12/18 NHSN Maintenance, Vs 9.4, Newsletter

The NHSN Dialysis Component will be down for “several hours” on December 18, 2019, starting at 6am PST, for scheduled maintenance.

NHSN Version 9.4 was released on December 7, 2019.  It includes many additions and changes, including analysis updates.  Review pages 1 (all Components) and 4-5 (Dialysis Component) of the Version 9.4 Release Notes at https://s3-us-west-2.amazonaws.com/nwrn.org/files/NHSN/NHSN9.4ReleaseNotes.pdf for important details.  The new analysis output options require regeneration of datasets.  Email all questions to the NHSN Helpdesk at NHSN@cdc.gov.

The December 2019 NHSN Newsletter has been published.  It includes no dialysis-specific articles, but there are relevant general articles on pages 14ff covering NHSN Training in 2020 and CDA changes for Version 9.4.  Find it at https://www.cdc.gov/nhsn/pdfs/newsletters/nhsn-nl-dec19-508.pdf.

Slides from the December 4-5 NHSN Dialysis Surveillance Call can be found at https://s3-us-west-2.amazonaws.com/nwrn.org/files/NHSN/NHSNDialysisEventUpdates2020.pdf.  They include sections on AKI, Data Quality Checks, Annual Training, Missing SIRs, Data Review, QIP Updates, and Version 9.4.

Recall: Baxter AKI Prismaflex Control Unit

The FDA has announced Class II recalls of Baxter Prismaflex Control Units for AKI Recovery (https://www.baxter.com/healthcare-professionals/critical-care/prismaflex-system-critical-care) with software versions below 7.21 because of communication errors that may interrupt or delay therapy or result in blood loss.  Product Codes and Lot Numbers recalled include:

• Product Code 107493; All Lot numbers; GTIN 07332414073718; see https://www.accessdata.fda.gov/scripts/ires/index.cfm?Product=176496.

• Product Code 113081; All Lot numbers; GTIN 07332414105266; see https://www.accessdata.fda.gov/scripts/ires/index.cfm?Product=176499.

• Product Code 115269; All Lot numbers; GTIN 07332414117702; see https://www.accessdata.fda.gov/scripts/ires/index.cfm?Product=176501.

• Product Code 955542; All Lot numbers; GTIN 07332414124236; see https://www.accessdata.fda.gov/scripts/ires/index.cfm?Product=176501.

• Product Code 6023014700; All Lot numbers; GTIN 07332414073718; see https://www.accessdata.fda.gov/scripts/ires/index.cfm?Product=176502.

9/27 CMS Proposed Changes to Dialysis Reimbursements

CMS will publish in the Federal Register on August 6, 2019 a Proposed Rule that includes changes to the CY2020 ESRD PPS, ESRD QIP, AKI payments, and many other details, including adjustments to the PY2022 NHSN and STrR measures, and provisions for new and innovative treatments.  The Proposed Rule also includes requests for public comment on the case-mix adjustment model and wage indices.  Comments will be due by September 27, 2019.  Find:

• A pre-publication version of the Proposed Rule at https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-16369.pdf.
• A comprehensive Fact Sheet on it at https://www.cms.gov/newsroom/fact-sheets/end-stage-renal-disease-esrd-and-durable-medical-equipment-prosthetics-orthotics-and-supplies-dmepos.
• The Press Release announcing it at https://www.cms.gov/newsroom/press-releases/new-cms-proposals-strengthen-medicare-unleash-innovation-and-promote-competition-provide-kidney.

ANNA Fact Sheets on PD, AKI

The ANNA Special Practice Networks have published a series of several-page Fact Sheets on a number of topics:

• Peritoneal Dialysis Fact Sheet at https://www.annanurse.org/download/reference/practice/pdFactSheet.pdf.
• Pediatric Peritoneal Dialysis Fact Sheet at https://www.annanurse.org/download/reference/practice/pedPDFactSheet.pdf.
• AKI Fact Sheet on Clinical Issues at https://www.annanurse.org/download/reference/practice/akiClinicalFactSheet.pdf.
• AKI Fact Sheet on Financial/Payment/Billing Issues at https://www.annanurse.org/download/reference/practice/akiFinancialFactSheet.pdf.

NHSN Updates

NHSN was updated to Version 9.3 on April 27, 2019.  There have been many additions and changes with this release, including the following updates to the Dialysis Component:

• CDA Dialysis Monthly Summary – the CDA for version R3D3 of the Dialysis Monthly Summary was updated to allow “Report No Events”.  The functionality is available for both manual CDA import and Direct CDA submissions.

• Analysis and Reporting:
  • Updated dialysis aggregate data from 2016-2017 for rate tables and run charts.
  • Created a new TAP report type and changed report icon for Excess Infections.  A new Excess Infections report type allows for modifications to the TAP report without disturbing functionality used by other NHSN components.
  • In 2018, the Dialysis Component began collecting data using an AKI location.  Now that some data have been collected, data reported to that AKI location are included in dialysis rate tables and run charts so facilities and groups can review AKI-specific rates for the various dialysis event measures.

In order to use any of the new analysis output options you must first regenerate datasets.  As always, send all questions to the NHSN Helpdesk at NHSN@cdc.gov.

5/22 CMS/NKF Webinar on CKD Risk Reduction

CMS and NKF will present a May 22, 2019 webinar on on Population Health Strategies for Kidney Disease Risk Reduction, at noon PST.  Nephrologists, dialysis facility medical directors and renal care providers are invited and encouraged to attend. The NKF CKD Change Package will be introduced, systematic strategies for improving identification and management of CKD will be described, and a population health strategy for registry function, QI, and patient engagement for people living with CKD will be presented.  Register for the webinar at https://meetings-cms.webex.com/meetings-cms/onstage/g.php?MTID=e06e8b0a5642756b1b7a7e0998d0eeeb8.  Find the NKF CKD Change Package at https://www.kidney.org/sites/default/files/02-11-8036_JBI_CKD_ChangePackV17.pdf.

CY2019 PPS/AKI MLN Matters

CMS has published an MLN Matters bulletin on Implementation of Changes in the ESRD PPS and Payment for Dialysis Furnished for AKI in ESRD
Facilities for CY2019.  Find it at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11021.pdf.