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Welcome to the January 11 issue of the Quality Insights Renal Network 4 e-newsletter. In this issue, we bring you information about a CDC Health Advisory on increased flu activity, a new study on more effective IV dosing for anemic dialysis patients, 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.  
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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. 

CDCFlucdc issues health advisory on increased flu activity 
The Centers for Disease Control and Prevention (CDC) has issued a "HAN" Health Advisory on increased influenza A (H3N2) activity and its clinical implications. The HAN also includes a summary of influenza antiviral drug treatment recommendations, an update about approved treatment drugs and supply this season, and background information for patients about influenza treatment.  Learn more

The Centers for Medicare & Medicaid Services (CMS) has also recently published a list of flu vaccine resources. View the resources.  

NewStudynew study: lower iv iron dosing in anemic dialysis patients may be more effective
A new study suggests that optimal intravenous (IV) iron dosing may be <300 mg/month for the average hemodialysis (HD) patient with anemia. Researchers examined IV iron doses and response to therapy in 9471 HD patients from the 2009-2011 Dialysis Outcomes and Practice Patterns Study (DOPPS) and analyzed changes in hemoglobin, transferrin saturation (TSAT), ferritin, and erythropoiesis-stimulating agent (ESA) dose according to various IV iron dosage categories over 3 months. According to the BMC Nephrology findings, TSAT, ferritin, and ESA dose changes were minimized when IV iron was administered at <300 mg/month, including maintenance and replacement doses. Learn more
ThirdQuarterDatathird quarter 2017 dialysis event data should be submitted no later than january 31 
To meet the CMS ESRD QIP NHSN reporting requirements for Payment Year 2019, outpatient hemodialysis clinics must submit their third quarter 2017 Dialysis Event data collected from July 1, 2017 through September 30, 2017, by Wednesday, January 31, 2018. New or revised third quarter data entered into NHSN after January 31 will not be sent to CMS. Therefore, please be aware that any changes or corrections to third quarter 2017 data should be made prior to the reporting deadline.

We recommend using the following resources to review your data before the deadline. These resources and others can be found on the Dialysis Event homepage:
Contact the NHSN Helpdesk (, subject line 'Dialysis') with any questions.

NHSNUpdatedAgreementNHSN 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."

AKIPatientsAKI 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 attached instructions 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.

NewChecklist2018 Checklist for Reporting Healthcare Personnel Influenza Vaccination Summary Data
With 2018 in full swing, we wanted to review a few points for facilities preparing to submit healthcare personnel (HCP) influenza vaccination summary data for the 2017-2018 influenza season.
  • New requirement: Dialysis facilities that do not provide in-center hemodialysis must complete the Home Dialysis Center Practices Survey before entering HCP influenza vaccination summary data.
  • Keep Secure Access Management Services (SAMS) credentials active. If a NHSN user does not log into NHSN at least once within a 12-month timeframe, he/she will lose access to SAMS and NHSN. NHSN users will also be prompted to change their SAMS password every 60 days.
  • Ensure that at least two staff members can enter data into NHSN.
  • Create a new monthly reporting plan. A reporting plan must be completed once for each influenza season. You will not be able to enter or save any influenza vaccination summary data until you create a reporting plan for that influenza season
  • Select the appropriate influenza season when entering data. For the 2017-2018 influenza season, you must select "2017-2018" in the drop-down box. This is very important, since data submitted under the incorrect influenza season will not be shared with CMS and will not fulfill reporting requirements.
  • Ensure that your CMS certification number (CCN), CCN effective date, and facility type are entered into NHSN. Specific guidance on adding/updating the facility CCN and CCN effective date within NHSN can be found online.
More information on each of the above bullets can be found on pages 13-14 on the NHSN December Newsletter. For your reference, comprehensive training slides can be accessed online
If you have any questions about reporting HCP influenza vaccination summary data, please e-mail

NewNHSN New 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
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 to Host Conference Call on CY2018 ESRD PPS Final Rule
The Centers for Medicare & Medicaid Services (CMS) will host a conference call on January 23, 2018 on provisions in the CY2018 ESRD PPS final rule, including plans for the ESRD QIP PY2019, 2020, and 2021.  Topics include ESRD QIP legislative framework, Measures, standards, scoring method, and payment reduction scale for PY 2021, and Modifications to PY2019 and PY2020 policies.  A question and answer session follows the presentation.  Register for the callView the CY2018 final rule.

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.
  • Submit New Facility-Specific Questions to CMS - 1/31/2018
  • 2018 Introduction to the ICH CAHPS Survey Webinar Training - 2/14/2018
  • 2018 ICH CAHPS Survey Vendor Update Training Session - 2/15/2018
  • 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
  • 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 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 s ponsored by Pentec Health.

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.

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 

Latest edition of KCER Watch is Now Available 
The the December 2017 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. ESRD4-011018