Quality Insights Renal Network 4 
A Periodic Newsletter from Quality Insights Renal Network 4 | www.qirn4.org
In This Issue
Alerts and Recalls
Quick Links
QIRN 4 Staff
Executive Director
Quality Improvement Director
Quality Improvement Coordinator
Patient Services Director
Patient Services Coordinator
Data Manager
Administrative Assistant
August 20, 2014 
Greetings from QIRN 4
Quality Insights Renal Network 4 (QIRN 4) is committed to providing valuable resources that help improve the quality of renal care in Pennsylvania and Delaware. 
We encourage you to visit our Web site for the most up-to-date information or to contact us with questions, comments or suggestions. 
IMPORTANT NOTE: In an effort to bring you the most important information in the most convenient way, we have started to send our newsletter on a bi-weekly basis. Look for important updates about alerts and recalls, Quality Incentive Program news, Infection Prevention updates, and much more in your inbox every other week. 

*This will serve as our primary method of communicating important news and updates. 
Your QIRN 4 Team
Mark Your Calendars: Mandatory Network Council Meeting
Mandatory Network Council Meeting
September 24, 2014, from 2:00 to 3:00 p.m.

  • Tish Lawson, Executive Director will present a brief Network update
  • Margaret Leid, Transplant Outreach Coordinator from Penn Transplant Institute will present on UNOS Kidney Allocation Policy Changes
Each facility is to have a network council representative on the call. Thank you for your participation.

Webinar Information:

Meeting Password: meeting

Teleconference: 866-951-1151. Teleconference access code: 5505276. Please join us 15 minutes prior to the presentation to ensure the automatic system set-up has been properly established.

Attendee Instructions:
  1. Click or Copy and Paste this to your web browser: https://qualitynet.webex.com
  2. Locate the event you wish to join
  3. Click on Join Now (located to the right of the event title)
  4. Enter your name and email address as prompted
  5. Enter the password: meeting
  6. Dial in to the teleconference. The number is 866-951-1151. The access code is 5505276.
If you have any questions or problems accessing the meeting, please call the General Dynamics Information Technology WebEx Helpline at 540-347-7400 x390.

CMS Restructures QIOs and Medicare Case Review
The Centers for Medicare & Medicaid Services (CMS) has restructured the Quality Improvement Organization (QIO) Program from its historical 53 contracts (in which each QIO performs both Medicare case review and quality improvement support for each state or territory) to a regional structure for case review and an industry-determined service structure for quality improvement initiatives.

In the new structure, case review and quality improvement functions will be performed by different contractors. Beneficiary and Family Centered Care QIOs (BFCC-QIOs) will handle case review while Quality Innovation Network QIOs (QIN-QIOs) will provide technical assistance to support providers.

Both Quality Insights of Pennsylvania and Quality Insights of Delaware applied to be QIN-QIOs. Therefore, they will no longer be performing case review and appeals. 

What This Means for Pennsylvania
Effective August 1, 2014, the new Beneficiary and Family Centered QIO for the region that includes Pennsylvania is Livanta. This means:
  • Livanta will be responsible for all beneficiary quality review case work and appeals in Pennsylvania.
  • Healthcare providers and Medicare beneficiaries must contact Livanta toll-free at 1-866-815-5440 for all appeal requests and Quality of Care concerns.
  • All outstanding Higher-Weighted DRG medical record requests after August 1 should be mailed to:


9090 Junction Drive Suite 10

Annapolis Junction, MD 20701

  • Contact information for Livanta is as follows:

Area 1: 

HelpLine 1-866-815-5440

TTY Helpline 1-866-868-2289

Fax: Appeals 1-855-236-2423

Fax: All other 1-844-420-6671

What This Means for Delaware
Effective August 1, 2014, the new Beneficiary and Family Centered QIO for the region that includes Delaware is KEPRO. This means:
  • KEPRO will be responsible for all beneficiary quality review case work and appeals in Delaware. 
  • Healthcare providers and Medicare beneficiaries must contact KEPRO toll-free at 1.844.455.8708 for all appeal requests and Quality of Care concerns.
  • All outstanding Higher-Weighted DRG medical record requests after the above date should be mailed to:  


5201 W. Kennedy Blvd, Suite 900 

Tampa, FL 33609

For additional contact information for KEPRO, please review this document

If a case was under review or in process prior to August 1, please be assured that every effort has been made to ensure a seamless transition for Medicare beneficiaries with no disruption in case review services. 

These changes are part of CMS' QIO transformation effort to further enhance the quality of services to Medicare beneficiaries. You can learn more at qioprogram.org.  


Nephrology Certification Review Course
Have you been thinking of becoming certified but didn't know where to start? The Keystone 110 Chapter of the American Nephrology Nurses Association (ANNA) will be offering a Certified Nephrology Nurse (CNN)/Certified Dialysis Nurse (CDN) review course on Saturday, September 20, 2014 from 7:30 a.m. to 4:00 p.m. Continuing Education (CE) credits will be available. Licensed Practical Nurses (LPNs) and technicians are welcome to attend. Please review this brochure for more information.
Determining Denominators for Out-Patient Dialysis NHSN Surveillance Reporting
The following information will assist you in correctly entering data into the National Healthcare Safety Network (NHSN) database.

For each type of vascular access listed:
  • Enter the number of patients who received maintenance hemodialysis at this location on the first two working days of the month, including transient patients.
  • Consider all vascular accesses the patient has, even if they are not used for dialysis and even if they are abandoned and/or are non-functional.
  • A patient must be physically present for in-center maintenance hemodialysis on one of these days to be counted on this form (exclude patients who are hospitalized).
  • Record each patient only once. If a patient has more than one vascular access, record the access type with highest risk for infection.

Vascular accesses are listed in the following hierarchy from highest risk to lowest risk: 

  1. Fistula
  2. Graft
  3. Other access device (e.g. hybrid access device and other access devices not listed)
  4. Tunneled Central Line
  5. Non-tunneled Central Line
More information is available in the Dialysis Event Protocol, a requirement for annual training.

We encourage you to complete new and updated annual training online Dialysis Event Surveillance Training located on the CDC website.
Infection Prevention
Dialysis Patients Speak: Prevention Infections
Please take a moment to view this Centers for Disease Control and Prevention (CDC)  video, which seeks to empower hemodialysis patients and teach the importance of hand hygiene, proper equipment and careful technique in preventing infection. 

Put Together the Pieces to Prevent Infections in Dialysis Patients
This wall poster is a visual reminder of measures that staff can take to reduce infections in dialysis patients. View the Spanish version here


Save the Date: 4th Annual Creating a Culture of Quality Conference
Guidelines, incentives, patient centered care, shared decision making...how do we judge quality?

March 23-24, 2015
(Immediately following the RPA Annual Meeting March 19-22)
Baltimore Marriott Inner Harbor at Camden Yards, Baltimore, MD

This conference will examine quality care as it applies to the tension between Patient/Family Centered Care and the reality of renal replacement therapy in the current environment of clinical directives and cost consciousness. Participants will gain a better understanding of how to incorporate patient centered care into decision making and how to respond when patient goals and values are different than those of the clinician(s) and/or the dialysis provider.

The conference will consist of three sessions, each with a different theme and each containing at least one valuable "take home" technique in the spirit of a "train the trainer" approach. This interactive meeting will enrich the abilities of the dialysis team including patients, physicians, administrators and everyone who cares about quality patient care. This conference will provide an opportunity to connect with care providers, patients and professionals from across the country.

The Keynote address will be presented by Raymond Hakim, MD, PhD, Professor in the Division of Nephrology and Hypertension at Vanderbilt University School of Medicine.

Call for Posters
The Forum of ESRD Networks invites your organization to present a poster showcasing your work on any quality project, either recently completed or currently ongoing. Posters will be displayed throughout the conference and highlighted during the Monday evening Wine and Cheese Reception. Poster abstracts are due to the Forum office by Friday, February 20, 2015. Instructions are available at the Forum website.

More Information
Please visit the Forum website or contact the Forum office for more information.

This is a renal community collaboration presented by the Forum of ESRD Networks and its Beneficiary Advisory Council in partnership with DaVita, DCI, Fresenius, the Renal Physicians Association, the American Nephrology Nurses Association, the National Renal Administrators Association and the American Association of Kidney Patients.

Emergency Preparedness Updates
Submit Your Disaster Preparedness Articles
Our focus at QIRN 4 is to "Be Disaster Aware, Take Action to Prepare." If you have any disaster preparedness articles or links, please e-mail your information to dknight@nw4.esrd.net so it may be posted in our bi-weekly newsletter. 
Mock Emergency Drill Scheduled with Robert Grant
Robert Grant is a patient and one of our subject matter experts at QIRN 4. He has more than 20 years of emergency management experience and has been working with us to develop a mock emergency drill. 

Mr. Grant will assist us in presenting the mock drill on September 23, 2014 from 10:00 to 11:15 a.m. and again from 2:00 to 3:15 p.m. Click on the link to your desired attendance time for call information. The scenario for the mock drill is sudden water loss. We will be offering two sessions on the same day.
1st Annual Emergency Management Coordinator Meeting Scheduled
In preparation for upcoming inclement weather, we will also hold our first annual Emergency Management Coordinator Meeting in conjunction with the mock drill on September 23, 2014 from 10 to 11:15 a.m. and again from 2:00 to 3:15 p.m. Click on the link to your desired attendance time for call information. The Center for Medicare and Medicaid Services (CMS) requires that all facilities designate an individual to the position of Emergency Management Coordinator. This person will communicate his or her facility's closures/schedule changes to the Network office. The designated facility Emergency Management Coordinator needs to complete a Coordinator form and submit completed form by September 9, 2014.

ESRD NCC Information Exchange
The ESRD Network Coordinating Center (NCC) provides centralized coordination and support for the Medicare ESRD Network program. Each month, the ESRD NCC distributes an e-newsletter, known as the Information Exchange, that compiles the most important information from numerous ListServs and publications related to renal health. 

To sign up to receive this informative newsletter, please contact the ESRD NCC at ncc@ncc.esrd.net or visit the ESRD NCC Web site. You can also check the QIRN 4 website for updates that include material from the Information Exchange.


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Quality Insights Renal Network 4
 630 Freedom Business Center, Suite 116
King of Prussia, PA 19406
800-548-9205 (patients only) 
610-783-0374 (fax)
This material was prepared by Quality Insights Renal Network 4 under contract with the Centers for Medicare & Medicaid Services (CMS). The contents do not necessarily reflect CMS policy. 
Publication No. ESRD4-081814

Copyright 2014. All Rights Reserved.