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The mission of the Network includes helping dialysis and transplant facilities to improve the level of care provided to patients with end stage renal disease (ESRD). We accomplish this through providing:

  • Education
  • Resources
  • Technical assistance

We are also involved in the collection and validation of information about persons with ESRD. This information is collected through a variety of means including:

  • EQRS (The old CROWNWeb)
  • The National Healthcare Safety Network (NHSN)

Please review the topics provided on this website for more in-depth information. If you cannot find the resources you seek online, please contact our office.   

Click on your ESRD Network name below to electronically complete and submit your MOU with the Network:

If there have been any changes in key personnel or their contact information has changed, please complete the form below and follow the instructions on the bottom of the form to return it to the Network.

Facility Closure

Emergency Preparedness

One of the major barriers to coordinated and effective care in dialysis facilities is poor communication between:

  • Patients and facility staff.
  • Nephrologists and primary care physicians.

Open lines of communication enhance patients':

  • Satisfaction and experience of care.
  • Adherence to treatment protocols, including:
    • Medication regimens.
    • Dietary restrictions.
    • Dialysis schedules.
  • Ability to self-manage their chronic condition(s).
  • Adoption of preventive behaviors, including:
    • Getting immunizations.
    • Infection control practices, including hand and vascular access washing.

Staff's ability and willingness to listen and empathize can have a profound effect on patients' health outcomes and the provision of quality of care.

The following tools are intended to assist dialysis facilities with improving communication between patients, staff and physicians.

Improving Communication Tools

Staff Communication Patient Audit Tool (PDF) and Materials

This audit tool and supporting materials can be used to receive feedback from in-center hemodialysis patients regarding how and when staff are communicating with them before, during, and after treatment. This easy to implement quality improvement activity can be used to identify areas for better staff and patient communication on the treatment floor and to enhance patient engagement and the experience of care. 

The attached tools include:

We're Not Being Nosy—We Care! 

Is a one-page tool that can used to remind patients of important situations that they should update their care team about.

Retaliation

These resources can be used to educate patients and staff regarding building a culture of safety in which patients do not fear retaliation:

Other Resources

The ESRD Network is working to improve the quality of care for patients receiving dialysis in a Nursing Home (NH) or Skilled Nursing Facility (SNF). Patients that receive dialysis in a NH or SNF can receive dialysis in a den or at the bedside depending on the dialysis program and individual state regulations. The patients do not have to be transported to and from an outside dialysis facility.

Centers for Medicare & Medicaid Services (CMS) has set goals to decrease hemodialysis catheter and peritonitis infection rates, and to decrease blood transfusion rates for dialysis facilities that provide dialysis in NHs. To support CMS’ goals, the Network recommends dialysis facilities use A Change Package to Improve Dialysis Care in Nursing Homes, which includes actionable change ideas, collected from high performing dialysis facilities. The change ideas are intended as a menu of interventions from which leaders can choose to implement within their facilities.

Decreasing Blood Transfusion Rates

Decreasing Catheter and Peritonitis Rates

ESRD National Coordinating Center Resources to Improve Dialysis Care in a NH

EQRS is a web-based data-collection system that allows Medicare-licensed facilities to transmit ESRD-patient data electronically to Medicare (CMS). Access to EQRS is restricted to registered users who have completed security training. Data that is submitted into EQRS is manually entered at the facility level or is “batched” transmitted directly from dialysis-corporation databases.

What can EQRS do?

EQRS provides facilities with a means of reporting their patient and facility data directly to CMS in real-time. The system allows users to:

  • Admit, track, and discharge patients.
  • Complete CMS forms, such as the CMS-2728 Medical Evidence and CMS-2746 Death Notification forms.
  • Submit clinical data including vascular access and lab info to CMS.
  • Submit vaccination data via the Vaccination Module.

Accessing EQRS

Users must register in order to gain access to EQRS. For additional information, help, tutorials, education and more please visit www.MyCROWNWeb.org or contact your local ESRD Network.

Resources

The resources below offer support for the ESRD QIP, Dialysis Facility Compare (DFC), Star Ratings, and Dialysis Facility Reports (DFRs) for performance assessment and improvement.

End stage renal disease (ESRD) quality improvement activities (QIAs) are designed to assist dialysis facilities and transplant centers to achieve optimal clinical outcomes and experience of care for all dialysis and kidney transplant patients. The Network's QIAs are focused on enhancing the quality of service for Medicare beneficiaries by:

  • Gathering information systematically to clarify issues or problems.
  • Implementing interventions to achieve improvements.
  • Measuring quality outcomes.
  • Incorporating the patient voice in all activities to maximize learning
    and cooperation between providers and patients through shared decision-making.
  • Supporting the spread of best practices.

Resources

Dialysis Facility Reports Website

DialysisData.org houses the DFRs and the DFC Reports that include information about directly actionable practice patterns such as dose of dialysis, vascular access, and anemia management, as well as patient outcomes (such as mortality, hospitalization, and transplantation) that can be used to inform and motivate reviews of practices.

Annual DFRs and quarterly DFC Reports are made available to facilities, State Survey Agencies, and Regional Offices online at dialysisdata.org which replaces the old DialysisReports.org website. Only authorized users can access the reports.

Facilities can use the DFR and DFC reports to assist in their quality improvement efforts; state surveyors use the DFR data when deciding which facilities to survey. Facilities are given a chance to preview and comment upon these reports. The quality measures from the reports are posted on the Dialysis Facility Compare website which is used by dialysis patients to review and compare characteristics and quality information on dialysis facilities in the United States. Facilities are also assigned a Star Rating which is solely based on a bell-curve comparison to other facilities.  

General Notes About Accessing DFRs and DFC Reports

  • Facility Administrators are designated as Master Account Holders (MAH) for the Dialysis Data website and are responsible for setting up other user’s accounts for this website.
  • Each year all facility-user accounts (including those of the MAH) are disabled. Shortly thereafter, Facility Administrators receive updated passwords and information for enabling existing and new users and setting permissions for all users (including themselves.) 
  • University of Michigan Kidney Epidemiology and Cost Center (UM KECC) oversees the Dialysis Data website and, with help from Networks, oversees the process of providing IDs and Passwords, and accessing the DFRs.
  • FAQs can be found on the Dialysis Data website regarding the login process, general information, and the Star Ratings associated with DFC measures.
  • Sample reports as well as the methodology and technical documentation can be found on the dialysisdata.org website.

Questions should be directed to the UM KECC helpdesk by sending an email to DialysisData@umich.edu or calling 855.764.2885.

National Healthcare Safety Network (NHSN)

The National Healthcare Safety Network (NHSN), managed by the Centers for Disease Control and Prevention (CDC), is a secure, internet-based system which tracks healthcare-associated infections (HAIs). NHSN provides data to identify problem areas and measure progress of prevention efforts, with the ultimate goal of eliminating HAIs. Participation in NHSN reporting is part of the ESRD Quality-Incentive Program for in-center dialysis facilities treating more than 10 patients.

Enrollment Requirements

In order to access NHSN, facilities need to be set up in NHSN, and individuals need to register as users. This is a multi-step process that requires the completion of online training, installation of a digital certificate, and the submittal of both electronic and paper forms. The entire process can take 2-3 weeks to complete. Below are resources to assist with enrollment:

Data to be reported on NHSN

Each month, facility users must log on to NHSN to indicate their patient census and the results of dialysis-event surveillance.  In general, infection events would include:

  • IV antimicrobial starts
  • Positive blood cultures
  • Pus, redness, or increased swelling at the vascular access site

The following resources can assist dialysis facilities in reducing infection rates.

Reducing Long-Term Catheter (LTC) Use

Catheter Tracking Form

CDC Resources

Other Provider Resources

Patient Resources

The HSAG ESRD Networks, on behalf of the Centers for Medicare & Medicaid Services (CMS), want to make sure that all patients have access to dialysis care in an outpatient setting. No facility takes lightly the involuntary discharge (IVD) of a patient. Challenging patient situations are often the result of unresolved issues involving both the patient and staff, where expectations of responsibilities on both sides are not met. Discharge should ALWAYS be the last resort of resolving an issue with a patient.

In the unlikely event that your facility is faced with making a decision about involuntarily discharging a patient, you must abide by the parameters set forth in the Conditions for Coverage. That includes having ample documentation of your efforts to work with the patient to resolve issues, prior to any discussion of discharge. Unless there is an imminent threat of harm or immediate safety concern, when considering an IVD your first step should be to contact your Network representative. Before you notify the patient, please reach out to the Network here.

Resources

Involuntary Discharge (IVD) Guidelines and Checklist

The Network frequently receives calls regarding the process of involuntarily discharging a patient. Again, it is important  to note that the IVD process should be an option of last resort. Additionally, discharging a patient for "non-compliance" is NOT an acceptable reason for discharge per the Centers for Medicare & Medicaid Services (CMS) Conditions for Coverage. Patients who are non-compliant are at higher risk for morbidity and mortality.

Use these guidelines and IVD checklist when considering an IVD for one of your patients. These checklists should be completed AFTER consulting with your Network representative to ensure proper compliance with CMS protocols. Typically, the checklist  for your facilty must be completed and returned to the Network within two business days of an IVD being completed.

Before considering an IVD, the facility interdisciplinary team (IDT) should conduct a thorough assessment of the situation and develop a plan to address any problems or barriers the patient may be experiencing. In the event that all options have been exhausted, please reach out to your ESRD Network for guidance through the IVD process. For your reference, please find below the IVD checklists for all our Networks and regions. Use these guidelines and IVD checklists when considering an IVD for one of your patients. These checklists should be completed AFTER consulting with your Network representative to ensure proper compliance with CMS protocols. Typically, the checklist for your facility must be completed and returned to the Network within two business days of an IVD being completed.

Network 7—Guidelines and Checklist

Network 13—Guidelines and Checklist

Network 15—Guidelines and Checklist:

Network 17—Guidelines and Checklist

Network 18—Guidelines and Checklist

If you have a new facility that is opening, follow these steps:

  • Complete the HSAG ESRD Networks’ new facility form via this link: www.surveymonkey.com/r/HGSBK3L
  • Email the HSAG Network Data Manager at cwilliams@hsag.com when the form has been completed.
    • The Network will enter the facility in EQRS.
  • Begin registering users in HCQIS (Healthcare Quality Information System) Access Roles and Profile so that your staff will have access to EQRS. For more information about registering users go to harp.cms.gov.
  • Submit the following as soon as you start seeing patients (prior to receiving Medicare license):
  • Once you receive your CMS letter approving your participation in the ESRD program, email a copy of the letter to the HSAG Network Data Manager at cwilliams@hsag.com.

Resources

  • End Stage Renal Disease Quality Reporting System (EQRS) (Formally known as CROWNWeb)
    EQRS is a web-based data-collection system that allows Medicare-licensed facilities to transmit ESRD-patient data electronically to Medicare (CMS). Access to EQRS is restricted to registered users who have completed security training. Data that is submitted into EQRS is manually entered at the facility level or is “batched” transmitted directly from dialysis-corporation databases.
  • National Healthcare Safety Network (NHSN)
    CDC’s National Healthcare Safety Network is the nation’s most widely used healthcare-associated infection tracking system. NHSN provides facilities, states, regions, and the nation with data needed to identify problem areas, measure progress of prevention efforts, and ultimately eliminate healthcare-associated infections.
  • Conditions for Coverage
    CMS ESRD Conditions for Coverage (CfCs). CMS develops CfCs that healthcare organizations must meet in order to begin and continue participating in the Medicare and Medicaid programs. These minimum health and safety standards are the foundation for improving quality and protecting the health and safety of beneficiaries.

The following links are external to HSAG. Should any link not work, please notify Sherry Berg at sberg@hsag.com.

National Kidney Foundation (NKF)

More nutrition resources, including kidney-friendly superfoods, are at the A to Z Health Guide (English / Spanish). Click Patient Education Library links for additional pintable brochures & flyers.

Other

  • American Association of Kidney Patients (AAKP) Nutrition Pocket Guide (English / Spanish)
  • National Institutes of Health (NIH) Tips for People with CKD (English / Spanish)
  • Dialysis Patient Citizens (DPC) Dining on a Budget (English)
  • Spanish/English resources from the DPC Education Center
  • Kidney Community Emergency Response (KCER) 3-Day Emergency Kidney Diet (English / Spanish)

Dialysis Facility Scorecard

Contact your HSAG ESRD Network to obtain your facility's Scorecard. Have questions about the measures? See the Scorecard Measure Specifications.

Resources

Why Promote Gainful Employment?

Working promotes improved quality of life for patients and increases patient positivity by:

  • Creating routines 
  • Maintaining a healthy lifestyle 
  • Boosting self-esteem
  • Increasing:
    • Income
    • Independence
  • Promoting a sense of purpose
  • Enhancing social interaction
  • Reducing risk for depression

Best Practices

  • Offering appointment times that accommodate patients’ work schedules.
  • Educating patients and families about the benefits of working and avoiding disability, when possible.
  • Partnering with local EN/VR programs.
  • Referring patients to the Ticket to Work program, when local EN and/or VR programs are unable to provide services to patients.
  • Enhancing efforts to educate patients, family, and staff by posting educational bulletin boards and hosting Lobby Days.

Resources

Top Tips for Engaging Patients and Hosting a Successful Vocational Rehabilitation (VR) and Employment Network (EN) Lobby Day
A one-page tool providing practical advice for organizing and hosting a productive and successful Lobby Day.

Interested in Returning to Work or School? Did You Know ...
A one-page resource for patients that summarizes the benefits of VN and ER services and offers the patient perspective on returning to work and VR.

Are You Ready for Work?
This one-page resource helps patients determine if they are ready to go back to school or work.

Social Security Administration Resources

Ticket to Work

The Social Security Administration provides resources for both patients and providers. Patients can attend Work Incentives Seminar Events (WISE) or watch videos about a VR success story. Providers can download marketing materials and toolkits to utilize when educating patients.

Use this toolkit to:

  • Create an informational VR bulletin board.
  • Help plan and host a Lobby Day in your facility.
  • Locate and download additional resources for your interested patients, including videos.

National Coordinating Center (NCC) Resource

Getting Back to Me: A Goal-Setting Journey (PDF)
Use this workbook to help patients identify personal goals and set a plan to achieve them. This resource was developed by kidney patients and family members, designed to help restore a sense of dignity and increase self-esteem through goal setting.

Telemedicine Reporting

Reporting patient telemedicine visits in EQRS (formerly CROWNWeb) is required by the Network. Use this simple guide to assist you with reporting each patient telemedicine visit in EQRS each clinical month. This guide also includes Frequently Asked Questions (FAQ) to further help you with reporting this important information.

Download the Guide Here

Note: documents in Portable Document Format (PDF) require Adobe Acrobat Reader 5.0 or higher to view, download Adobe Acrobat Reader.

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Do you have a concern or grievance?

Do you have a concern or grievance? You may call the Network at any time. Learn more by clicking below.

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