2014 FRAA / FRC Annual Report Bob Winston Past President FRAA Florida Renal Association Florida Renal Coalition Florida Society of Nephrology National Kidney Foundation, S. FL ANNA CNSW RD / LD 2014 FRC Contributors GOLD Level: >$25,000 Fresenius Medical Care DaVita SILVER Level: $5,000 to $24,999 American Renal Associates Bronze Level: up to $4,999 Central Florida Kidney Center DSI Innovative Dialysis/Renal Care Partners Kidney Kare, Inc. Watson Clinic www.floridarenaladministrators.com Officers and Directors Officers Candace Magiera President Amy Kozsuch Vice President Laureen Marino Treasure Brenda Tilley Secretary Bob Winston Past President Bob Loeper Legislative Chair www.floridarenaladministrators.com Directors Dan Nye Peggy Crowley Jennifer Haggkvist Sara Knott Betty Verbal Sue Rotturo FRAA Activities Monthly conference calls on the Second Friday at 10:00 AM Legislative Updates Year Round Access to Industry Experts Annual meeting focused on ESRD facility administrative issues Renal Industry Updates Network with Colleagues CEUs awarded www.floridarenaladministrators.com FRAA Activities Sponsor Florida Kidney Day in Tallahassee since 2005 Presents annual legislative agenda Over 60 Legislative visits in one day Press Conference with Senate and House speakers Statewide media coverage www.floridarenaladministrators.com FRAA Accomplishments Established the CKD/ESRD Advisory Committee with AHCA in 2008. Convinced AHCA in 2004, 2006 and 2009 that ESRD facilities should be exempt from the Florida Health Care Clinic Licensure Act Killing of a bill is as important as enacting one www.floridarenaladministrators.com Early FRAA Accomplishments Secured Florida Medicaid Reimbursement for outpatient dialysis services in 1996 Secured Reimbursement from Florida Medicaid for EPO in 1996 www.floridarenaladministrators.com FRAA Accomplishments-2013 • Secured $2.4 Million Dollar Appropriation increase Medicaid reimbursement rate to $125.00. Sets baseline for managed care negotiations. • Kept Budgetary language in Appropriations Bill for direct reimbursement for Pharmaceuticals. • Maintained no clinic licensure status • Laid predicate for direct reimbursement of vaccines. ( Now a managed care issue ) • Continued direct communication with AHCA through ESRD advisory Committee. www.floridarenaladministrators.com FRAA Accomplishments-2014 B.R. Focus www.floridarenaladministrators.com • Maintained Dialysis rate of $125.00 • Maintained separate Pharmacy billing • Corrected Medicaid co-pay for Treatments (Dan Nye ) • Clarified Clinic regulations • Eliminated premium for Medically Needy • Pharmacy ratios from 1/1 to 1/4-can petition to go to 1/6 2015 FRAA Legislative Agenda Ensure Medigap pools merge in 2016 – The Medigap <65 and =/> 65 pools are legislatively designed to merge January 1, 2016. The insurance industry generally is against merging these risk pools and they predict the Medigap insurance premiums would increase for seniors. The Medigap rates for 2016 are to be set no later than 12-31-2015, so any legislative attempts to keep the pools separate would have to be introduced and passed during the 2015 session. The insurance industry has set the <65 Medigap premiums more than twice that of >65, making it unaffordable. FRAA notes other states with merged pools do not have higher premiums . MSW Internship only for 5 years- FRAA supports the limitation of internship to 5 years. These interns need to obtain licensure and the program is difficult to manage if it remains open ended. Support Nurse Compact Program – The Nurse compact rule would allow out of state MCOs and their RNs to provide telephonic case management to Floridians. The Board of Nursing opposes this as a threat to nursing jobs. Being that there is a chronic shortage of nurses, and many MCOs perform case management from out of state locations, the FRAA supports the Nurse Compact Program. Support ARNP role expansion – FRAA would support the expansion of the ARNP scope of work to allow them to be independent practitioners and have the authority to prescribe certain medications. This would resolve the issue of MDs having to co-sign ARNP orders for dialysis patients Support Telemedicine- FRAA would support telemedicine legislation which would allow a physician to round electronically via video to ESRD patients in remote areas even if they had to cross states lines. FRAA and FRC FRAA is the major contributor to the Florida Renal Coalition FRAA and FRC share the same BoD Lobbyist Bob Reynolds OTJ 24/7 Contributions to key legislators Access to decisions makers www.floridarenaladministrators.com Florida Market Share 2012 www.floridarenaladministrators.com Florida Market Share 2011 ESRD FMQAI 2011 Annual Report www.floridarenaladministrators.com General Population & Medicare Patients General Population www.floridarenaladministrators.com 70% of Total Healthcare Cost are due to Chronic Conditions 60% will develop Kidney Disease 10% now have CKD 25M are Diabetic 1 of 3 Diabetics will develop CKD 27M Heart Disease 67M have High Blood Pressure 1 of 5 will develop CKD 80M are pre-diabetic 26% of Florida population considered Obese Low risk patients have 3 PCP visits per year Medium Risk 5 visits High Risk 6 visits per year General Population & Medicare Patients End Stage Renal Disease www.floridarenaladministrators.com Approximately 40% Black vs. 10% population May have 2 or 3 comorbid conditions Rx 8 to 12 daily medications May have a daily pill burden of 15 to 20 pills 1/3 never fill their Rx 1/3 will be readmitted to the Hospital They are 1% of Medicare total population They represent 8 to 10% of total cost They represent 20% of Hospital readmits 5 Modalities; Transplant / HD / PD / HHD / Nocturnal Accountable Care Organizations ACO’s to ESCO’s 144-57-29 www.floridarenaladministrators.com WHAT IS AN “ESCO”? CMS intends to partner with groups of health care providers and suppliers, who will form ESRD Seamless Care Organizations (ESCOs), to test and evaluate a new model of payment and care delivery specific to Medicare beneficiaries with ESRD. Office Starts / Avoid the Spike Months on Pre- and Post-Initiation of Dialysis 23 Benchmark All A & B Charges for Medicare Dialysis Patients only 100 K 90 K www.floridarenaladministrators.com Revised 2014 ESCO www.floridarenaladministrators.com Benchmark Three-year historical based on participating facilities No change Rebasing Benchmark rebased for years 4 & 5 Eliminated rebasing Guaranteed Discount Escalating guaranteed discount off the top before shared savings in years 2+ Guaranteed discount based on non-dialysis costs only ESCO - 1st ESRD pts in ACOs and ESCOs No change JV Physicians Required non-JV nephrologist/group Eliminated requirement ESCO Growth One-time application for each specific market No change / can aggregate for minimum of 350 Quality Metrics Undefined Industry Standards Legal Waivers Undefined No change, waivers TBD Visit Us Anytime At www.FloridaRenalAdministrators.com www.floridarenaladministrators.com FRAA / FRC Lifetime Achievement Award • 1979 Mark Zawiski …Posthumously • 2010 Maureen Michael • 2014 Sarah Knott www.floridarenaladministrators.com We will be know by the people we Honor Rich Salick 1949-2012 In His Own Words: “I am a Former Professional Surfer that returned to Professional Surfing after my first Transplant raised $$ for Kidney Patients starting in 1976 got very successful and was drafted by the NKF. It was like the Mafia, I CAN'T LEAVE” NKF Pro/Am Surf Festival has raised almost $5 million for patient support, public education and organ donation. Rick was Honored/Awarded: The National Chairman of the National Kidney Foundation Patient and Family Council 2000 “Making Lives Better Award “At the 2000 US Transplant Games at Walt Disney World “Charles T Weber” Award for Humanitarian Efforts – one of the only two awards given by the National Professional Staff Association. His real ‘dream’ came true as he was a 2000 Inductee into the “Surfing Hall of Fame as an “East Coast Legend” After 3 kidneys from 3 Brothers over 35 years = 2 Sons, Rick passed away July 2, 2012. As His brother Phil Salick said on Rich’s Memorial : “In The Words of Rich, See Ya And Let’s Have Fun” Rich, you will be greatly missed! www.floridarenaladministrators.com ” House Passes Legislation to Designate : Cocoa Beach Post Office the “Richard K. Salick Post Office” Legacy A person’s legacy is more or less what we remember about a person. What you do today may be important enough to be considered your Legacy. Today thousands of individuals are receiving dialysis treatments three times a week to survive. This disease has broken many families financially . The National Kidney Foundation of Florida assists thousands of patients each year through their patient fund, primary with food and past due utility bills For every thousand patients we can help, another thousand may go without help. You can make a difference. Visit us on line at National Kidney Foundation of Florida http://www.kidney.org Call…407-894-7325… Become a Volunteer – You will receive more than you give. For more information about the Direct Aid Program, contact Sarah Knott www.floridarenaladministrators.com Leave a Legacy Hot Topics Transportation Exchanges Access to Care / narrow networks Co-Pays & Deductibles Transplant Medications ICD 10 Declining reimbursement Rising Cost Integrated Kidney Care Ebola ( EVD ) Visualizing Health Policy is a monthly infographic series produced in partnership with the Journal of the American Medical Association (JAMA). The full-size infographic is freely available on JAMA's website and is published in the print edition of the journal. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California. Visualizing Health Policy is a monthly info-graphic series produced in partnership with the Journal of the American Medical Association (JAMA). The full-size info-graphic is freely available on JAMA's website and is published in the print edition of the journal. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California. 851 GULF SHORE BOULEVARD NORTH, NAPLES, FLORIDA 34102 • RESERVATIONS: 1.800.237.7600, RESORT: 1.239.261.2222 www.FloridaRenalAdministrators.com Save the Date Tallahassee, FL Florida Kidney Day ACHA Meeting 2/24/15 Florida Kidney Day 2/25/15