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Welcome to the June 29 issue of the Quality Insights Renal Network 4 e-newsletter. In this issue, we bring you information about the Network 4 Annual Report, training webinars, CMS updates, NHSN updates, patient education features, ESRD events, resources and much more. We encourage you to  contact us with any questions, concerns or suggestions.  
CMSInvitescms invites you to attend esrd qip webinar
The Centers for Medicare & Medicaid Services (CMS) End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) invites you to attend a webinar about the Payment Year (PY) 2018 Preview Period. The webinar, titled  End-Stage Renal Disease Quality Incentive Program: Previewing Your Facility's Payment Year 2018 Performance Data,
will take place on Monday, July 10 from 1:00 - 2:00 p.m. ET. 

This webinar will focus on steps dialysis facilities need to take to participate in the PY 2018 Preview Period. The ESRD QIP PY 2018 Preview Period will begin on July 17 and CMS will make the Preview Performance Score Reports (PSR) available to facilities. These reports provide the results CMS will use to determine if a facility will incur a payment reduction for PY 2018. During the Preview Period, facilities can review their measure scores and ask CMS questions about how their scores were calculated. Facilities will also be able to submit one formal inquiry if they find or suspect an error in how their scores were calculated. 

After this webinar, participants should know:
  • How to access and review their facility's PSR
  • How CMS calculated their facility's ESRD QIP performance scores using quality data
  • What the total performance score means to their facility's 2018 payment rates
  • When and where to ask questions regarding their PSR, including how to submit one formal inquiry
  • Their duty and responsibility to make ESRD QIP performance data transparent to patients
  • Where to get help and additional information.

CMS encourages every dialysis facility to review its Preview PSR before this information is made available to the public in December 2017 and payment reductions are finalized. Facilities will be able to generate and review Preview PSRs beginning July 17. The preview period will end on August 18 at 5 p.m. ET.

Please visit the ESRD QIP website to learn more about ESRD QIP and the PY 2018 Preview Period. For any questions about registration, please e-mail  

CMSAdvanceCopycms releases advance copy of Interpretive guidelines and procedures  
The Centers for Medicare & Medicaid Services (CMS) has released an advance copy of Interpretive Guidelines and Survey Procedures for the new Medicare Emergency Preparedness Requirements rule that became effective on November 15, 2016 and will be implemented on November 15, 2017.  View a copy  
NTDSWebinarTargeting zero infections: ntds webinar now online 
The first Nephrologists Transforming Dialysis Safety (NTDS) webinar was a huge success. As a result, the American Society of Nephrology (ASN) is proud to host this webinar online and support the NTDS mission of transforming dialysis care. This highly rated, one-hour program will help you make a difference for your patients through:
  • Case Study: Lessons learned in the management of a Hepatitis C outbreak in a dialysis facility.
  • Leadership Focus: Lessons learned in the management of a Hepatitis C outbreak in a dialysis facility.
  • Team Care: Engaging and empowering staff, improving safety.
  • Tools and Resources: Reducing and preventing infections: using CDC tools and resources in QAPI programs.
  • Presenters: Alan S. Kliger, MD, Yale New Haven Health System; Priti R. Patel, MD, MPH, Centers for Disease Control and Prevention; and Leslie P. Wong, MD, MBA, FASN, Cleveland Clinic

Mark your calendars for the next webinar: MDROs and Antimicrobial Stewardship in the Dialysis Facility on September 27 from 12:00 to 1:00 p.m. EDT.

Why Target Zero Infections? Approximately 63,690 U.S. dialysis patients died from infectious complications in 2012. Infection-related morbidity and mortality have increased in recent years. NTDS has committed to reversing this trend and transforming dialysis care.

Join us at Kidney Week 2017:

  • Early Program: The Dialysis Infection Crisis in the United States: A Call to Action  - Wednesday, November 1
  • Annual Session: Infection Prevention: Are You Prepared for the Next "Ebola"? - Friday, November 3 at 2:00 p.m. CT
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. 
AnnualReport2Quality Insights Renal Network 4 Annual Report Now Available
Quality Insights Renal Network 4's 2016 Annual Report is now available online. Visit our website to view the report. 
Network 4 Annual Report
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

PACPatient Advisory Council Updates
Our goal for the Patient Representative Program is to have Patient Representatives spread the word that Dialysis Means Life (DML). The Patient Advisory Council (PAC) - made up of patients throughout Network 4 - believes sharing the concept of DML with patients will help engage them in their care.

Facility Survey: 
The PAC would like to know how the Patient Representative Program has been improving patient engagement at dialysis facilities in Network 4. Please take a moment to fill out this survey.

Patient Representative Packages
If you have a Patient Representative at your facility, you should have received a hard copy of the 2017 Network 4 Patient Representative Handbook. This copy should be kept at your facility so your Patient Representative can refer to it while on dialysis. Each facility also received Patient Representative Pins. Patient R epresentatives may wear these pins while at your facility if they choose. As your facility adds more Patient Representatives, Network 4 will send more pins. Let us know if you need more pins. 

If your facility has a Patient Representative but did NOT receive this package, please let us know by emailing Tish Lawson at

If your facility does NOT currently have a Patient Representative, we encourage you to recruit one. Patient Representatives can help your facility engage patients. Patient Representative forms and tools can be found on our website. Once we receive a Patient Representative application from your facility, we will send a Patient Representative Package to your facility's social worker.

Meeting Update
Also, just a reminder, there will be no July Patient Representative meeting.  The next meetings will be August 1 and 2 from 2:00 to 3:00 p.m. on both days. The topic for these meetings will be Support Groups Do Work!

PASpotlightpatient advocate spotlight: bill 
Raising awareness, talking to legislators and helping people better understand the dialysis community are all part of a typical day's work for Bill Murray.

Before being diagnosed with chronic kidney disease, Murray worked as a self-employed plumber. Initially told he would only have five years until he would need to start dialysis, Murray made it to 16. But once he began his six-days-a-week dialysis treatment, he quickly lost his strength, struggled to keep working and had to close his business.

No longer able to work and fighting to stay alive each day, Murray found his new calling in life: advocacy. Read Murray's full story

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.

NHSNReleaseNotesNHSN Release Notes for June 17, 2017
The following changes will affect all reporting dialysis facilities. 

Changes to All Components
  • Enrollment/Facility Data: On the Facility Information screen, the AHA ID field and VA Station Code field can now be edited/updated. This functionality allows the facility to edit or update the fields at any time. 
Changes to the Dialysis Component
  • Analysis and Reporting: An update for 2015 aggregate data has been completed so that users can have access to the most recent data available when comparing a facility or group's rate to the national pooled mean rate. This update includes new aggregate rates, p-values and percentiles for six rate tables and six run charts (all of those in Analysis Reports > Dialysis Events > Rates > CDC-Defined Output).

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

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 

New ASPR Resources Now Available
The Office of the Assistant Secretary for Preparedness & Response (ASPR) recently shared the following new resources: 

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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Quality Improvement Coordinator
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610 Freedom Business Center,  
Suite 102 
King of Prussia, PA 19406 
(610) 265-2418 
(800) 548-9205 (patients only) 
(610) 783-0374 (fax) 
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. ESRD4-061617