This ESRD facility monthly newsletter highlights the latest ESRD insights and resources. Our goal is to provide you with a resource that makes it easy for you to stay on top of trends and support you in providing the best possible care for those you work with and serve.

In This Issue: 

• News You Can Use 
• Patient Services
• Home Dialysis
• Hospital Admissions, Readmissions and Emergency Visits
• Transplant
• Vaccinations
• Patient and Family Engagement
• EQRS

News You Can Use 

May 1, 2024, marked the beginning of Year Four of our five-year ESRD Network contract with the Centers for Medicare & Medicaid Services (CMS). This contract cycle runs from May 1 through April 30, 2025. CMS made the following contract modifications this cycle:

• Removed depression screening and treatment measure 
• Removed nursing home measures 
• Removed telemedicine measure
• Changed definition of “incident” for home dialysis from day one initiation on home modality to use of home modality within 90 days of treatment start
• Removed data quality measure related to 2728 submission for forms more than one-year-old

We will continue to focus on:

• Home dialysis – incident and transition to home from in-center
• Hospitalization – admissions, unplanned readmissions, and ED visits
• Transplant – additions to waitlist and actual transplants
• Vaccinations: 
  • Patient – pneumococcal, flu, and COVID-19
  • Staff – flu and COVID-19
• Data quality – submission of 2746 form within 14 days of death; submission of 2728 form within 45 days of start of dialysis
• Patient and family engagement – Patient participation in QAPI, life plan development, and patient-to-patient support programs    

Notifications were sent to all facilities we will work with through October 2024. Please keep an eye on your email and schedule your one-on-ones as requested. We are in the process of updating monthly facility report cards to reflect contract changes. We anticipate having all updates made by June distribution. As a reminder, if you have questions about the measures, please review the measure specifications linked at the bottom of the page. Also, because these measures are cumulative, most of you will have a “green” report card for the first few months. By July, expect to see some red creeping in as the dataset grows. 

Call For Nominations
Network 8 has two Medical Review Board vacancies. We need nominations for a physician from East Tennessee and a social worker from West Tennessee. If you are a social worker and would like to nominate yourself, please do! If you would like to nominate a physician, please obtain his/her permission prior to sending the nomination. Send all nominations to sheila.mcmaster@allianthealth.org.

New EQRS Rebranding and Top Navigation Bar Updates
On June 10, 2024, CMS will release an update to the top navigation bar, allowing users to change applications more easily. This will simplify moving between the EQRS and QIP applications and allow users with access to multiple facilities to change more easily between facilities. The update will not affect the existing Dashboard, Facilities, Patients, and Reports options and sub-options in the navigation bar. CMS will release additional instructions on using these new features when the feature is released on June 10.

Free Nursing Continuing Education Credits
Sepsis Alliance is hosting the 2024 Sepsis Alliance Symposium: Sepsis in Immunocompromised Patients. This live, virtual event will cover critical topics related to sepsis in immunocompromised patients, including a special focus on cancer and HIV patients. The key outcome of this half-day event is to establish the burden of sepsis in immunocompromised patients and improve clinical outcomes for immunocompromised patients affected by sepsis.
Covered topics will include:

• Infection and sepsis burden and risks in the immunocompromised host
• Sepsis recognition and care considerations in the immunocompromised patient
• Sepsis and acute respiratory failure in patients with cancer
• The effect of HIV infection on the host response to bacterial sepsis
• Outcomes of patients with or without HIV infection

Suggestions
If you have ideas for how the Network can better assist with quality improvement, EQRS, or patient care needs, please email sheila.mcmaster@allianthealth.org. We are here to help, so send suggestions our way!

Patient Services
 

Do you have questions or concerns about how to deal with challenging patients? Our patient services team offers consultation and training to anyone who needs more information related to the role of the Network on topics such as involuntary discharge, conflict resolution, CLAS and patient/staff dynamics.

Please consider offering this service to any staff members who were hired post-pandemic. Understanding how the Network can help and reaching out when navigating complicated patient situations can be immensely beneficial. We can serve as a missing piece to the puzzle. Contact Ericka Webb, senior patient services manager for Network 8 (ericka.webb@allianthealth.org) or Cassandra Hanna, patient services manager for Network 14 (cassandra.hanna@allianthealth.org). 

Contacts:  
Network 8: ericka.webb@allianthealth.org  
Network 14: cassandra.hanna@allianthealth.org 

Home Dialysis

Home dialysis continues to grow, and patient education is being provided consistently; however, patients often have barriers that prevent them from converting to a home modality. Some of these barriers are unsurmountable, and not every patient is a candidate. However, many barriers can be broken by finding the root of the problem. Is it fear, transportation, space or lack of a caregiver?

Utilizing the interdisciplinary team for barrier discussions and ways to mitigate barriers can be helpful. Change can be uncomfortable but typically brings about growth, satisfaction and patient empowerment. Empowering and providing our patients with independence through a home modality should continue to be a priority for facilities to strive toward. Getting Creative to Break Down Barriers to Home Dialysis is a helpful resource that discusses common barriers and creative ways to mitigate those barriers.  

Home Dialysis Contacts: 
Network 8: katherine.buntin@allianthealth.org
Network 14: grace.robbins@allianthealth.org 

Hospital Admissions, Readmissions and ER Visits

The hospitalization measures may seem daunting, but we are here to help. The hospitalization rates in your report card will differ from your internal facility hospitalization rates, as CMS is looking at Medicare Fee For Service patients with a specific list of ESRD-related diagnosis codes that are billed as the primary admission diagnosis by the hospital. 

Re-admissions are defined as admissions that occur within 30 days of an ESRD-related inpatient discharge. Emergency department (ED) visits are those ED visits for any of the ESRD-related diagnosis codes. The Network has access to data that shows patient-specific hospitalization information, including primary diagnosis code as billed by the hospital, which can be very helpful in addressing issues of patients to help prevent hospitalizations. The hospital change package provides various strategies found to be successful in improving hospital outcomes. If additional assistance is needed, please reach out to Koby Guthrie at the email address provided.

Resource:

• ESRD NCC Hospitalization Change Package

Hospitalization Contact: koby.guthrie@allianthealth.org

Transplant

The kidney transplant waitlist continues to increase as new patients are added. Some of these patients face barriers that can hinder their progress in the transplant process and delay transplant. Some patients with more challenges to overcome tend to give up on the waitlist when those barriers become too overwhelming and unattainable. Getting Creative to Break Down Barriers to Transplant is a guide to help care teams and their patients identify solutions to common barriers that can be a challenge to overcome. 

Transplant Contact: arlandra.taylor@allianthealth.org

Vaccinations: Back to Basics

Our improvement focus during June and July is immunization against pneumococcal disease. From May 2024 to April 2025, ESRD Networks are charged with helping dialysis facilities improve pneumococcal vaccination rates by 10%. The importance of this vaccine is data-driven. According to the National Institute of Infectious Diseases, pneumococcal pneumonia hospitalizes 150,000 people in the United States each year, killing 1 in 20. 

Pneumococcal meningitis and bloodstream infections are less common but more deadly and can result in lifelong disability, including deafness, brain damage, and limb amputation. A 2021 report in Scientific Reports noted the overall mortality rate is relatively unchanged over the past few years at 20.8%. Older age (64 years old and older) and underlying chronic diseases were two of the multiple factors influencing mortality from invasive pneumococcal disease.

According to the CDC, more than 31,000 cases and more than 3,500 deaths from invasive pneumococcal disease (bacteremia and meningitis) are estimated to have occurred in the United States in 2017. Over half of these cases occurred in adults who indicated pneumococcal polysaccharide vaccine. Helpful resources are listed below; additional resources are available if needed.

Resources:

• ESRD NCC Vaccine Change Package
• CDC Pneumococcal Disease

Vaccination Contact: hayley.errington@alllianthealth.org 
 

Patient and Family Engagement (PFE)

The Network has a new way to provide patient education. In April, the Network released its first Toonly video on YouTube to explain what a facility patient representative (FPR) is, what they do and how to become an FPR. Patients can watch the video in their language of choice and/or using closed captions. Viewers can leave comments to let us know if the video was helpful or offer suggestions for improvement. Facilities can tie the video into their computer systems and loop the video to the lobby television for patients to watch while waiting for treatment or transportation. Access the Toonly using the video link below. Please leave a comment and let us know what you think.

Meeting CMS QAPI Expectations for Medicare-Certified Facilities
CMS expects Medicare-certified facilities to include patients' voices in their QAPI (quality meetings), set goals (Life Plans), roll them into the patient’s plan of care, and provide a patient-patient support program. Below are some resources from the ESRD NCC to assist you with ensuring your facility meets CMS QAPI expectations. 

Resources:
QAPI Professional Resources

• Helping Patients Understand their Role in QAPI (English) (Spanish)   
• Patient Engagement in QAPI
• Module Part 2: Overcoming Barriers with QAPI
• Module Part 3: QAPI self-survey

QAPI Patient Resources

• Understanding and Participating in QAPI (English) (Spanish)
• Part 2: Overcoming Barriers to Attending QAPI Meetings (English) (Spanish)
• Because Your Voice Matters! (English) (Spanish)

Patient and Family Engagement Contacts: 
Network 8: casey.rich@allianthealth.org 
Network 14: debbie.odaniel@allianthealth.org 

EQRS

Dialysis Patients Receiving a Transplant or Treating in Your Facility After a Transplant
The best choice for many patients is to receive a transplant. Of course, not all patients are eligible, and some refuse for personal reasons.
 
There are several considerations in how to discharge a patient for a transplant. Patients should be discharged on the last day they were treated in your facility before the transplant. For example, if a patient receives dialysis in your facility on April 15 and receives a transplant on April 16, they should be discharged from your facility on April 15 as Transplant in US (assuming that they are having the transplant in the United States). 

Sometimes, facilities want to hold off on discharging the patient in EQRS to see if the patient will need a kick-start. Please know that is not the correct approach. If a patient does return to your facility to be treated for a brief period following the transplant, they should be admitted on the day they return to your facility as Dialysis in Support of Transplant. There are two possible outcomes from there. One possible outcome is that the transplanted kidney begins functioning. If the transplanted kidney begins to function, discharge the patient as Delayed Function Resolved following a Transplant. Do not select Recovered Function of Original Kidney. This selection may cause the patient to lose approximately two years of Medicare coverage. 

The other possible outcome when a patient is admitted as Dialysis in Support of Transplant is that the transplanted kidney does not function. In that case, the patient should be (1) discharged as Delayed Function Unresolved following a Transplant and (2) admit the patient as Dialysis After Transplant Failed.

Dialysis in Support of Transplant is a temporary (transient admission). This admission status allows the patient to remain on the transplant facility roster while they are treated at your facility. This is important for the proper calculation of Medicare benefits.

If a patient returns to your facility (or comes to your facility) after having had a successful transplant that has now failed, you should admit the patient as Dialysis after Transplant Failed.

There are several factors in admitting a patient whose transplant has failed. The admission reason should be Dialysis after Transplant Failed. If the patient’s transplant lasted over 36 months, then unless they have another reason for entitlement to Medicare, their Medicare coverage will have already been terminated. Even though they don’t have Medicare coverage, they still have a Medicare Beneficiary Identifier (MBI). You must enter that number even if their coverage has lapsed to admit the patient. 

Also, remember that this is a new episode of ESRD for the patient, and that begins when the patient starts receiving dialysis in your clinic. The labs should be within 45 days prior to that date. The status of the kidney transplant will need to be changed from function to non-functioning. This is not something that the dialysis facility can do. Contact the transplant center or to the ESRD Network for assistance. We review these on a weekly basis, so when you generate (or edit) the Re-entitlement 2728, check to see if the status of the kidney transplant has been updated to non-functioning.

Trainings:

EQRS Contacts: 
robert.bain@allianthealth.org or mary.dearman@allianthealth.org