Volume 4 Ed. 6 | June 2020
HSAG End Stage Renal Disease (ESRD)
Network Updates
2019 Coronavirus (COVID-19) Update
The Health Services Advisory Group (HSAG) ESRD Network is available to provide support and answer any questions your facility may have related to COVID-19. The Network can also assist with: 
  • Communication issues with hospitals, transplant centers, nursing homes, or other
care providers.
  • Placing a COVID-19 positive patient in a cohort facility.
  • Screening and infection prevention guidance.
  • Transportation issues.
  • Testing concerns or needs.

Use the contact information at the end of the newsletter to call or email your HSAG ESRD Network or visit your Network’s webpage.

Update Your Facility's Emergency Plan
Many facilities are having to adjust schedules, use isolation rooms, add shifts, or transfer patients due to the need to cohort patients who are under investigation or are positive for COVID-19. Whatever your facility’s plan is, make sure your Emergency Preparedness Plan is updated accordingly. Resources to do so can be found on the Kidney Community Emergency Response (KCER) Program website .    

Preparing for Multiple Disasters
In addition to the COVID-19 pandemic, your facility will need to prepare for other possible emergencies such as wildfires, power outages, and severe weather (e.g., tornadoes, hurricanes). Connect Consulting Services hosted a presentation entitled, Disasters Don’t Stop: Competing for Resources During Multiple Disasters, that may help you and your team in your preparedness efforts. Download the  recording, slides, and the Pandemic Planning Guide.

Other resources for review:

Telehealth and Telemedicine Resources
The Centers for Medicare & Medicaid Services (CMS) has encouraged the use of telehealth and telemedicine throughout the COVID-19 pandemic. Consider using telehealth and/or telemedicine options for home dialysis facility visits. Below is a list of resources your facility can use to implement telemedicine or telehealth services.
Patient Services
Patient and Family Engagement: Taking Care
of Yourself and Your Patients During the
COVID-19 Pandemic

The COVID-19 pandemic has had an immense impact on the renal community, putting intense pressure on both dialysis patients and their care teams. Given this heightened environment, the need for self-care for staff and increased support for patients, cannot be overstated.

Provider Self-Care
Developing a good self-care regimen requires minimal time investment, but can provide dividends for a lifetime. Taking care of oneself allows you, the ESRD (dialysis/transplant) provider, to continue the amazing work you are doing to care for others. Below are resources to assist with your self-care plan:
  • The Center for the Study of Traumatic Stress (CSTS) Quick Guide on how to develop a self-care schedule
  • The Office of the Assistant Secretary for Preparedness and Response Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) series of mini modules to assist healthcare workers with creating a self-care plan.

Electronic Support Groups
It is well known that ESRD (dialysis/transplant) patients benefit greatly from participating in renal support groups. However, with the new social distancing requirements in place to limit exposure to the COVID-19 pandemic, joining a physical support group may not be practical. To compensate for not being able to have in-person support meetings, the Network recommends that dialysis/transplant facilities promote the increased availability of telephonic and electronic support group options. The HSAG ESRD Network created a list of support groups that can be shared with dialysis providers and patients. Educating staff and patients on the availability of these remote access support resources is a great way to help everyone weather the storm of the COVID-19 pandemic.
Clinical Topics
Dialysis Fluid Management
As the weather begins to warm and patients are spending more time at home, fluid management remains a struggle for many dialysis patients. Educating patients about watching what they eat and drink must be an ongoing effort by all facility staff. The HSAG Networks would like to remind you about the resources that are available to patients and staff:
  • Water Removal During Dialysis: A video produced by the Medical Education Institute (MEI) to help people understand how fluids move in our bodies and how important it is for fluid to be removed gently during dialysis. The video is also available in Spanish.
  • Patient to Patient—Let’s Talk About Fluids: A booklet that discusses fluid management that was created by patients for patients and includes everything patients need to know about controlling their fluids, and why it is so important. It is available in English and Spanish.  

Safe Care Transitions During COVID-19
Among the many challenges during the COVID-19 pandemic is the concern for patient safety during transitions of care. The CDC’s Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings includes information for everyone in a healthcare facility. Recommended guidelines include educating staff, patients, residents, and families about COVID-19, the actions that are being taken in the dialysis facility to protect them, and the actions they can take personally to protect themselves. Emphasis is placed on:
  • Implementing social distancing.
  • Encouraging hand hygiene.
  • Focusing on respiratory and cough precautions.
  • Wearing a face mask or covering.
  • Having an established plan and process in place for the management of patients or staff who test positive for COVID-19 and communicating that plan to staff, patients, and families. 

Communication is a key component of any transition. Shared responsibility for a smooth and safe transition minimizes the opportunity for issues to arise. It is important to communicate your processes and expectations and learn those of your sending/receiving partners. For example, facilities should have and follow an established process for communicating about a nursing home patient during a transition. Here are some things to consider:
  • Have a designated point of contact at the nursing home.
  • Share relevant information regarding patient’s status, including any symptoms or testing results.
  • Communicate your transition processes and expectations to the point of contact, such as requirements to wear a mask when coming to dialysis and finding out what the nursing home’s processes and expectations are.
  • Determine and follow processes and expectations when returning a patient to a nursing home. 
  • Communicate all processes to the patient and family to create an atmosphere of trust and feeling of safety

Additional information on transitions of care is available from the National Transitions of Care Coalition at https://www.ntocc.org/.

Bloodstream Infection (BSI) Prevention Efforts Continue
The Network is aware of how extremely busy everyone is at a dialysis facility due to the COVID-19 pandemic, but the focus on staff and patient safety and reducing BSIs remains a priority. Continued emphasis must also be placed on both catheter interventions and catheter reduction using CDC dialysis-core-intervention steps/tools such as scrub-the-hub, chlorhexidine for skin asepsis, antimicrobial ointment at the catheter exit site, staff education to include competency testing, and regular audits to reinforce proper catheter care. Work is underway to develop and distribute audit resources for hand sanitizer and physical environment. Additional resources include:
Data Management
CROWNWeb Code Update for COVID-19
It has been determined by the CDC that the ICD-10 code of U07.2 is not currently being used in the United States. Please only use U07.1 for COVID-19 related reference table coding. CROWNWeb will be updated as quickly as possible.

The following Death Cause codes remain applicable for the CMS 2746 form:
  • 105 COVID19
  • 106 COVID19 Unconfirmed
National Healthcare Safety Network (NHSN) Enrollment
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. In addition, NHSN allows healthcare facilities to track blood safety errors and important healthcare process measures, such as healthcare personnel influenza vaccine status and infection control adherence rates.

For complete detailed enrollment instructions, please download the NHSN Facility Administrator Enrollment Guide March 2018 (PDF-797K) or click here: https://www.cdc.gov/nhsn/dialysis/enroll.html to be taken directly to the 5 Step Enrollment for Outpatient Dialysis Facilities ―CMS Quality Incentive Program (QIP). Please see FAQs about NHSN and the CMS ESRD QIP Rule.
Dialysis Facility Compare (DFC)
DFC is the official CMS source for information about the quality of dialysis facilities and publishes data on thousands of Medicare-certified dialysis centers across the country. For more information on DFC, please visit: http://www.medicare.gov/dialysisfacilitycompare/#search.
Quality Incentive Program (QIP)
Extraordinary Circumstances Exceptions (ECE) for Dialysis Facilities
A Frequently Asked Questions for Exceptions for Dialysis Facilities Affected by COVID-19 document is now available here: https://www.qualitynet.org/esrd/esrdqip/participation#tab4 .

ESRD Quality Reporting System (EQRS) Modernization Efforts
On June 1, 2020, CMS started the next chapter of its ESRD Quality Reporting System (EQRS) modernization efforts by implementing the first phase of a two-part ESRD QIP User Interface (UI) rollout, in support of the ESRD QIP Payment Year (PY) 2021 Preview Period.

Purpose and Benefits of ESRD QIP UI Implementation Into EQRS
Incorporating the ESRD QIP UI into the EQRS system supports CMS’s efforts to consolidate the functionalities of the CROWNWeb, ESRD QIP, and Renal Management Information System (REMIS) applications into a single system. Users can now use one account to access multiple CMS EQRS business needs via a single platform —the EQRS Global Application.

This rollout of the ESRD QIP UI into EQRS is the first significant change to the ESRD QIP procedures since the inception of the program. The updates to the ESRD QIP UI will improve overall user experience and reduce burden. Phase 1 of the rollout consists of a new role request process and user interface with enhanced navigation features. Fictitious data will be visible in this first release for illustrative purposes only. Phase 2 will be released when the ESRD QIP PY 2021 Preview Period starts in mid-July 2020. Phase 2 will include facilities’ actual PY 2021 data and a streamlined communication and inquiry submission process. 

What You Need to Do at This Time
First, you should check with your organization to confirm if you need an ESRD QIP UI role as a Facility Point of Contact to submit inquiries and access reports, or as a Facility Viewer to see previously submitted inquiries as well as access reports within the ESRD QIP UI.

The June 1, 2020, implementation supports the PY 2021 Preview Period, which is scheduled to start mid-July 2020. This rollout provides users with early access to the ESRD QIP UI to allow them to verify and manage their roles and become familiar with the new UI prior to the start of the PY 2021 Preview Period.

Between June 1, 2020 and mid-July 2020, you should:
Complete the Healthcare Quality Information System (HCQIS) Access Roles and Profile (HARP) account registration process, if you have not done so, by going to https://harp.qualitynet.org/register/profile-info.
  1. Complete the HCQIS Access Roles and Profile (HARP) account registration process, if you have not done so, by going to https://harp.qualitynet.org/register/profile-info.
  2.  Log in to EQRS with your HARP account via https://eqrs.cms.gov/globalapp/.
  3. Review the applications listed on the My Access screen in EQRS for “QIP.” o NOTE: Roles maintained in the previous ESRD QIP system were automatically migrated into EQRS. Existing roles can be updated, and new users can request access.
  4.  Verify that your roles and organizations were migrated over correctly, update an organization’s role, or submit a new ESRD QIP role request.
  5. Click the QIP Scores link in the menu.
  6. Navigate through the ESRD QIP UI to ensure that you are able to access the screens. o  Important Note: Scores and measure feedback shown in the ESRD QIP UI between June 1, 2020 and mid-July 2020 are for the purposes of illustration only―using fictitious data. This does not reflect facilities' PY 2021 Preview Period Scores.
  7. Attend ESRD QIP UI Training and PY 2021 Preview Period webinar events.
  8. Maintain system access and log in to the ESRD QIP UI at the start of the PY 2021 Preview Period to access reports and submit necessary inquiries.

Training Materials and Assistance
Users who still need to complete the HARP account registration process or need step-by-step instructions on how to request roles within the EQRS system can review training videos, Quick Start Guides, Frequently Asked Questions, and additional materials via MyCROWNWeb.org at https://mycrownweb.org/harp-training/.

ESRD QIP UI Training and PY 2021 Preview Period webinar events will be provided prior to the start of the PY 2021 Preview Period. Event registration details will be sent via email and posted on www.MyCROWNWeb.org. Sign up for the EQRS Mailing List via www.MyCROWNWeb.org to receive updates regarding upcoming events.

If you need assistance with accessing EQRS or a HARP account or roles, contact the QualityNet Service Desk by email at qnetsupport-esrd@hcqis.org , by telephone at 1.866.288.8912, or by TRS: 711. Please do not  contact the QualityNet Service Desk regarding the fictitious ESRD QIP scores and measures in the ESRD QIP UI.

Should you need assistance with navigating through the ESRD QIP UI, contact your HSAG ESRD Network via the contact information at the end of this newsletter and ask for the Data Manager.
Upcoming Events
  • The American Society of Nephrology (ASN) presents a series of COVID-19 webinars. To register for upcoming webinars or to view previously recorded webinars and slides, visit their ASN webinars website.
  • The HSAG Networks invite all dialysis facilities and transplant centers to attend the National Coordinating Centers’ COVID-19 Quickinar Events. For a calendar of events and registration, visit the NCC webpage.    
  • The CDC’s Keep Learning with EPIC conference calls and webinars can be found at its website. 
Important Links
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Of Note
UNOS
Find patient transplant resources on the United Network for Organ Sharing (UNOS) website.
Visit the In-Center Hemodialysis Consumer Assessment of Providers and Systems (ICH CAHPS) website for up-to-date information on his important patient survey.
Health Services Advisory Group
This material was prepared by HSAG: ESRD Network 7, 13, 15, and 17, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication Number: NW-ESRD-XN-06122020-01