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Welcome to the October 20 issue of the Quality Insights Renal Network 4 e-newsletter. In this issue, we bring you information about National Diabetes Month, a search for Patient Subject Matter Experts (SMEs), flu season, National Healthcare Safety Network (NHSN) Release Notes, 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.  
DiabetesMonthnovember is diabetes month: Theme Focuses on Kidneys
November is National Diabetes Month and Quality Insights Quality Innovation Network's Everyone with Diabetes Counts (EDC) program is working with community partners and health care providers to improve health outcomes and quality of life among people with diabetes in its five-state network. The theme for this year includes a focus on the connection between kidney health and diabetes.

Quality Insights offers free diabetes education classes throughout Delaware, Louisiana, New Jersey, Pennsylvania and West Virginia as part of the EDC program, which is a national initiative of the Centers for Medicare & Medicaid Services (CMS).

According to the American Diabetes Association, diabetes affects nearly 30 million children and adults in the U.S. today. Additionally, around 30% of people with diabetes develop kidney disease with diabetes being the leading cause of kidney failure, according to the National Kidney Foundation. People with diabetes, high blood pressure, heart disease, obesity, or a family history of kidney disease are all at risk for developing chronic kidney disease (CKD). 

The EDC program engages patients in weekly group sessions over a six-week period. Participants learn about preventing complications, healthy eating, exercise, self-monitoring, dealing with stress and difficult emotions, managing medications, effective communication with healthcare providers and much more. Additionally, the program engages healthcare providers to improve their adherence to standards of care for people with diabetes and refer patients to the free self-management classes.

Graduates have reported weight loss, a gain in confidence, new friendships within the community, and improved blood sugar levels, just to name a few.

To check out the full list of current and upcoming free diabetes self-management classes, visit and click on the Events tab. For more information on American Diabetes Month, visit To learn more about chronic kidney disease as it relates to diabetes, visit  

Additional Resources
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
Medicare Parts A through D
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. 

Disease Management

Network4SMEsNetwork 4 is looking for patient subject matter experts
Quality Insights Renal Network 4 is looking for patient volunteers ready to make a difference by working to improve the care dialysis patients receive. Do you  know a patient that would be interested in being part of a group that meets just a few times each year through phone calls?

The NEW quality improvement work groups we are forming for our work in 2018 include:
  • Reducing Bloodstream Infections: We need the patient voice to explore ways to improve infections for patients in Network 4
  • Increasing the Use of Home Dialysis Modalities: Help us learn ways to improving the number of patients who dialyze at home in the Network 4 area
  • Increasing the Number of Patients who are Put on the Transplant Wait List: What improvements can be made to increase the number of patients on the Transplant Wait list from Network 4?
  • Improving the Number of Patients who are Screened for Depression: We need the patient voice to help us improve this CMS requirement in Network 4 dialysis facilities
  • Patient Learning and Action Network at the National Level: This is an opportunity for patients to be part of a group that works on tools to improve care patients receive across the country. This active committee meets monthly.
Download our Subject Matter Expert (SME) flyer to learn more. 

Please let us know if any of these groups interest your patients! Please email Tish Lawson by November 15, 2017. 

FluSeason2Flu Season Updates

Don't Wait Until You're "Sick as a Dog"
Quality Insights Quality Innovation Network recently developed this poster as part of its adult immunization task work to encourage individuals to get a flu shot. 

home health imagepack Exerciseexercise is beneficial for patients on dialysis
At Network 4's September Patient Representative Meeting, attendees discussed the benefits of exercise for patients who are on dialysis.  Patient Representatives were very responsive to the discussion and asked for recommendations for appropriate exercise. The following tips can be helpful to pass along to dialysis patients: 
  • Talk with your doctor. Your doctor can help you decide what is best for you and give you ideas on what kind of exercises you can enjoy.
  • Decide what kind of exercise you like. You should pick an exercise that you enjoy. For example, many people enjoy walking. Walking is one of the least strenuous exercises we can do, but it's also one of the healthiest. Walking helps with many bodily functions all at the same time.
  • Get started. But start slowly. Exercise at your own pace. You can always build up over time. 
  • Stretch. Always stretch before and after exercise. Proper stretching reduces the chance of cramping and helps you to exercise more comfortably. It also helps you to unwind when you are done exercising.
NHSNlatest NHSN Release Notes include changes to healthcare personnel safety and dialysis components 
Changes to the Healthcare Personnel Safety Component
  • Some issues with the HPS annual surveys - Even though a 2017 Home survey has been saved as complete, the application generated an error message when attempting to save HPS Monthly Reporting Plans (MRPs) for 2017-2018. MRPs can now be saved if a Home survey has been completed. The issue about being able to save a Home survey for 2016 will be resolve in a future release; the Home survey is only applicable for 2017 and going forward.
Changes to the Dialysis Component
  • DOB field on the Patient and Event form - There was an issue when using the calendar to edit the patient's date of birth. 
AKIAKI 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
Approaching Deadline for Compliance: CMS Emergency Preparedness Final Rule
On September 8, 2016 the Federal Register posted the final rule Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. The regulation went into effect on November 16, 2016. Health care providers and suppliers affected by this rule must comply and implement all regulations one year after the effective date, on November 15, 2017. Learn more by visiting the Kidney Community Emergency Response website, which provides resources for facilities that include Interpretive Guidelines and Survey Procedures, a survey tool and a knowledge center. The Rule requires dialysis facilities to conduct two emergency preparedness exercises per year.  One must be full-scale, but the other may be a "table-top exercise," a group discussion led by a facilitator using a narrated, clinically-relevant emergency scenario that challenges an emergency plan. KCER is also preparing a variety of table-top exercise templates that facilities may copy.

Revised 2017 ICH CAHPS Fall Survey Data Collection Schedule 
As you know, there has been a delay in providing the 2017 ICH CAHPS Fall Survey sample files to vendors due to a problem with CROWNWeb files.  Below is the revised tentative schedule for the 2017 Fall Survey. If any changes are required due to issues with the sampling process, vendors will be alerted as soon as possible.  Please contact the ICH Coordination Team via e-mail at or call 1-866-245-8083 if you have any questions about this.
  • Mail 2nd Questionnaire (mail only)/Begin phone follow-up (mixed mode):  12/6/2017
  • Data Collection Ends:  1/17/2018
  • Vendors Clean/Process Final Data and Construct XML File:  1/18/2018 - 1/31/2018
  • Deadline for Submitting XML Data File to ICH Data Center:  1/31/2018

UpcomingEventsUpcoming events
Save the Date for November 9: Infection Disease Webinar
On November 9, 2017, from 2:00 - 3:00 p.m. ET, ASPR TRACIE and the National Ebola Training and Education Center (NETEC) will host the webinar "Highly Pathogenic Infectious Disease Exercise Planning for Healthcare Coalitions." This fourth in a series of joint webinars will highlight NETEC's free exercise templates for HCCs to test their readiness to manage patients suspected or known to have a highly infectious disease and will feature speakers from HCCs that have already exercised their plans. Stay tuned for additional details and a registration link.

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 

CDC Offers "Get Ahead of Sepsis" Resources
The CDC's "Get Ahead of Sepsis" program has published four new resources: Learn more about the program and additional resources by visiting the CDC website

Latest Edition of KCER Watch Now Available
The October 2017 edition of KCER Watch - a monthly environmental scan that provides timely and pertinent information related to emergency preparedness - is now available. 

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

Executive Director
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Quality Improvement Coordinator
Patient Services 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. ESRD4-101317