The IPRO ESRD Network Program is pleased to announce that on 4/15/21 we were re-awarded the Centers for Medicare & Medicaid Services (CMS) contracts to manage the ESRD Networks 1, 2, 6, and 9 from 6/1/21 – 4/30/26.

We have recently released a Contact Management Survey to gather up to date contacts for all the facilities throughout our program. Your completion of this survey will flag our need to initiate a participation agreement with your facility. Following completion of the survey you will then be sent a copy of the ESRD Network Participation Agreement to execute and save in your contractual records for CMS surveying.

CMS continues to focus our efforts on reaching the goals of the American Kidney Health Initiative increasing the rate of transplantation and use of home modalities as the preferred mode of care in ESRD. They also are focused on slowing the progression of kidney disease and have tasked the ESRD Networks to collaborate with provider groups at all levels who interact with CKD patients to support this effort. One of their ongoing initiatives has been to raise the level of engagement patients and families have in their care supporting a proven method to improve outcomes through active participation. CMS also continues to require that the Networks advocate for patients to assure that their grievances are appropriately managed and all patients are provided with access to care for their kidney disease.

From a new work perspective CMS is asking the ESRD Networks to work on reducing hospitalizations, ED visits and unplanned readmissions in the ESRD population. This work coupled with an approach to work with the growing vulnerable population of patients receiving home therapies in the Nursing Home settings expands the work of the Networks beyond the walls of the dialysis and transplant facility. Lastly, the Networks are being asked to work with ESRD providers to improve mental health with a focus on depression looking to improve screening and referral to those patients in need of services.

All new work for the contract begins on 6/01/2021. The IPRO ESRD Program will be working with patients, providers and other key stakeholder to participate in quality improvement activities, assist in the maintenance of ESRD national databases such as EQRS and NHSN, support our providers and patients during an emergency situation, and to ensure patient are engaged in their care as well as help them to resolve grievances and access to care issues. We are excited to continue our work in your state and look forward to partnering with you again to assure the best possible outcomes for all those who live with kidney disease.

Recent events such as hurricanes, natural disasters and the COVID-19 pandemic are a constant reminder of the critical nature of emergency preparedness at dialysis facilities. Emergent situations have no schedule and therefore we do not know when they will arise or in what form. Dialysis facilities and their staff play a key role in emergency preparedness efforts for all types of events. The general elements of emergency management for dialysis facilities should include mitigation, preparedness, response, and recovery. It is crucial to have a well-communicated emergency plan in place that you can implement quickly should a disastrous event or other emergency take place. In preparation for natural disasters or other emergent events that could potentially impact your region, the IPRO ESRD Network Program is releasing the Annual Critical Assets Survey (CAS) to all dialysis facilities within the service area.

The purpose of the CAS is to identify facility and patient needs ahead of an impending emergency or disastrous event. Your participation and completion of the CAS will assist supporting state and local emergency management officials with expediting resources and assist with maintaining and/or re-establishing operations that affect ESRD patients’ access to medical care.

As we continue to focus our attention on keeping patients safe, it remains critically important that we also remember to make the necessary preparations for unprecedented events that could cause impact to ESRD patients and dialysis services. Social distancing and other Centers for Disease Control and Prevention (CDC) guidance to keep patients and staff safe from COVID-19 may impact the emergency preparedness plan your facility has in place and keeping in mind that your facility may need to revise and/or adjust your current emergency plan.

According to the Aggression Management Education for Acute Care Nurses: What's the Evidence? article, healthcare workers have an increased risk of workplace violence compared with workers in private industry. Nurses as the most common victims, with patients as the most common perpetrators. Risk factors include influences such as ongoing aggressive behaviors, psychiatric disorders, substance abuse, stress/frustration/anxiety, a sense of powerlessness, perceptions that violence is tolerated, inadequate security, long wait times, and lack of awareness.

A patient-centered approach is required when trying to understand and address patient distress. The How to Deal with Violent and Aggressive Patients in Acute Medical Settings offers a nice overview of understanding challenging behaviors caused by aggression, how education about aggression management was successful in building confidence in areas such as situational awareness, de-escalation practices, and early intervention. Facility staff can also contact the Network whenever further guidance is needed on managing difficult patient situations.

Healthcare teams within a dialysis facility should always involve patients, family members, and caregivers in the development of facility goals as well as reviewing patient plans of care using shared-decision making.

However, as the COVID-19 pandemic has continued to change facility policies, in-person patient engagement has been limited. Therefore, the Centers for Medicare & Medicaid Services (CMS) Interpretive Guidance for the Conditions for Coverage for End-Stage Renal Disease (ESRD) Facilities now allows facilities to hold patient care planning meetings with the interdisciplinary healthcare team members, patients, and caregivers through virtual meetings and telephone calls, or video conference calls. Care Planning through telehealth can provide patients with additional privacy that may not be provided through chairside meetings. It can also allow patients to fully grasp the conversation and understand the full extent of their treatment while becoming more active in their healthcare plan.

Care Planning Resources:

Emotional resilience is one's ability to adapt and cope with stressful situations and crisis. Individuals with kidney failure are models of what emotional resiliency looks like as we witness how they have adapted to live through our world's current crisis - the COVID-19 pandemic. Healthcare providers can help them continue to thrive by providing a safe space to share their emotions and let them know they are not alone.

Wondering what ways, you can support your patients? Click below to read an entry from the National Kidney Foundation Journal of Nephrology Social Work of a dialysis social worker’s efforts to help her patients cope with dialysis and their personal lives during stressful situations.

The Mental Health First Aid program developed a new toolkit for employers to use with their employees due to the demonstrated need as a result of the COVID-19 pandemic to support the mental health needs for everyone.

The toolkit provides guidance on how to identify when an employee is displaying signs and symptoms of stress, anxiety or depression and how to support them. It can be difficult to know what to say, and how to approach someone when it seems they may need support. This toolkit gives employers constructive ways on how to approach individual employees, as well as ideas about how to create a culture in your company that is open to discussion about mental health needs.

Please review the Tips for Supporting Employee Mental Health Toolkit, and check out other education opportunities the National Council for Mental Health Wellbeing has to offer.

According to "Effect of Peer Mentoring on Quality of Life among CKD Patients: Randomized Controlled Trial", Chronic Kidney Disease (CKD) has been associated with a decrease in an individual's overall quality of life. However, the implementation of a successful peer mentoring program has been correlated with an overall improvement in the Quality of Life of CKD/ESRD patients. The increased correlation was based on a randomized clinical trial that assessed the effectiveness of both face-to-face and online peer mentoring in comparison to patients receiving regular kidney treatment. The study incorporated peer mentors with CKD who received formalized training through a 16 hour informational. The individuals that were assigned to peer mentors received either 6 months of face-to-face or online peer mentoring. The results were based on time-related changes in domain scores of the Kidney Disease Quality of Life (KDQOL) instrument for each of the groups over the 18-month study period. The study found that compared to the control group the online peer mentoring participants showed improved scores in the KDQOL after an 18-month period. More specifically there was an improvement in the effects and burdens of CKD, symptoms, and problems associated with CKD and mental health. There were no statistically significant changes from baseline in scores of KDQOL within the face-to-face peer mentoring groups.

To learn more about how to start or support a peer mentoring program, please visit the IPRO ESRD Program website at https://esrd.ipro.org/patients-family/pfe/peer-mentoring/.

Each month the Social Security Administration's Ticket to Work program hosts the Work Incentives Seminar Event (WISE), which are free webinars on vocational rehabilitation services for eligible populations. They are held on the fourth Wednesday of each month. Past WISE webinars can be accessed On Demand.

You can check out this past WISE webinar Healthcare and the Path to Employment which originally was presented on April 28, 2021.

The presentation featured information and facts on:

Materials from this webinar including the power point presentation, transcript, and video are available for download here.

The Network has also created the Work Incentives Search Tool Guide to assist with locating a vocational rehab service provider as well as a Work Incentives Planning and Assistance representative.

More information on vocational rehabilitation can be found on the IPRO ESRD Network Program website at https://esrd.ipro.org/patients-family/patient-education/vocational-rehab/.

Vaccinations are an integral intervention in improving an individual's and a population's health. This year our work on vaccinations as prescribed by CMS will include influenza vaccination goals for patients and staff, COVID-19 vaccination goals for patients and staff, and an additional focus on pneumococcal vaccination, specifically the Pneumovax vaccine.

Please take the time now to check your facilities patient documentation vaccination records to assure appropriate document of the influenza vaccine and pneumococcal vaccine in the End Stage Renal Disease Quality Reporting System (EQRS). Vaccinations that occurred outside of the dialysis facility must also be captured.

Job Aid

The National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) have joined efforts by creating a taskforce to evaluate the inclusion of race in the eGFR laboratory results (as African American or non-African American) to determine kidney disease. This taskforce seeks to assess the problem, evaluate the evidence and provide a recommendation that addresses historical health disparities and access to care issues in the African American population. Potentially, if kidney disease could be detected earlier in African American persons, providers could start an earlier education about preemptive kidney transplants. This will help improve care for African Americans with kidney disease, who are impacted by longer transplant waiting time and other related allocation disparities.

To read the full article, please visit https://jasn.asnjournals.org/content/early/2021/05/04/ASN.2021010039.

The IPRO ESRD Data Department provides technical assistance using a customer support system. This is one place for your data submission needs for various systems such as CROWNWeb, NHSN, Dialysis data or Quality Incentive program. In order to meet the needs of our facilities, the new system will provide support:

NOTE: When submitting a request to the Network, you should NEVER include any patient-specific information such as Name, Date of Birth, Social Security Number, Medicare Claim Number, etc. The only patient identifier that can safely be communicated is the Unique Patient Identifier (UPI) from CROWNWeb.

For more information, please visit the Network website.