CY2019 QIP Final Rule

CMS has filed the CY2019 Final Rule for Medicare Program; ESRD PPS, Payment for Renal Dialysis Services Furnished to Individuals with AKI, ESRD QIP, DMEPOS CBP and Fee Schedule Amounts, and Technical Amendments to Correct Existing Regulations Related to the CBP for Certain DMEPOS.  Find the CMS press release at https://www.cms.gov/newsroom/press-releases/cms-finalizes-policies-modernize-and-drive-innovation-durable-medical-equipment-dme-and-end-stage, the Final Rule at https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-24238.pdf, and a fact sheet at https://www.cms.gov/newsroom/fact-sheets/cy19-esrddme-nprm-cms-1691-f-and-dmepos-competitive-bidding-program-temporary-gap-period.

9/21+ ANNA 503 Fall Workshop

The ANNA Chapter 503 Fall Workshop will be held in Seattle on September 29, 2018, but online pre-registration is required by September 21, 2019.  There will be no on-site or by-mail registration.  Topics include Learning Cultures, HD Case Studies, Marijuana, AKI, PD Catheter Placement, Gn, and Ethics.  7.2 CE are available.  For more information see https://s3-us-west-2.amazonaws.com/nwrn.org/files/N/ANNA/ANNA503Fall.pdf.  Register at https://www.eventbrite.com/e/anna-503-fall-renal-workshop-2018-tickets-47333611105, and find directions to the Workshop venue at http://www.seattlechildrens.org/contact/main-hospital/map/.  Parking is free in Lot 1; follow walkway to “River” Entrance.

1/10+ NW16 ANNA Renal Update

The Greater Puget Sound Chapter #503 of ANNA will present their 2018 Renal Update February 1-2, 2018 in Lynnwood WA.  Topics include incivility, surveys, iatrogenic death, teach-back, calciphylaxis, difficult conversations, passion and compassion, AKI, organ donation, ultrafiltration, lupus, hyponatremia, hyperoxaluria, and the future of dialysis.  Registration is online only, and closes on January 29, 2018.  Discounts are available until 11:30 pm PST January 10, 2018.  For more information see https://s3-us-west-2.amazonaws.com/nwrn.org/files/N/ANNA/RenalUpdate2018.pdf.

>1/1 AKI in NHSN

Beginning January 1, 2018, dialysis facilities must include AKI patients in NHSN Dialysis Event Surveillance.  Reporting AKI patient data to a new, separate NHSN location will enable CDC to exclude AKI patient data from NHSN BSI information shared with CMS for purposes of the ESRD QIP.

The “Acute Kidney Injury Location” should be used to report Dialysis Events, and denominator data, for patients who have AKI and do not have an ESRD diagnosis at the time of the Event, or at time of denominator data collection.  The AKI Location was released as part of the NHSN version 8.8 update on December 2, 2017.  Find instructions for using the AKI Location at https://s3-us-west-2.amazonaws.com/nwrn.org/files/NHSN/nhsn.AKI.Loc.pdf.

Among patients included in the NHSN Dialysis Event Surveillance population, the following criteria should be used to identify patients who have AKI:

  1. No diagnosis of “End Stage Renal Disease” or  “ESRD” in the patient medical record, or through the ESRD Medical Evidence Form (Form CMS-2728-U3)  AND
  2. Physician-diagnosis of “Acute Kidney Injury” or “AKI” listed in the patient medical record (e.g., nephrologist consult or referral form)  AND
  3. The event date, or date of denominator data collection, is not more than 6 months after the date the patient initiated outpatient hemodialysis.

PPS/QIP/AKI Final Rule

CMS has published a Final Rule on Updates to Policies and Payment Rates for End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, dealing with CY2018 and PY2019-2021.  The Rule is effective January 1, 2018.  Find the complete Rule on the Federal Register at https://www.federalregister.gov/documents/2017/11/01/2017-23671/medicare-program-end-stage-renal-disease-prospective-payment-system-payment-for-renal-dialysis , and a CMS summary at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-10-27.html .

10/22 NW16 Quality Conference

The Network 16 Annual Quality Conference will be held October 22, 2017 in Tukwila WA, near the Seattle-Tacoma International Airport.  The Conference will feature sessions on mental illness, fluid control, new CMS rules, AKI and residual function, and palliative care.  The registration fee includes continental breakfast, lunch, parking, airport shuttle, and five CE credits for nurses, social workers, technicians, and dietitians.  Find full details at https://s3-us-west-2.amazonaws.com/nwrn.org/files/N/NW16QC.Agenda.pdf .

NHSN News

NHSN has published their September NHSN Newsletter.  Dialysis-related news is found on pages 15-16, but some of the general NHSN information on pages 17-20 also applies to dialysis.  News includes:

  • A revised “NHSN Agreement to Participate and Consent” (“Re-Consent” for short) will be published in December, and all facilities must respond by February 24, 2018.
  • After January 1, 2018, including AKI patients will be mandatory, but they will be entered into a separate “AKI Location.”  Some information is included below, but full details will be included with release of Version 8.8.
  • NHSN Version 8.8 is scheduled to be released in December 2017.  Two webinars will introduce it:
  • Volunteers are solicited for beta testing of Version 8.8 with simulated data.
  • A plea for NHSN users to keep their User Contact Information current (pp.18-20).

Find a copy of the Newsletter at https://www.cdc.gov/nhsn/newsletters/index.html .

In a separate bulletin, CDC has published some instructions for dealing with AKI patients in NHSN in 2018:

Beginning January 1, 2018, dialysis facilities should include AKI patients in NHSN Dialysis Event Surveillance.  Reporting AKI patient data to a new, separate NHSN location will enable CDC to exclude AKI patient data from NHSN BSI information shared with CMS for purposes of the ESRD QIP.

The “AKI Location” should be used to report Dialysis Events and denominator data for patients who have AKI and do not have an ESRD diagnosis at the time of the Event, or denominator data collection.  The “AKI Location” will be released as part of the NHSN version 8.8 update.  Instructions for using the “AKI Location” are forthcoming.

Among patients included in the NHSN Dialysis Event Surveillance population, the following criteria should be used to identify patients who have acute kidney injury:

  • No diagnosis of ESRD in the patient medical record, or through the ESRD Medical Evidence Form (Form CMS-2728-U3)  AND
  • Physician-diagnosis of AKI listed in the patient medical record (e.g., nephrologist consult or referral form)  AND
  • The event date or date of denominator data collection is not more than 6 months after the date the patient initiated outpatient hemodialysis.