July 2021
Announcements & Updates
WE NEED YOUR HELP! Safelist Constant Contact Web Domains to Ensure Important Network Communications are Received
In an effort to improve the IPRO ESRD Network Program's ability to ensure educational materials and public announcements get the right information, to the right people, at the right time, we need your help.

Certain firewall and intrusion prevention security programs can interfere (or block) email coming from Constant Contact (the Network’s service for email communication). You can tell your security program that content from Constant Contact is okay to view by putting Constant Contact's domains or IP addresses on a safelist (formerly referred to as a whitelist).

ACTION: Search on the web page of your security program for instructions to find out how to locate and add "safe senders" or contact your IT department directly. You'll need to add Constant Contact's URLs or IP addresses to the safe sender list.

Constant Contact URLs

If your program allows website URLs, copy the following Constant Contact URLs and add them to your safelist:

  • constantcontact.com
  • r20.rs6.net
  • a.rs6.net
  • rs6.net
  • s3.amazon.com
  • files.ctctcdn.com
  • files.constantcontact.com
  • files.ctctusercontent.com

Constant Contact IP Address

If your program allows IP addresses, add this Constant Contact IP Ranges to their safelist:


The formatting (CIDR notation) above signifies a range or IP addresses which is equivalent to 208.75.123.* and 205.207.106.*

Note: Some security programs will prompt you to restart your computer, to allow the changes to take effect.

If staff in your organization are still having any trouble, and not receiving email communication from the Network, via Constant Contact, please call the Constant Contact technical support line at 866-289-2101 for additional help.
Now Recruiting Patient Facility Representatives (PFR):
Submit a Nomination TODAY!
Patient and Family Engagement (PFE) is an integral part of a successful healthcare team. Acknowledging the positive impact of empowering patients, the IPRO ESRD Network Program aims to increase the numbers of patients and family members representing dialysis facilities through the recruitment of Patient Facility Representative (PFR), previously known as the Network’s Patient Advisory Committee (PAC) members.

Throughout 2021, the IPRO ESRD Network Program will be supporting dialysis facilities and PFR members by providing them with training, resources, interventions, and educational tools to utilize at the facility level. PFE in healthcare is essential to achieve successful outcomes at the facility. PFR members should be incorporated into the Quality Assurance Performance Improvement (QAPI) to provide the patient perspective. This would allow the Network and facility staff to evaluate how PFE has impacted quality measures and patient satisfaction.

ACTION: Facilities are asked to identify and nominate a PFR member (more than one can participate) to help facilitate quality improvement activities. All patients interested in becoming PFR members must have a Patient Facility Representative (PFR) Application and Confidentiality Agreement completed by facility staff.

If your facility already has an existing PAC member that wishes to continue to serve as the PFR, please contact Danielle Andrews, MPH, MSW, GCPH, Community Outreach Coordinator, at 516-209-5549 or danielle.andrews@ipro.us to confirm their ongoing participation with the Network.
Please Report COVID-19 Breakthrough Cases
The Centers for Disease Control and Prevention (CDC), Making Dialysis Safer Coalition, is working to characterize end-stage renal disease (ESRD) patients on maintenance dialysis who are diagnosed with SARS-CoV-2 infections after being fully vaccinated.

CDC is requesting healthcare providers who work with patients with ESRD on maintenance dialysis to report SARS-CoV-2 infections that meet the following criteria:

  • Patients with ESRD on maintenance dialysis (hemodialysis or peritoneal dialysis) with a laboratory-confirmed SARS-CoV-2 infection diagnosed by PCR, other NAAT, or antigen who are >14 days from receipt of the second COVID-19 vaccination of a two-dose COVID-19 vaccine, or >14 days from receipt of the first COVID-19 vaccination of a one-single dose COVID-19 vaccine.

ACTION: If you have any cases to report, please email CDC’s Dialysis Coalition email box dialysiscoalition@cdc.gov using the subject line: “Breakthrough cases”. Include in your email*:

  • First and last name
  • Facility name
  • Phone number

*Please do not include any patient names or personal identifiers.
Extreme Summer Heat
The heat and humidity may cause heat stress during outdoor exertion or extended exposure. Extreme heat can cause illness and death among the at-risk population who cannot stay cool.

Planning Recommendations:
  • Dialysis centers are advised to review their emergency management plans and anticipate impacts on service should they be impacted by air-conditioning failure or water contamination which can be common during the summer months.

  • Tips for Dialysis Patients (PDF) - Please use this Kidney Community Emergency Response (KCER) flyer as a handout for your patients who may struggle with the impact of summer heat. 
  • Additional heat preparedness resources can be found at Ready.gov - Extreme Heat
Quality Improvement Initiatives
Improving Patient Safety and Reducing Harm in Nursing Home Dialysis
ESRD Networks have been tasked by the Center for Medicare & Medicaid Services (CMS) to decrease the rate of infections in peritoneal and venous catheters used for dialysis and the amount of blood transfusions given to ESRD patients dialyzing in a nursing home, keeping with our focus of improving health outcomes and access to care in vulnerable populations. The IPRO ESRD Network Program has organized both of these goals into one overarching quality improvement activity (QIA) due to the close nature and overlapping focus areas. The Network will be closely monitoring dialysis programs providing home modalities to patients residing in a nursing home. QIA initiatives include:

  • Decreasing dialysis catheter infection rates
  • Decreasing peritonitis rates
  • Anemia management and the reduction of blood transfusion rates

The Network recognize that dialysis in the nursing home is not a widespread practice at this time. However, with the advent of the pandemic there was a noted interest in home therapies for nursing home residents and it is anticipated this form of home therapy will continue to grow. For the next five years, CMS has provided a unique opportunity for the Network to be involved the initiation of a new quality improvement project and the IPRO team has been working diligently to identify barriers, and gather educational resources to help dialysis facilities and nursing home staff improve the quality of care and outcomes for this population. 

The Network will be providing more information in the coming months as educational tools are developed.
Improving Patient Outcomes by Reducing Hospital and Emergency Room Visits
Every year 37% of ESRD patients are hospitalized. One in three will be readmitted in 30 days for the same condition as the initial visit. Patient outcomes deteriorate with each hospital and emergency room visit, with the greatest negative impact to those patients greater than 65 years of age.

The Centers for Medicare & Medicaid Services (CMS) has tasked ESRD Networks to collaborate with facilities to improve patient outcomes by reducing hospitalizations, unplanned hospitalizations and Emergency Room (ER)visits.

Your Network Quality Team will be working closely with a small intervention group (community coalition) and regional hospital quality and leadership membership to effect this change. The Network Service Area will also be provided all resources and interventions to implement. This quality improvement activity (QIA) aligns with the Quality Initiatives Program (QIP) metrics. Therefore, by improving patient outcomes your facility may reduce payment reductions.

Safely and effectively transitioning patients to and from the hospital and receiving patients from the hospital are fundamental to reducing subsequent readmissions and emergency room visits. Obtaining timely patient information after patients return to dialysis from hospitalization has always been a major area of concern. An effective communication process is essential to ensure a safe patient hand-off between healthcare settings and should require the active participation of both a sending provider and a receiving provider.

Establishing a good system of communication between healthcare settings is the key to successful care transitions. Here's an immediate action your facility can take to improve communication aimed at reducing hospitalizations, ER visits and readmissions: 

ACTION: An Immediate action your facility can take to reduce hospitalizations, ER visits and readmissions:

  • Appoint a transitions champion to perform a “warm handoff” between all care transitions, i.e hospital and ICHD, ER and ICHD, to reduce medication errors and promote patient follow up with the correct provider.  
  • The ESRD forum has produced a Transitions of Care Toolkit. Chapter 8 is specific to smoothing transition of care between ICHD and hospitals.
Learning, Listening and Teaching: Providing a Clear Consistent Message
The choice of home modality has been shown to enhance a patient’s quality of life and improve patient outcomes with better blood pressure control and fewer hospitalizations.

Network communications with current in-center hemodialysis patients has identified the need for additional patient and staff education on home modalities. Educating your facility staff on home modality options is essential to providing patients with clear consistent messaging when discussing peritoneal and home hemodialysis. Each staff member should have enough understanding of these modality options to answer basic questions while providing encouragement and guidance to their patients. Staff should understand the steps to home utilization and provide contact information to area home programs to interested patients and family members. Facility home modality educational policies should include educational materials, testing competencies, and communication guidance with emphasis on empathy, listening, and patient preference to ensure consistent messaging on this topic and ultimately appropriate patient modality selection.

The ESRD National Coordinating Center (NCC) Home Dialysis Universal Staff Education Course will give dialysis staff an educational option and provide 1.5 CEs (applies to RNs, MSWs, RDs, and technicians) upon completion of the following modules. Please share the link with all facility staff members.

  • Course Module One: Toward Home: Understanding and Empowering Dialysis Choices
  • Course Module Two: Clearing the Road to Home: Overcoming Barriers and Misconceptions to Home Dialysis
  • Course Module Three: Putting It All Together To Make a Difference
Is Communication with Transplant Centers Working Out for Patients?
Good communication between dialysis facilities, transplant centers and patients has been a key best practice that leads to patients successfully moving through the transplant process and eventually obtaining a kidney transplant. However, communication with transplant centers has often been described as a challenge that dialysis providers experience. To improve communication, providers have sometimes developed internal tracking systems or processes that would help them support the patient through the transplant process. Some dialysis providers have access to communication softwares that facilitate bidirectional communication with the transplant center. To learn more about some of these softwares and how it can work for your facility, please watch the recorded demos for:

ACTION: If your organization does not have access to a tool that streamlines communication with transplant centers, the Network encourages facility leadership discussion of these and other possible alternatives to consider for implementation.
Vaccination Reporting and Tracking
Have you ordered flu vaccines yet?

All Medicare certified dialysis facilities are required to report in the National Healthcare Safety Network (NHSN) and track vaccination status for:

  • COVID-19 (patients and staff)
  • Influenza (patients and staff)
  • Pneumonia and Hepatitis B

Part of the ongoing initiatives of the Network is to work with providers that have low vaccination rates for both patients and staff.

ACTION: Please start reviewing the facility's vaccination planning during QAPI and know your vaccination rates, barriers, and share your success stories with the Network. Network staff will be reaching out to facilities to discuss vaccination planning, processes, and overall rates. Remember, if you are part of a Large Dialysis Organization your corporation delivers clinical data via batch submission weekly (for COVID-19 NHSN) and monthly for EQRS/CROWNWeb. If the facility is not using batch upload for submitting data, make sure staff is reporting accurately for the clinic, and that the facility is prepared for the upcoming flu season.
Patient Services
Virtual Quality Assessment/Assurance Performance Improvement (QAPI) Meetings
QAPI is a combined approach of two mutually reinforcing aspects of a quality management system: Quality Assurance (QA) and Performance Improvement (PI). QAPI takes a systematic, comprehensive, and data-driven approach to maintain and improving safety and quality in nursing homes while involving all nursing home caregivers in practical and creative problem-solving.

Similar to virtual support groups, virtual QAPI meetings utilize online applications such as Webex, Zoom, and Google Meets. Creating and conducting virtual QAPI meetings should consist of:

  1. Assessing your facility's patient representatives, advocates, PAC members, and advisors to determine which online platform is the most patient-friendly and easily accessible.
  2. Choosing a patient representative from each shift to get a stronger reflection of the patient population
  3. Addressing previously discussed issues to determine if procedural changes were effective in remedying this issue for the patient population
  4. Assessing new issues to patient care
  5. Allow for the sharing of the patient perspective, as well as the staff perspective on the best way to remedy ongoing issues

QAPI Resources:
Educational Opportunities Culturally Responsive Practices for Mental Health
Mental Health is a growing concern in the ESRD community, and with that comes the responsibility to assist patients to improve mental and emotional wellbeing. The dialysis population is culturally diverse and the type of support provided should be culturally appropriate to meet their individual needs.

The Mental Health Technology Transfer Center (MHTTC) Network is hosting online sessions this month for its Culturally Responsive Evidence-Based and Community-Defined Practices for Mental Health Series. Below are two opportunities to expand professional skill set to continue to meet the cultural needs of the people in the ESRD community.

Effects of Peer Mentoring on ESRD Patients
The April 2015 article Potential Impact of Peer Mentoring on Treatment Choice in Patients with Chronic Kidney Disease: A Review, by Dr. Ghahramani, states that Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD) have been directly correlated with increased mortality, morbidity, and overall medical cost. Complexities of a CKD or ESRD diagnosis have created an increased passiveness among new patients that have taken a less active approach in the kidney treatment plan. Additionally, ineffective education of patients and increased passiveness have been associated with increased morbidity and mortality among ESRD patients. According to Dr. Ghahramani, the utilization of a peer mentoring program has the potential to reinforce self-management skills, activities, increase overall patient engagement and improve healthcare outcomes. Moreover, an effective peer mentoring program can be divided into seven model approaches: professional-led group visits, peer-led self-management training, peer coaches, community health workers, support groups, telephone-based peer support, and web- and email-based programs. Dr. Ghahramani noted the success of peer mentoring programs has been attributed to its individualized, patient-centered approach with an emphasis on decision and self-management skills to help improve health outcomes. The relationships built through peer mentoring have the ability to establish trust and recognize individualized healthcare barriers that may have a negative impact on a chronic healthcare condition. These relationships have been correlated with decreased feelings of isolation and increased coping skills among CKD patients. Peer mentoring can equip CKD patients with the necessary skills to combat ongoing anxieties and increase self-awareness.

For more information on Peer Mentoring, please visit the IPRO ESRD Network Program website at https://esrd.ipro.org/patients-family/pfe/peer-mentoring/
Navigating the Ticket to Work Program
The Social Security Administration's Ticket to Work program connects individuals with free employment services to help them decide if working is right for them, prepares them for work, find employment or maintain success for patients who want to continue to work. Services offered include career counseling, vocational rehabilitation, and job placement and training from authorized Ticket to Work service providers, such as Employment Networks (EN) or your State Vocational Rehabilitation (VR) agency.

Each month the Ticket to Work program hosts the Work Incentives Seminar Event (WISE), which are free webinars on vocational rehabilitation services for eligible populations. They are held on the fourth Wednesday of each month. Past WISE webinars can be accessed at WISE on Demand. The next webinar will be held:

When: Wednesday, July 28, 2021
Time: 3:00pm – 4:30pm (EST)

Please also visit the IPRO ESRD Network Program website for additional information and resources about vocational rehabilitation.
Data Systems and Reporting
EQRS Clinical Data Reporting Update
On January 29, 2021, the Centers for Medicare & Medicaid Services (CMS) suspended End-Stage Renal Disease (ESRD) Quality Reporting System (EQRS) Clinical Data, In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) Attestation, and Clinical Depression Screening and Follow-Up Plan submissions in EQRS.

As of May 26, 2021, all EQRS users must continue to follow the data suspension guidelines outlined via the January 29, 2021 EQRS Announcement (Accessible via: https://mycrownweb.org/2021/01/eqrs-system-announcement-jan-2021/). 

Please note that this temporary suspension applies to Clinical Data, ICH CAHPS Attestation, and Clinical Depression Screening and Follow-Up Plan submissions ONLY. Users must continue to use EQRS to complete tasks such as admit and discharge patients, complete CMS forms (such as the 2728, 2744, and 2746), add or update treatment summaries, and resolve accretions within a timely manner. Users should also continue to keep facilities’ information up-to-date on the Facilities screen in EQRS.

Submission deadlines on the Facility Dashboard, Clinical, ICH CAHPS Facility Attestation, and Clinical Depression Screening and Follow-Up Plan screens will be updated, as needed.

Impacted Clinical Months may continue to transition from “Open” to “Closed” on the Clinical screen, but will be re-opened to allow data reporting, once data submission resumes.

Facilities must continue to gather and maintain patients’ clinical data and plan to provide all necessary data, once data reporting resumes.

CMS will provide updated information on submission requirements and deadlines.

CMS is aware of the challenges that some users are experiencing with submitting data via EQRS. CMS is committed to ensuring the accuracy and reliability of data, and are working to rapidly resolve these issues. CMS will continue to monitor and assess its systems for any issues on an ongoing basis as a part of continuous process improvement and to ensure a positive user experience.

For further information please visit QualityNet at https://qualitynet.cms.gov/ or contact the QualityNet Help Desk at 1-866-288-8912, Monday – Friday (7 a.m. - 7 p.m. CT).
Auditing Data Entered in the End-Stage Renal Disease (ESRD) Quality Reporting System (EQRS)
As outlined on page 33 of the 2021-2026 ESRD Statement of Work, CMS is requiring ESRD Networks to audit the data entered by facilities in EQRS to ensure the accuracy of the information on all 2728 and 2746 forms and the EQRS Patient Roster. Twenty percent (20%) of facilities in the Network service area will be selected for this auditing process. The Network will select ten patient records per facility for auditing. Facilities will be requested to provide patient medical records and a facility patient census report to verify the information in EQRS. The Network will provide feedback to facilities on the outcome of the audit, as well as technical assistance during and after the audit. This work is expected to start in the fall of 2021.
Monitoring Data Submission Compliance

  • New patients are admitted into EQRS within 5 business days of the first treatment.
  • 2728 forms are submitted within 45 days of the date of regular chronic dialysis. They are considered late after 45 days.  
  • 2746 forms are submitted within 14 days of the date of death. 

ACTION: Facilities should have an established internal process to meet these timelines and include this as a measurement in their overall facility Quality Assurance and Performance Improvement (QAPI) process. The Network will monitor compliance and will provide facilities with a monthly compliance report. Facilities that are not meeting the CMS Data Management Guidelines will be asked to develop a performance improvement plan and will be provided technical assistance until the goals are met.
Information Systems Technical Assistance
The IPRO ESRD Data Department provides technical assistance using a customer support system. This is one place for your data submission needs for various systems such as CROWNWeb, NHSN, Dialysis data or Quality Incentive program. In order to meet the needs of our facilities, the new system will provide support:

  • Email: To reach the Network Data Support Team by email, send requests for assistance to IPROESRDHelp@iproesrdnetwork.freshdesk.com. The help can be a return email providing information about the data submission from our knowledge base or a phone call from the staff.

  • Support Portal: By registering for the IPRO ESRD Network Support Portal, you will be able to quickly and easily submit questions and requests for assistance directly to the Network Data Support staff. You can register for the portal by going to http://help.esrd.ipro.org and selecting “Sign Up”.

  • Knowledge Base: The Network Data Team has documented answers to a multitude of “Frequently Asked Questions” and have posted them to the Knowledge Base on the Support Portal. You can browse the different knowledge items, and if you still need help, you can register for the portal and submit a ticket for help. The Knowledge Base can also be located at http://help.esrd.ipro.org.

NOTE: When submitting a request to the Network, you should NEVER include any patient-specific information such as Name, Date of Birth, Social Security Number, Medicare Claim Number, etc. The only patient identifier that can safely be communicated is the Unique Patient Identifier (UPI) from CROWNWeb.

For more information, please visit the Network website.
Network Staff Directory
Susan Caponi, RN, BSN, MBA, CPHQ
(516) 209-5619

Jeanine Pilgrim, MPH, PMP, CPHQ, CHES,CPXP
Network Program Director
(516) 209-5365

Anna Bennett
Emergency Manager/QI Coordinator
(516) 209-5474

Erin Baumann, LMSW, MSL
Patient Services Director
(516) 209-5348

Jaya Bhargava, PhD, CPHQ
Regional Operations Director
(203) 285-1215

Shasha Aylor, MBA
Data Analyst
(919) 463-4520
Laura Edwards
Administrative Coordinator
(516) 209-5672

Elena Balovlenkov, RN, BSN, MS
Quality Improvement Director
(516) 209-5416

Danielle Andrews, MPH, MSW, GCPH
Community Outreach Coordinator
(516) 209-5549

Kathryn Betts, MSW
Patient Services Coordinator
(919) 463-4529

Sharon Lamb
Data Coordinator
(516) 209-5459