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Welcome to the July 14 issue of the Quality Insights Renal Network 4 e-newsletter. In this issue, we bring you information about CMS reporting deadlines, CMS updates, health alerts, 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
Network Role in Facilitating Access to Care
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. 
ICHCAHPSupdate on ich cahps phone surveys: administering while sample patient is at a dialysis center
Concern has been raised that some sample patients may not provide or might not feel comfortable providing survey responses that best reflect the dialysis care they receive if they are completing the ICH CAHPS telephone interview while at the sampled facility receiving dialysis. After discussion with CMS, the Coordination Team has added protocol to help telephone and mixed-mode administration vendors handle this situation.

If a sample patient tells a telephone interviewer that he or she is at the dialysis center when the interviewer contacts the patient, the interviewer should not attempt to complete the interview. Instead, the telephone interviewer should make an appointment to call the patient back at a time that is convenient for the patient, but not while the patient is at the dialysis center.

Please contact the ICH CAHPS Coordination Team via email at or call (866) 245-8083 if you have any questions.
PADOHOverdoseAlertpa department of health releases alert on carfentanil-related overdose   
Through its partners, the Pennsylvania Department of Health (PADOH) has been made aware of carfentanil-related overdoses in several areas of Pennsylvania. Some of these areas have seen significant numbers of these overdoses, some of which were fatal. Carfentanil is a synthetic opioid, federally categorized Schedule II controlled substance, with a clinical potency 10,000 times that of morphine and 100 times that of fentanyl. 

First responders should use caution and utilize appropriate personal protective equipment (PPE) when handling carfentanil due to the drug's ability to be absorbed through the skin. As a result, carfentanil could pose a grave danger to law enforcement and other first responders encountering the drug in an emergency medical situation.

Signs and symptoms of exposure to carfentanil are consistent with opioid toxicity and include:
  • pinpoint pupils;
  • respiratory depression (shallow or absent breathing);
  • depressed mental status (dizziness, lethargy, sedation or loss of consciousness);
  • gastrointestinal irritation (nausea, vomiting); and
  • cardiovascular failure (weak or absent pulses and cold, clammy skin). 

Learn more

AAKPScholarshipsAAKP scholarships available for national patient meeting
The American Association of Kidney Patients (AAKP) is offering scholarships for the September 8 - 10 AAKP National Patient Meeting in St. Petersburg Florida. The scholarship application deadline is August 1, 2017. Download the application. Learn more
RSN Essay Contest
RSNEssayIndividuals Invited to enter 15th annual rsn essay contest
Renal Support Network (RSN) is encouraging people with chronic kidney disease (CKD) to enter its 15th Annual Patient Essay Contest. RSN is a nonprofit, patient-run organization that provides non-medical services to those affected by CKD. This year, the essay contest commemorates 15 years with the theme, " Describe a positive decision that you have made about your healthcare. " All submissions must be written by someone who has been diagnosed with CKD. 

The essay contest inspires people with kidney disease to share their experience with others traveling the same road and looking for answers. Contest winners will receive cash prizes of $500 for first place, $300 for second place and $100 for third place. 

The submission deadline is August 10.  Winners' will be announced on September 14. Winning essays will be featured in RSN's publication,  Live & Give , and on . For information about the contest, rules and read previous winning essays visit

AAKPMEIaakp and mei release report on job retention program 
The American Association of Kidney Patients (AAKP) and the Medical Education Institute (MEI) have released a report on KidneyWorks: A Job Retention Program for People with CKD. Recommendations for providers include:
  • Offer appointment times that accommodate patients' work schedules
  • Talk with patients and families about the benefits of working and avoiding disability when possible
  • Remember that patients who can keep their jobs are more likely to retain employer group health plans that will bring in more revenue to a practice or clinic than Medicare or Medicaid
  • Consider the societal benefits of a healthier population with fewer hospitalizations, less anxiety and depression, and a more active lifestyle

ANNAAwardsANNA Now accepting nominations for nursing excellence awards and scholarships
Now is the time to nominate a colleague for an American Nephrology Nurses Association (ANNA) award or to apply for a personal scholarship or grant.  ANNA has over $100,000 in nursing excellence awards, scholarships, and grants available but the submission deadline is quickly approaching. Do you know a great co-worker and fellow nephrology professional who has gone "above and beyond"? There is no greater satisfaction than seeing someone recognized who truly deserves it. T ake a brief moment to complete the application or nomination process - for yourself or for someone else.  Choose from over 35 awards, scholarships, and grants. View a full list of available awards The application deadline for all awards and scholarships is October 15th. 

CMSUpdatesCMS Updates 

New Subsection of Contains QIP Information and Resources
In preparation for the Payment Year (PY) 2018 Preview Period, CMS has created a new subsection in the ESRD Facilities section of This subsection contains ESRD QIP information and materials for system users to reference when accessing the ESRD Quality Reporting System (EQRS) for the Preview Period. 
Later this year, CMS expects to release additional pages in this ESRD QIP section to continue to improve access to program information. 
If you have any questions or concerns, please contact ESRD QIP team at
New Rule Modifies QIP for PY2019-2021
CMS has proposed a new rule that modifies the QIP for PY2019-21. Comments on the rule will be accepted until August 28, 2017. The proposed rule includes updates to reimbursement rates, the ESRD QIP Extraordinary Circumstances Exception Policy (ECE), PSC, NHSN dialysis event data validation sampling methodology, and quality measures. The rule also requests comments on how to include individuals with AKI in the ESRD QIP, and on the feasibility and appropriateness of accounting for social risk factors in the program.  View an advance copy of the proposed rule. The proposed rule was scheduled for the July 5, 2017 Federal Register.   Read the CMS press release
A CMS Fact Sheet summarizes the various changes and proposals in the rule, and also introduces a planned CMS RFI that will welcome continued feedback on the Medicare program with the aim of increasing efficiency, transparency, flexibility, program simplicity, and innovation.  View the fact sheet
Listening Session: Proposed Rule for Payment Year 2021 
During this call, learn about provisions in the CY 2018 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) proposed rule, including plans for the program in Payment Years (PY) 2019, 2020, and 2021. Topics include:
  • ESRD QIP legislative framework
  • Proposed measures, standards, scoring method, and payment reduction scale for PY 2021
  • Proposed modifications to PY 2019 and PY 2020 activities
  • Methods for reviewing and commenting on the proposed rule
If time allows, we will open the lines for feedback. Note: feedback received during the listening session will not be considered formal comments on the rule. See the proposed rule for information on submitting these comments by the close of the 60-day comment period on August 28. Learn more

CMSReportingDeadline CMS Reporting Deadline for NHSN Dialysis Event Surveillance is extended to July 31
To meet the CMS ESRD QIP NHSN reporting requirements for Payment Year 2019, outpatient hemodialysis clinics must submit their first quarter 2017 Dialysis Event data collected from January 1, 2017 through March 31, 2017, by Monday, July 31, 2017. The extension to July 31 is an effort to allow facilities to comply with the guidance on Acute Kidney Injury (AKI) and reporting calendar year 2017  Dialysis Event Surveillance data to the NHSN. New or revised first quarter data entered into NHSN after July 31 will not be sent to CMS. Therefore, please be aware that any changes or corrections to first 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.

CDCClarificationCDC Clarification on Patients with Acute Kidney Injury (AKI) and Reporting Calendar Year 2017 Dialysis Event Surveillance Data to the NHSN
The Centers for Disease Control and Prevention (CDC) is providing the following guidance to clarify how dialysis facilities that treat acute kidney injury (AKI) patients should report 2017 Dialysis Event Surveillance data to the National Healthcare Safety Network (NHSN). Adherence to this guidance will enable CDC to exclude AKI patient data from NHSN Bloodstream Infection (BSI) data shared with CMS for purposes of the ESRD QIP.

Dialysis BSI Data

BSI are reported to NHSN as positive blood culture events. Facilities should select one of the following two options for positive blood culture events that occur in AKI patients during calendar year (CY) 2017, including Quarter 1 and 2. Complying with either option will ensure AKI BSI data are not shared with CMS for the ESRD QIP:
  • Option 1: Exclude positive blood culture events that occurred in AKI patients from CY 2017 Dialysis Event Data reported to NHSN. Dialysis facilities selecting this option should not report positive blood cultures to NHSN that occurred in patients with AKI, and delete AKI positive blood culture event data that has been entered for Quarter 1 or 2 of CY 2017.
  • Option 2: Include AKI patients in CY 2017 Dialysis Event Data reported to NHSN, and clearly label these events in AKI patients, to facilitate their removal from the QIP dataset. Facilities should select this option if they prefer to retain AKI patient data in NHSN for their internal use. To facilitate this process, facilities must follow the attached guidance to indicate which positive blood culture events occurred in patients with AKI. Instructions are attached for identifying AKI patients when adding new events, and for editing events that have been previously entered for CY 2017. CDC will exclude properly labeled AKI positive blood culture events from the 2017 BSI standardized infection ratio (SIR) measure calculations, and from the dataset provided to CMS for QIP scoring.
Adding and Editing Dialysis Positive Blood Culture Events to Indicate an AKI Patient

Denominator Data

Regardless of the option selected for handling positive blood cultures events among patients with AKI, when reporting CY 2017 denominator data via the Denominators for Dialysis Event Surveillance form, all facilities should exclude patients with AKI in "the number of hemodialysis outpatients who were dialyzed in the facility on the first two working days of each month" and all stratified patient counts reported for calendar year 2017. Instructions for removing AKI patients from CY 2017 denominator data are attached.

To allow facilities to comply with the above guidance, CMS has extended the 2017 ESRD QIP Quarter 1 NHSN reporting deadline to July 31, 2017.

If you have any questions regarding how to update AKI data in NHSN, please contact the NHSN helpdesk at with "dialysis" in the subject line. If you have any questions or concerns regarding ESRD QIP, please contact the CMS ESRD QIP team at with "AKI" in the subject line.

SummerCamps3CAn't wait for Summer? Take a Look at Upcoming ESRD Camps
Philadelphia Area
Central and Western Pennsylvania
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 is offering a new online continuing education (CE) course titled Managing Hyperphosphatemia. The course is free and offers 1.00 CDR CE credit and 1.20 NANT CE credits. The goals of the course are to identify and understand challenges dietitians and other allied health professionals face in managing hyperphosphatemia in their patients and identify effective tools and strategies they can employ in their own practice. Learn more.  

Centers for Disease Control and Prevention (CDC)
The CDC has new free continuing education opportunities available: 
  • Risk Recognition in Healthcare Settings
  • Environmental Services and Infection Prevention
  • Recognizing Infection Risks in Medical Equipment
Additionally, three others are planned for upcoming months:
  • Infection Transmission Risks Associated with Nonsterile Glove Use
    Infection Prevention: A Hierarchy of Controls Approach
    Injection Safety: A Systems Approach

Morbidity and Mortality Weekly Report (MMWR) and Medscape
CDC's MMWR presents a FREE continuing education activity on opioid prescribing in partnership with Medscape. 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 - CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. This activity is intended for primary care clinicians, nurses, and other clinicians prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.

KFCPGolf10th annual kidney classic golf tournament
The Kidney Foundation of Central Pennsylvania (KFCP) is coordinating the 10th Annual Kidney Classic Golf Tournament on Monday, July 24 at 1:00 p.m. ET at the Country Club of Harrisburg. The even is an effort to raise money for KFCP's Patient Emergency Assistance Fund, which helps hundreds of dialysis patients who rely on KFCP. When unexpected hardship happens, even the smallest amount of support can make the impossible possible. The Patient Emergency Assistance Fund is a compassionate response to aid patients with the greatest needs as they adjust to dialysis treatments. This fund is used as a bridging tool to help dialysis patients, often overwhelmed by their circumstance and health issues to take the first step in managing their health. In 2016, KFCP supported 384 dialysis patients and helped social workers at the 62 dialysis centers and transplant programs in its 28-county region respond to the short term financial needs of patients with nutritional renal supplements, transportation to scheduled dialysis treatment appointments, medication co-pays, durable medical equipment and unplanned medical expenses to avoid readmission to the hospital. Join KFCP for an afternoon of golf with friendly competition and for a great cause. Learn more and register today 
ESRDResourcesESRD resources 

KCER Revises Emergency Preparedness Book
Kidney Community Emergency Response (KCER) has revised the English version of the book Preparing for Emergencies: A Guide for People on Dialysis.   View the new edition.

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. ESRD4-063017