Transcript FRAA 2009 -2010

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
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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
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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
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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
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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
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Early FRAA
Accomplishments
 Secured Florida Medicaid Reimbursement
for outpatient dialysis services in 1996
 Secured Reimbursement from Florida
Medicaid for EPO in 1996
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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.
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FRAA Accomplishments-2014
B.R. Focus
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•
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
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Florida Market Share 2012
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Florida Market Share 2011
ESRD FMQAI 2011 Annual Report
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General Population & Medicare
Patients
General Population
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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
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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
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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
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Revised 2014 ESCO
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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
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FRAA / FRC Lifetime
Achievement Award
• 1979 Mark Zawiski …Posthumously
• 2010 Maureen Michael
• 2014 Sarah Knott
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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!
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”
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
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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.
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