The ESRD Network of the South Atlantic (GA, NC, SC) is tasked by the Centers of Medicare and Medicaid Services (CMS) to work with dialysis facilities with Quality Improvement Projects on different focused that will improve the quality of life of ESRD patients.

The participation of dialysis facilities in these projects is required as part of Conditions of Coverage (CfC). In addition, your State Surveyor Agency could request evidence of participation in a QIA project at any time. A State Surveyor Agent could decide to give a standard citation upon confirming lack of participation in one or more QIA projects or other required activities with the ESRD Network. 

For each project activity, the ESRD Network communicates with the provided contacts by communicating via email. Some activities are also introduced via required webinars. Instructions, links and resources for activity completion and a due date is always provided. In addition, each project has a Project Lead Outline, and project contacts receive a monthly QIA calendar with important dates. 

To assure completion of activities, the ESRD Network follows the following levels of communication:

  • Level 1 - "ACTION REQUIRED" - E-mails with this subject line go to project leads, back-ups, managers and directors. This is to notify about a required activity
  • Level 2- "REMINDER" or "REMINDER DUE TODAY" - As important calls or due dates approaches, the ESRD Network will send a reminder of an activity. This email goes again to the roles indicated in Level 1.
  • Level 3- "REMINDER LATE ACTIVITY" - The ESRD Network understands that sometimes facilities cannot meet certain due dates. The Network will send one (1) reminder after a due date is passed to the same contacts as Level 1 and 2.

When activities have not been completed after two (2) business days of a reminder for a late activity has been sent, the ESRD Network escalates to regional leadership. Many times, this helps the ESRD Network with learning about staff contact changes that have not been updated. The escalations are as follow:

  • Escalation 1- "PAST DUE #1" - A notification that an activity has become past due is sent to the project lead, back-up lead, manager, director AND Regional Quality Manager/ Director of Clinical Services or equivalent role.
  • Escalation 2 - "PAST DUE #2"- After two (2) additional business days after a first escalation, the Network will escalate further to the Regional/ Divisional Vice President if this activity has not been completed yet.

If the ESRD Network has tried all 5 levels of communications mentioned above and the completion of one (or more) activities have not been done, the ESRD Network has the ability to report a facility for non-compliance as follows:

  • CMS Contract Officer Representative (COR) - The Network has monthly calls with our CMS representative, where noncompliant facilities are discussed.
  • State Surveyor Agency - The Network can report any facility for noncompliance to the State Surveyor at any time.



  1. Maintain your facility contact up to date in CROWNWeb and with QIA project leads at the ESRD Network. Submit a Freshdesk ticket if a contact has changed. Maintaining a good contact will assure that the person leading the project receives the information on time.
  2. Pay attention to email subject lines to complete activities within the due date and/or within the late activity grace period.
  3. Communicate with the ESRD Network when your facility needs an extension or it's believe that you won't be able to meet a required intervention for the Network to work with your specific situation.