THE ACCESS — AN ATLAS OF THE U.S. DIALYSIS SYSTEMPLATE III — PROOF STATE — 07|2026

The Stakeholder Matrix

A GENERATED VIEW · WHO FEEDS WHAT, WHO IS SCORED BY WHOM

Rows are stakeholders; columns are the data systems and registries. Every filled cell cites the relationship in the dataset. An empty cell is a finding, not a gap: that stakeholder has no direct line to that system.

AN ATLAS OF THE U.S. DIALYSIS SYSTEMPLATE III
The Stakeholder MatrixPROOF STATE
THE SEATS THE MACHINES MEDICARE-CERTIFIED DIALYSIS FACILITIES KIDNEY TRANSPLANT CENTERS NEPHROLOGISTS / MEDICAL DIRECTORS ESRD NETWORKS (18 REGIONAL) STATE SURVEY AGENCIES CMS CDC MEDICARE ADMIN. CONTRACTORS HHS THE ESRD PATIENT POPULATION ESRD QIP CARE COMPARE EQRS MEDICARE CLAIMS SYSTEMS NHSN OPTN / UNOS USRDS 2728 · 45-DAY [R16] 2746 · 14-DAY [R17] 2744 · ANNUAL [R18] CLINICAL · MONTHLY [R19] EVENTS · QUARTERLY [R20] ANNUAL [R24] STARS · QUARTERLY [R56] SCORED · QUARTERLY [R61] CONTINUOUS [R28] ATTRIBUTION · CONTINUOUS [R63] QUARTERLY [R32] OPERATES [R42] ADJUDICATED · CONTINUOUS [R65] NIDDK · FUNDS [R51] ADR · ANNUAL [R60] PAYMENT-YEAR [R21] PAYMENT-YEAR [R22] PAYMENT-YEAR [R23] QUARTERLY [R31] ANNUAL [R25] ANNUAL [R29] no direct line to any system — the physician signs, the facility types no direct line — the surveyor reads, through other doors A silent station is a finding, not a gap in the data: two of the eleven seats never touch the machines directly. SOLID CYANOTYPE = DATA FEEDS · DASHED VENOUS = THE SYSTEM SCORES THE SEAT · EVERY LINE CITES ITS R-ID
THE ACCESS · 07|2026
ED. 001 · GENERATED VIEW SRC: THE ESRD ATLAS DATASET
47 ENTITIES / 65 RELATIONSHIPS · PUBLIC SOURCES GENERATED FROM THE ATLAS DATASET
AWAITING THE AUTHOR’S PASS
THE LEDGEREVERY CELL CITES ITS R-ID
HOW TO READ · → FEEDS = ROW SENDS DATA TO COLUMN · ← FEEDS = COLUMN SENDS DATA TO ROW · SCORED-BY = THE COLUMN SCORES THE ROW · REPORTS-TO = ACCOUNTABILITY LINE
Care Compare / Dialysis Facility Compare EQRS (ESRD Quality Reporting System) Medicare claims systems NHSN (National Healthcare Safety Network) OPTN / UNOS USRDS (United States Renal Data System)
PROVIDERS
Medicare-certified dialysis facilities scored-by (quarterly) [R56] → feeds (per-event/45-day) [R16]
→ feeds (per-event/14-day) [R17]
→ feeds (annual) [R18]
→ feeds (monthly) [R19]		 → feeds (quarterly) [R20]
scored-by (quarterly) [R61]		 → feeds (annual) [R24]
Kidney transplant centers → feeds (continuous) [R28]
Nephrologists / medical directors
OVERSIGHT
ESRD Networks (18 regional) → feeds (continuous) [R63]
State Survey Agencies
Centers for Medicare & Medicaid Services ← feeds (quarterly) [R32]
Centers for Disease Control and Prevention ← reports-to (continuous) [R42]
Medicare Administrative Contractors → feeds (continuous) [R65]
U.S. Department of Health & Human Services ← reports-to (continuous) [R51]
PROGRAMS & POPULATION
ESRD patient population scored-by (annual) [R60]
ESRD QIP (Quality Incentive Program) ← feeds (payment-year-cycle) [R21] ← feeds (payment-year-cycle) [R23] ← feeds (payment-year-cycle) [R22]
TWO GENUINELY EMPTY ROWS ARE THE PLATE’S FINDING · THE NEPHROLOGIST SIGNS THE 2728, ONLY THE FACILITY TOUCHES THE KEYBOARD · ASPEN IS OUT OF SCOPE
SYSTEM-TO-SYSTEM FLOWSBOTH ENDS ARE COLUMNS
[R25] Medicare claims systems → feeds (annual) → USRDS
[R29] OPTN / UNOS → feeds (annual) → USRDS
[R31] EQRS → feeds (quarterly) → Care Compare / Dialysis Facility Compare
FORM-LEVEL DETAILFORMS ARE A FOOTNOTE LAYER, NOT COLUMNS
CMS-2728 Medical Evidence Report rides R16 (facilities → EQRS, per-event/45-day) · also populates the USRDS registry [R30]
CMS-2746 Death Notification rides R17 (facilities → EQRS, per-event/14-day)
CMS-2744 Annual Facility Survey rides R18 (facilities → EQRS, annual); the Network reviews and finalizes 2744s inside EQRS [R63]
FOOTNOTES — TRACEABILITY (EVERY CELL CITES ITS SOURCE)
[R16] Facilities file CMS-2728 in EQRS within 45 days of first outpatient dialysis (submitted, not just saved). (HSAG; Alliant)
[R17] Facilities file CMS-2746 death notification within 14 days of death. (HSAG)
[R18] Facilities submit CMS-2744 annual facility survey to the Network via EQRS. (Quality Insights)
[R19] Facilities submit monthly clinical data (Kt/V, Hgb, vascular access, ultrafiltration) to EQRS; the monthly window closes approximately two months after the reporting month. (mycrownweb.org)
[R20] Facilities report Dialysis Events (BSI) to NHSN; quarterly deadlines (Q1 due Jun 30 … Q4 due Mar 31). Facilities with more than 10 in-center HD patients only. (CDC)
[R21] EQRS clinical/reporting data feed QIP scoring. (CMS)
[R22] NHSN BSI/dialysis-event data feed QIP measures. (CDC; CMS)
[R23] Claims data feed QIP claims-based measures (SHR, SRR, etc.). (CMS)
[R24] Facility/EQRS/claims data flow to USRDS for the Annual Data Report. (USRDS)
[R28] Transplant centers report waitlist and transplant data to OPTN/UNOS. (OPTN)
[R32] CDC shares dialysis-facility NHSN data with CMS for QIP compliance files. (CDC)
[R42] NHSN is operated by CDC. (CDC)
[R51] USRDS is funded by NIDDK within NIH/HHS. (USRDS)
[R56] Care Compare star ratings refreshed periodically for public reporting. (data.cms.gov)
[R60] USRDS Annual Data Report published each fall. (USRDS)
[R61] NHSN dialysis-event reporting scored quarterly with fixed deadlines tied to QIP. (CDC)
[R63] ESRD Networks manage patient attribution, monitor facility data quality, and review/finalize CMS-2744s within EQRS. (ESRD Network Statement of Work; CMS EQRS documentation)
[R65] MACs adjudicate ESRD claims and post processed claims into Medicare claims systems. (Medicare Claims Processing Manual, Pub. 100-04, Ch. 8)