-term Care, which has a deadline of June 15, 2018. If you have any questions about the re-consent process, please email the NHSN helpdesk.

Patient Safety Component Annual Surveys DUE SOON
The deadline to complete the mandatory 2017 Patient Safety Annual Survey is approaching. All active facilities must successfully submit their survey in NHSN by March 1, 2018. Facilities that do not meet this deadline will be unable to complete and edit monthly reporting plans. As a reminder, NHSN reports that use elements taken from the annual survey will reference the most recently completed survey for 2017 data to generate a standardized infection ratio (SIR). This is important to consider for the upcoming CMS Inpatient Quality Reporting Program submission of 2017 Quarter 3 data, due on February 15th, 2018. Facilities that do not successfully complete the 2017 annual survey prior to that date (February 15th) will have their data risk adjusted using the 2016 survey. If possible, we encourage facilities to complete their survey prior to the CMS 2017 Quarter 3 deadline. If you have any questions about completing the survey, please email the NHSN helpdesk.

NHSN 8.8.1 to Introduce Updated Agreement 
The January 23 release of the NHSN 8.8.1 application will introduce an updated NHSN Agreement to Participate and Consent for current NHSN facility users who enrolled in NHSN prior to December 2, 2017.  Facilities that enrolled in NHSN on or after December 2, 2017, have already accessed this new Consent and will not need to accept it again if they have already done so.  Primary Contacts or Facility Administrators should agree to this updated Consent form for each component by April 14th, 2018, or risk losing access to NHSN.  Once the Consent form is available on January 23rd, an alert will appear on all NHSN component home pages, and primary contacts and facility administrators will receive an email notification.  Additional information, including Frequently Asked Questions and the updated NHSN purposes, are available on CDC's NHSN website.  If you have any questions, please send an email to with the subject line "NHSN Reconsent."

AKI Patients to Be Included in NHSN Dialysis Event Surveillance
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 at time of denominator data collection.
The "Acute Kidney Injury Location" was released as part of the NHSN version 8.8 update on December 2, 2017. Please see the instructions below for using the "Acute Kidney Injury Location".

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.

For questions, please contact the NHSN helpdesk at with "dialysis" in the subject line.

CMSUpdatesCMS Updates

Updated Dialysis Facility Compare Data Now Available
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that new data on the quality of dialysis facilities is available on Dialysis Facility Compare, the website that allows patients and health centers to view and compare quality data about dialysis facilities. CMS uses this data, organized into a series of measures, to create a rating system that can help patients make educated decisions about where to get their dialysis treatments, as well as to assist them in speaking with their healthcare team regarding their care.

What's In the January 2018 Refresh?
With the January 2018 refresh, patients and facilities can now see the latest data from dialysis facilities on the Dialysis Facility Compare website. However, only certain values have been updated in this release. A breakdown of the affected measures is below.

New data is available for the following measures:
  • Frequency of patient death, hospital admission, or readmission
  • Rate of transfusions
  • Adult patients who received treatment through an arteriovenous fistula
  • Adult patients who had a catheter (tube) left in a vein longer than 90 days, for regular hemodialysis treatments
  • Survey of patients' experiences tab
  • Hemoglobin management
  • Preventing bloodstream infections: standardized infection ratio
These measures will continue to display the Dialysis Facility Compare July 2017 release data until the next update: 
  • Adult and child patients who had enough waste removed from their blood during hemodialysis or peritoneal dialysis
  • Adult patients who had too much calcium in their blood
  • Phosphorus concentrations in the blood
  • Quality of patient care star rating
For more information about the January 2018 measures refresh, visit the DFC website. In addition to the data on Dialysis Facility Compare, there is also data on anemia management and phosphorus levels in adult dialysis patients in the downloadable databases and the interactive datasets on

New Q&A Tool Available for ESRD QIP
A new communications tool for submitting questions about the ESRD QIP is now available on QualityNet as the ESRD QIP Q&A tool. The new ESRD QIP Q&A tool provides a streamlined process to submit questions to CMS subject-matter experts and receive answers in a timely manner on a wide variety of program topics, including issues related to policy, measure specifications, and deadlines. In addition, the Q&A tool provides immediate answers to commonly asked questions through its Frequently Asked Questions (FAQ) feature. A robust search engine allows users to quickly locate information based on keywords or phrases, and it provides a convenient summary of relevant answers.

CMS has posted an overview of the tool in the right-hand "Resources" menu on the ESRD QIP QualityNet homepage. In addition, a brief tutorial can be found at ESRD QIP Q&A tool tutorial. The tutorial guides users to create an account on the tool which will enable CMS to communicate directly with them.

CMS will continue using the ESRD QIP Mailbox to receive and process Extraordinary Circumstances Exception (ECE) requests and supporting documents, payment questions, and facility-specific information. Likewise, facilities should continue to use their accounts on the QualityNet Secure Portal to pose formal inquiries and clarification questions during each year's preview period.

Facilities and the public should not use any of these channels to submit Protected Health Information (PHI) or Personally Identifiable Information (PII) to CMS.

CMS encourages facilities and other stakeholders to access the ESRD QIP Q&A Tool and submit their questions. CMS will redirect questions that come into the ESRD QIP Mailbox to the ESRD QIP Q&A tool.

CMS-2744 Submission Dates Updated
ESRD Networks across the country have come to a consensus regarding the submission dates for CMS-2744 forms. Please have your 2744 generated by February 15, 2018 and submitted for acceptance with NO errors or warnings by March 31, 2018. This means that you may begin working on your surveys at your earliest convenience.

Be aware that Batch Submitting Organizations (BSOs) such as DCI, DaVita, FMC and any other facilities that have data submitted electronically may still have 2017 data being loaded into CROWNWeb (CW) through the beginning of February.

Training on the 2744 is available on the website.  

The training link will take you step-by-step through the 2744 process. Also, the CROWNWeb Outreach, Communications and Training team will begin conducting training by next month. We will inform you as soon as those training dates are available.

Please remember that you are completing the survey for calendar year 2017 and thus will be examining data for activity that took place between January 1, 2017 and December 31, 2017.
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 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.

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
Institute for Healthcare Improvement (IHI)
Managers and clinical team leaders - check out this one-day Quick Course from the Institute for Healthcare Improvement (IHI) called High Impact Leadership: Developing Core Leaders. Taking place March 8, 2018, in Philadelphia, PA, expert faculty will provide you with practical improvement methods to further develop your leadership skills. By the end of this one-day workshop you will have:
  • A deeper understanding of the four critical core leader competencies
  • Knowledge of where to focus your efforts when it comes to developing your management and improvement skills
  • An understanding of how to shape culture at the team and department level
  • The ability to better develop capabilites within your team
  • Ways to cultivate behaviors crucial to management leadership
Learn more and register

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.

ESRDResourcesESRD Resources
RPA president-elect featured in "aha Moment" video series
Renal Physicians Association (RPA) President-Elect, Dr. Jeffrey Perlmutter (aka Dr. P) will be featured in several upcoming "Aha Moment" videos. Dr. Perlmutter is a nephrologist in private practice in Rockville, MD. In addition to clinical practice, Dr. Perlmutter is the Medical Director of Dialysis Services at Holy Cross Hospital, Silver Spring, and the Medical Director for DaVita Silver Spring dialysis center. He holds a voluntary appointment at the Uniformed Services University of the Health Sciences in Bethesda, Maryland and at George Washington University. Dr. Perlmutter is the past chair of the Medical Review Board of the Mid-Atlantic Renal Coalition and is a member of its Board of Directors. In the community, Dr. Perlmutter has been an active member of The National Kidney Foundation serving the National Capital Area since 1995. View episode #1 of "The Aha Moment" featuring Dr. Perlmutter

Latest edition of KCER Watch is Now Available 
The  January 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.

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. ESRD4-012218