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For Providers

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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

Patient Experience and Empathy

Facility staff may find the following videos to be helpful in working through difficult situations with patients:

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

Coalition for Compassionate Care of California

This website is a statewide partnership of regional and statewide organizations, state agencies, and individuals working together to promote high-quality, compassionate end-of-life care for all Californians.

Caring Information

This Web site is an initiative of the National Hospice and Palliative Care Organization (NHPCO) and provides a wide range of free materials about end-of-life care including State Specific Advance Directive Documents.

Aging with Dignity

This is a private, non-profit organization that offers resource and information in 28 different languages for people who are aging with a serious illness.

Additional Resources

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

Following are links to tools that will assist you in achieving your LTC reduction goals:

Catheter Tracking Form

  • This Catheter Tracking form (XLSX) tracks the number of catheters in the facility by month. Use this tracker when completing your monthly reporting to the Network via Survey Monkey link.
  • QAPI QIA LTC Monitoring Form (PDF) tracks the number of patients >90 days who are eligible and who have been referred for a permanent access, and for discussion of progress toward goals during QAPI meetings.

CDC Resources

  • CDC Infection Protection Tools Page
    This page includes additional links to all CDC infection protection tools, including core interventions, the Scrub-the-Hub Protocol, all audit tools and checklists, as well as clinician education.

Other Provider Resources

  • Vascular Access Consultation Appointment Sheet
    This appointment sheet is a helpful way to remind and encourage patients to seek a vascular access consultation.
  • Vascular Access Options (English/Spanish)
    This patient handout illustrates the vascular access options for patients. Review this handout with your patients upon admission to educate them on dialysis access types and to help keep track of their next vascular access appointment.
  • Vascular Access Manager Job Description (PDF) A sample job description for staff offering suggested roles and responsibilities of a Vascular Access Manager (VAM).  This tool is designed to assist facilities in designating the role of a VAM to a staff member for more efficient tracking and monitoring of vascular accesses.
  • Helping Patients Cope with Needle Fear (PDF) This one-page document explains the reality of needle fear and offers tips for staff in helping to reduce the fear of needles.

Patient Resources

  • Hemodialysis Vascular Access (English/Spanish)
    The resource lists the advantages and disadvantages to each hemodialysis vascular access type. Use this handout to educate patients and staff members about the different vascular access types.
  • Sepsis Zone Tool
    This one-page document specifies and categorizes symptoms of sepsis and actions to be taken if those symptoms manifest by green—No Signs of Infection, yellow—Caution, and red—Medical Alert.
  • Sepsis Zone Tool—Spanish
    This one-page document specifies and categorizes symptoms of sepsis and actions to be taken if those symptoms manifest by green—No Signs of Infection, yellow—Caution, and red—Medical Alert.
  • Additional Tips for Needle Fear (English/Spanish) This document offers strategies to help patients overcome the fear of needles so they can use their permanent dialysis access for dialysis treatments.

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 of a patient. Challenging patient situations are often the result of unresolved issues involving both the patient and staff, where each has an expected responsibility.

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. You should also call your respective Network regarding the issuance of a 30-day notice or immediate involuntary discharge at:

  • Network 7 at 813.383.1530
  • Network 13 at 405.942.6000
  • Network 15 at 303.831.8818
  • Network 17 at 415.897.2400
  • Network 18 at 818.696.7040

All efforts to work with the patient and avoid a discharge should be documented in the patient’s medical record. 

Difficult Staff-Patient Situations: De-Escalation in the Dialysis Unit (Presentation for dialysis facility staff training)(PDF)

This presentation can assist with teaching facility management and floor staff to:

  • Identify contributing factors and indicators significant in patients or caregivers who may become difficult or violent.
  • Use measures, techniques, and effective communication skills to decrease the likelihood of violent behavior from occurring and to de-escalate or defuse an explosive situation.
  • Improve staff knowledge and skill in communicating with and caring for the difficult and/or potentially violent patient or caregiver. 

Safety is No Joking Matter

This poster highlights the importance of safety in your facility and that comments and actions are taken seriously. The poster is available in both English and Spanish.

Network 7

Network 17

Resources

Involuntary Discharge (IVD) Guidelines and Checklist

Use these guidelines and IVD checklist when considering IVD for one of your patients. The checklist must be completed and returned to the Network within two business days of an IVD being completed.

The Network frequently receives calls regarding the process of involuntarily discharging a patient. It is important first to note that involuntary discharge (IVD) 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.

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, the Network has several recommendations for the IVD process provided in the guidelines offered in the document below. An IVD Checklist is also included detailing the required steps to use for your facility. Please select your region below.

Network 7—Guidelines and Checklist (PDF)

Network 13—Guidelines and Checklist (PDF)

Network 15—Guidelines and Checklist (PDF)

Network 17—Guidelines and Checklist (PDF)

Network 18—Guidelines and Checklist (PDF)

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 ChrysWilliams@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 ChrysWilliams@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)

American Kidney Fund

The American Kidney Fund is dedicated to ensuring that every kidney patient has access to health care, and that every person at risk for kidney disease is empowered to prevent it. The site offers patient programs, kidney disease education, and professional education.

American Nephrology Nurses Association (ANNA)

The mission of the American Nephrology Nurses Association (ANNA) is to promote excellence in and appreciation of nephrology nursing so we can make a positive difference for people with kidney disease.

American Society of Nephrology

The American Society of Nephrology (ASN) is a nonprofit corporation to enhance and assist the study and practice of nephrology, to provide a forum for the promulgation of research, and to meet the professional and continuing education needs of its members.

American Society of Pediatric Nephrology

The American Society of Pediatric Nephrology is an organization of pediatric nephrologists and affiliated healthcare professionals. Our primary goals are to promote optimal care for children with kidney disease through advocacy, education, and research; and to disseminate advances in clinical practice and scientific investigation.

American Society of Transplantation

The American Society of Transplantation (AST) is dedicated to research, education, advocacy and patient care in transplantation. Our goal is to offer a forum for the exchange of knowledge, scientific information and expertise in the field of transplantation.

Association for the Advancement of Medical Instrumentation

The Association for the Advancement of Medical Instrumentation (AAMI) is a unique alliance of over 6,000 members united by the common goal of increasing the understanding and beneficial use of medical instrumentation.

Centers for Disease Control and Prevention (CDC)

CDC works 24/7 to protect America from health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same.

Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS) official website with links to CMS programs, initiatives, information, and resources.

Coalition for Supportive Care of Kidney Patients

The Coalition for Supportive Care of Kidney Patients brings together like-minded people who care deeply about the quality of compassionate, supportive care for kidney patients. We are professionals from many disciplines and laypersons who are working for true patient-centered care that values quality of life.  The website includes education, helpful links, and resources.

Donate Life America

Donate Life America is a not-for-profit alliance of national organizations and state teams across the United States committed to increasing organ, eye and tissue donation.

ESRD National Coordinating Center

The End Stage Renal Disease (ESRD) National Coordinating Center (NCC) provides support at the national level for the Medicare ESRD Network Program. This website includes education, tools, and resources for both patients and providers, including those related to vascular access, decreasing conflict, and emergency preparedness.

Florida Department of Health

The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county, & community efforts.

Florida Department of Health Disease Reporting Information

All practitioners, hospitals and laboratories licensed in Florida are required to notify the Department of diseases or conditions of public health significance under section 381.0031, Florida Statutes, and Chapter 64D-3, Florida Administrative Code.

Florida Division of Vocation Rehabilitation

Vocational Rehabilitation (VR) is a federal-state program that helps people who have physical or mental disabilities get or keep a job. VR is committed to helping people with disabilities find and maintain employment and enhance their independence. VR has additional specific programs designed to help eligible people with disabilities become employed.

Forum of End Stage Renal Disease Networks

The Forum of ESRD Networks is a nonprofit organization that advocates on behalf of its membership and coordinates projects and activities of mutual interests to ESRD Networks.

Home Dialysis Central

Home Dialysis Central is a one-stop, online source of up-to-date, unbiased information about home dialysis—in all its forms—for people with kidney disease, their families, and the healthcare professionals who provide kidney disease care.

National Institute of Diabetes and Digestive and Kidney Diseases

The National Institute of Diabetes and Digestive and Kidney Diseases conducts and supports research on many of the most serious diseases affecting public health.

National Kidney Foundation

The National Kidney Foundation is the leading organization in the U.S. dedicated to the awareness, prevention and treatment of kidney disease for hundreds of thousands of healthcare professionals, millions of patients and their families, and tens of millions of Americans at risk.

Nephrology News and Issues

This website offers a unique opportunity to cover and offer commentary on stories while they are still developing, giving the renal community a resource for the latest developments in renal care.

Renal Physicians Association

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) conducts, supports, and coordinates research on many of the most serious diseases affecting public health. The Institute supports clinical research on the diseases of internal medicine and related subspecialty fields, as well as many basic science disciplines.

United Network for Organ Sharing

United Network for Organ Sharing (UNOS) is the private, non-profit organization that manages the nation's organ transplant system under contract with the federal government. UNOS is involved in many aspects of the organ transplant and donation process.

United States Renal Data System

A national data system, which collects, analyzes and distributes information about end stage renal disease in the United States.

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.

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