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Welcome to the November 17 edition of the Quality Insights Renal Network 4 (QIRN4) e-newsletter. In this issue, we bring you information about many CMS updates, including information on the 2017 final rule, key dates and deadlines for data collection, new fire protection guidelines, ESRD events, resources and much more. We encourage you to contact us
with any questions, concerns or suggestions.  
ICHCAHPSSurveyDataKey dates and data collection schedule for the 2017 ich cahps spring survey 
The tentative data collection schedule and the dates for some key activities related to the 2017 In-Center Hemodialysis CAHPS (ICH CAHPS) Spring Survey have been announced. Please note that these dates are subject to change. Should a schedule change occur, an announcement will be posted. Key dates for the 2017 Fall Survey will be announced later in 2017.  Learn more.  
CMSFireProtectionCMS Proposes new fire protection guidelines for dialysis facilities
CMS has proposed new fire protection guidelines for dialysis facilities.  Public comment will be solicited when the proposed rule is published in the Federal Register.  It updates reference to the National Fire Protection Association Life Safety Code to the 2012 edition, and addresses construction, protection, and operation of dialysis facilities to provide safety for Medicare beneficiaries from fire and smoke.  Some of the primary requirements include self-closing doors to hazardous areas, location of alcohol based hand rub dispensers, provisions for when a sprinkler system is out of service, and requirements for facilities that do not have grade-level exits from the treatment area.  View an advance copy of the proposed rule and the CMS press release.
ACA1557information for ACA 1557 Rule and  REquired Postables now available
Information and links to required postables on the Final Rule implementing Section 1557 of the Affordable Care Act (ACA) are now available. The ACA 1557 requires all healthcare providers receiving Medicare and or Medicaid dollars to post the material that includes nondiscrimination and taglines that alert individuals with limited English proficiency (LEP) to the availability of language assistance services. The translated resources below are available for use by covered entities.
PatientMixPatient Mix Coefficients for the ICH CAHPS Survey Results Publicly Reported in October 2016
CMS began publicly reporting In-center Hemodialysis CAHPS (ICH CAHPS) Survey results on Dialysis Facility Compare (DFC) on the website in October 2016. The ICH CAHPS Survey results that are currently posted on the DFC are based on ICH CAHPS Survey data from the two semi-annual surveys administered in calendar year 2015 (the 2015 ICH CAHPS Spring and Fall Surveys.) The results shown are statistically adjusted for both data collection mode and for patient mix. Learn more about the adjustments made to the survey results and the coefficients used to adjust the results. Information presented in this document will allow ICH facilities to approximate the effect of patient mix adjustment on their ICH CAHPS Survey results that were posted on DFC in October 2016. Please contact the ICH CAHPS Survey Coordination Team at (866) 245-8083 or via e-mail at if you have any questions about patient mix adjustment.

UpdatetoDFCcMS Announces updates to dialysis facility compare: patient experience ratings now available
Today, the Centers for Medicare & Medicaid Services (CMS) announced changes to the Dialysis Facility Compare (DFC) website on, which provides information about thousands of Medicare-certified dialysis facilities across the country, including how well those centers deliver care to patients.

These changes are in direct response to the important feedback CMS has received from dialysis patients and their caregivers about what is most important to them in selecting their dialysis facility. CMS remains committed to seeking and incorporating input from all stakeholders, but especially patients, on an ongoing basis so that we can continually improve our Compare sites and make health care quality information more transparent and understandable for patients and their caregivers.

Since the initial release of the Dialysis Facility Compare website, patients have emphasized in their feedback to CMS that understanding how others like them view a dialysis center- in particular the cleanliness of the facility and how well the staff cares for them- is valuable information when choosing a facility. As a result, visitors to the updated Dialysis Facility Compare website will now be able to see how patients rate their experiences with dialysis facilities.

CMS collects patient experience data though the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) Survey, which measures patients' perspectives on the care they received at dialysis facilities. A total of six ratings on patients' experiences with care will be reported, including three that cover specific aspects of patient experience and three overall patient ratings of the kidney doctors, the facility staff and the dialysis facilities. For each dialysis center on Dialysis Facility Compare, the site will include this patient experience information, the quality star rating, and detailed clinical quality information.

CMS is also adding two quality measures to Dialysis Facility Compare:
  • The standardized infection ratio (SIR) is a ratio of the number of bloodstream infections that are observed at a facility versus the number of bloodstream infections that are predicted for that facility, based on national baseline data.
  • The pediatric peritoneal dialysis Kt/V measure equals the percent of eligible pediatric peritoneal dialysis patients at the facility who had enough waste removed from their blood during dialysis.
Other major changes to the site include modifications to the methodology for calculating dialysis facility star ratings based on recommendations from a 2015 Technical Expert Panel. The updated methodology for calculating star ratings:
  • Establishes a baseline to show improvement by taking into account year-to-year changes in facility performance on the quality measures compared to performance standards set in a baseline year. Star ratings will reflect if a facility improves (or declines) in performance over time.  
  • Limits the impact of a few very low scores by applying a statistical method called truncated z-scores to percentage measures. This ensures that star ratings are not determined by extreme outlier performance on a single measure.  
  • Ensures accuracy of ratings by keeping the continuity of the measures.
A final change to the DFC website relates to ratio measures:
  • The Standardized Mortality Ratio, Standardized hospitalization Ratio, Standardized Transfusion Ratio, and Standardized Readmission Ratio will now be reflected as rates to display them more clearly.
These changes reflect CMS' ongoing commitment to making sure that Dialysis Facility Compare meets the needs of individuals with kidney disease and their caregivers. This Compare website and today's updates are part of the agency's larger effort to make health care quality information more transparent and understandable for consumers.  As part of that effort, CMS also has other Compare websites to help in selecting providers across the continuum of care, including Home Health Compare, Hospital Compare, Nursing Home Compare, and Physician Compare.
For more information, see the fact sheet.

CMSFinalRuleCMS Issues final rule updating payment policies and rates under the esrd prospective payment system 
On October 28, CMS issued a final rule (CMS 1651-F) that updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2017. This rule also:
  • Finalizes new quality measures to improve the quality of care by dialysis facilities treating patients with ESRD
  • Implements the Trade Preferences Extension Act of 2015 provisions regarding the coverage and payment of renal dialysis services furnished by ESRD facilities to individuals with acute kidney injury
  • Makes changes to the ESRD Quality Incentive Program (QIP), including Payment Years (PYs) 2019 and 2020
  • Makes changes to the scoring methodology for the ESRD QIP for PY 2019 and added one new measure
  • Addresses issues related to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and the DMEPOS Competitive Bidding Program
The finalized CY 2017 ESRD PPS base rate is $231.55. CMS projects that the updates for CY 2017 will increase the total payments to all ESRD facilities by 0.73 percent compared with CY 2016.  For hospital-based ESRD facilities, CMS projects an increase in total payments of 0.9 percent, while for freestanding facilities, the projected increase in total payments is 0.7 percent. Aggregate ESRD PPS expenditures are projected to increase by approximately $80 million from CY 2016 to CY 2017.

Changes to the ESRD PPS:
  • Update to the base rate
  • Annual update to the wage index and wage index floor
  • Update to the outlier policy
  • Home and self-dialysis training add-on payment adjustment
Changes to the DMEPOS Competitive Bidding Program:
  • Bid surety bond
  • State licensure
  • Appeals process for breach of contract actions
  • Bid limits
  • Changes for similar items with different features
For More Information: See the full text of this excerpted CMS fact sheet (issued October 28).

EmergencyPreparednessFederal Register posts final rule on emergency preparedness requirements for medicare & medicaid participating providers and suppliers 
On September 8, 2016 the Federal Register posted the final rule Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. The regulation goes 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 16, 2017.

Purpose: To establish national emergency preparedness requirements to ensure adequate planning for both natural and man-made disasters, and coordination with federal, state, tribal, regional and local emergency preparedness systems. The following information will apply upon publication of the final rule:
  • Requirements will apply to all 17 provider and supplier types.
  • Each provider and supplier will have its own set of Emergency Preparedness regulations incorporated into its set of Conditions or requirements for certification.
  • Must be in compliance with Emergency Preparedness regulations to participate in the Medicare or Medicaid program. The below downloadable sections will provide additional information, such as the background and overview of the final rule and related resources.
Additional information has been provided on the left side hyperlinks categorized by information from the EP Rule, such as the Emergency Preparedness Plan, Communication Plan, Policies and Procedures and Testing.

The below downloadable sections will provide additional information, such as the background and overview of the final rule and related resources.

SystemsUnavailableAnnouncement: Systems Unavailable for limited times in December     
CROWNWeb, QIP, QARM, and Secure File Exchange will be unavailable from 6:00 p.m. PST on December 8, 2016 through 9:00 p.m. PST on December 11, 2016.
NHSNDialysisEventSurveillanceNHSN Dialysis Component to be Updated in December; training webinars scheduled
The National Healthcare Safety Network (NHSN) Dialysis Component is scheduled to be updated on December 10, 2016.  To learn about new features and updates, join a webinar on December 1 with an encore presentation on December 2.  Pre-registration is required. Links to pre-registration are below. Contact the NHSN helpdesk with any questions at nhsn@cdc.govFor both webinars, listen-only audio will be available through your computer speakers.  No conference line is available, but attendees will be able to use the chat function to ask questions of the presenters.  
ESRDResourcesESRD resources

General Vaccination FAQs from the CDC 
The Centers for Disease Control and Prevention (CDC) have issued this document with frequently asked questions (FAQs) regarding vaccinations.  

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. ESRD4-110316