Overview of

Renal Services Exchange

FRAA

July 26, 2014

Historical Perspective

Formed in 2003 as NRAA GPO

For Profit Subsidiary of NRAA

Five Board Members

Purpose: Discounted Pharmaceuticals for NRAA

Members

Competitive Market

Achieved 25% to 30% Market Share

Historical Perspective

2005 Partnered with Metro Medical to form RPG

2011 Expanded Board 9 Members

Revised Vision & Mission Statements

Developed 1, 3 and 5 Year Goals

Created Committee Structure around the Goals

2012 Name Change to Renal Services Exchange (RSE)

RSE Mission

To provide independent, regional, community-based organizations,

nephrologists, and other clinicians that provide care for patients with chronic

kidney disease access to competitively priced drugs, products, supplies, and

business services that help their organizations to thrive.

• Jeff Lehman (President)

• Larry Emerson (Vice President)

• Dan Nye (Secretary/Treasurer)

• Doug Johnson

• Larry Jones

• Sheri Floramo-Korbet

• Ellen Davis

• Maria Regnier

• Diane Wish

• Marc Chow (ex officio)

RSE Board

2013 - 2014

RSE Committee

Structure

Management

Oral Drugs

Pharmacy Services Integrated

Care

Marketing &

Communications

RSE & RPG*

Committee

Data

Services

Risk

Management**

HIE for

CROWNWeb

and HIT

ESRD PPS

Calculator

Partnership &

Relationships

Benchmark Governance

RSE

Provider

Database New Services

Current Partners:

*ICH-CAHPS (Six Preferred Vendors)

**Group Purchasing Organizations (RPG)

***Insurance and Risk Management (Gallagher

Healthcare)

ICH

CAHPS*

Metro Medical NRAA

RPG

CPG 48% ownership

50% governance

RSE 52% ownership

50% governance

Ownership /

Governance

RPG & Partnerships (1)

• RPG Partnership allows NRAA members and non-members

access to competitive pricing • Vasc-Alert: Vascular access device and surveillance service

• EnterSource: Video, Phone & Internet for offices and

healthcare facilities

• MedPro Waste: Reliable cost-effective medical waste services

• AHS Renal Staffing: National staffing firm for dialysis

professionals

• Dialysis Jobs Weekly: Dialysis recruitment and job board

Current

•Over 205 Dialysis Organizations

•Submission of data from 800+ dialysis facilities

•77,000+ ESRD patients data submitted per month

•14 Certified EMR Vendors

Future

• Continuing to certify new EMR vendors (Discussion with

VA, Mayo Clinic, EPIC, and Kaiser )

•Increase use of NRAA HIE

•Expanded use of NRAA HIE with HIE services

HIE/HIT

• Deployment of the NRAA QAPI tool

• Discussion with RPA regarding PQRI reporting • NRAA and ESRD Forum leading a coalition to discuss

the role of HIT within the ESRD Community (implications

for integrated care, NRAA HIE platform, etc…)

• Discussion with CDC/NHSN and possible electronic submission

Pharmacy

• Initial focus was to prepare NRAA members for inclusion

of orals in the bundle

• Surveys, interviews, webinars, and presentations

• May and August 2013 Webinar and Conference

Presentations

• Overview of potential vendors, discussion of

pharmacy terminology, and related operational

options, challenges, and solutions

• Orals in the bundle in 2016? 2024?

• RSE will prepare for an education launch with additional

resources and tools as the mix evolves

Risk Management

• Partnered with Gallagher Healthcare

• Conducted a survey of NRAA Members about risk

management and insurance program and process

• Developed and released a Risk Assessment tool for NRAA

Members

• Provide educational webinars and conference presentations

• HIPAA/HITECH Update: Are you prepared?

• Social Media & Healthcare: Best Friends or Worst

Enemies?

• Healthcare Workplace Violence: Are You Prepared for the

Unthinkable?

Cyber Product and Errors & Omissions

Billing Errors & Omissions Regulatory Liability Policy • Billing E&O Coverage

• Medicare & Medicaid Audit Coverage (Defense and Fines & Penalties

Coverage)

• Commercial Payor Audit Coverage (Defense Only)

• STARK Coverage (Defense and Fines & Penalties Coverage)

• EMTALA Coverage

• Patient Data Breach Coverage Endorsement

• Security & Privacy Liability (Defense and Fines & Penalties Coverage)

$1M

• Crisis Management, Patient Notification (Defense and Fines &

Penalties Coverage) $250k

• Multimedia $100k

• Data Recovery $250k

• Data Extortion $250k

Business Tools & Data Services

• ESRD PPS Calculator (Released March 2014)

• Preferred Vendor Pricing for ICH-CAHPS

• Benchmarking

• Benchmark (cost report data) collection tool created

in partnership with Avalere Health

• Contracted with Prima Healthcare Analytics for an

expanded benchmark and database • 2008 to 2012 Cost Report Data • 2008 to 2011 DRF Data

• RSE Provider Database

Physicians

• NRAA Committee

• 2014 Medical Directors’ Workshop and Nephrology

Symposium (October 17 – 18 in Chicago, IL)

• Focus: Practical tools and applications

• Sample topics • Infection control

• AKI

• Care transition

• Extra cellular volume control

• Unique staffing models

• Quality blueprint

• Depression

• ICH CAHPS survey

Partnerships

•One Health Port provides the HIE capabilities and support for

the NRAA HIE for CROWN Web

•Gallagher Healthcare has allowed the RSE to work on

developing risk assessment tools and will be offering insurance

products beginning in the Spring 2014

•Continued relationship building with ANNA, RPA, ASN, Renal

Executive’s Forum, ESRD Forum, and others

Integrated Care

• The Gorman Health Group facilitated the NRAA Executive

Committee and RSE Board on a discussion about integrated

Care and ESCO (Jan 2014)

Webinars, Workshop, Presentations

• The Integrated Care Model, ESCO and Envisioning the Future:

A Strategic Webinar for the Independent Provider (Feb 2014)

• Integrated Care and ESRD Seamless Care Organizations

Workshop (Feb 17-18 in Dallas, TX)

• The Integrated Care Model: Key Points to Know in Evaluating

Your Decision to Participate in the CMS/CMMI ESCO

(Webinar: March 28, 2014)

• Integrated Care (April 30, 2014, NRAA Spring Workshop)

1.Integrated care has a significant role in the future of the

dialysis industry. Integrated care means taking responsibility

for coordination of all care received by CKD patients,

beginning well before the commencement of dialysis. It also

includes a strong patient education component.

2. The NRAA / RSE supports the research of integrated care

models, including the Medicare ESCO demonstration

program, and will help educate NRAA members to participate

in a broader approach to integrated care. The NRAA / RSE

desires to be a productive voice in this future.

Integrated Care Perspective (1)

3. The NRAA / RSE will provide support to members who

are considering ESCO participation.

4. The NRAA / RSE will be proactive in the development of

CKD integrated care methodologies and payment

provisions.

The RSE is assessing care management programs and the

role the possible role of the NRAA HIE within current and

the future of integrated care to kidney patients

Integrated Care Perspective (2)

Product Development

New Services • Inventory Management

• Cost reporting

• Coding and billing/collections

• Disaster planning

• Payroll

• Human resources consultation

• EMR

RSE & FRAA

How Can We Work Together?

• RPG

• HIE

• Risk Management

• Integrated Care

• Other Services

Update from

NRAA

FRAA

July 26, 2014

NRAA – Education

NRAA Eblast

The NRAA Education Council is now accepting applications for the Director of Education

position. We are seeking a dynamic, self-motivated individual to join the NRAA team.

Promoting education is at the heart of NRAA’s strategic plan. In order to continue

improving upon this area, the NRAA Board is in agreement that a Director of

Education is critical to helping us achieve our mission.

Summary of Position

The Director of Education will research, develop, coordinate and enhance educational

opportunities, professional resources and other programs that support the NRAA

mission and strategic goals, add value to the NRAA membership. More information

regarding this job announcement can be found here.

Interested candidates are encouraged to visit the NRAA website (www.nraa.org) to

gain insight into the organizations’ mission and strategic plan. To apply for Director of

Education, or for questions or concerns, send an email to education@nraa.org.

Opportunities to Learn thru Active Participation

DFC 5 Star Rating

Quality Measures Used

DFC Quality Measures used in calculation of Star Rating:

– Standardized Transfusion Ratio (STrR)

– Standardized Mortality Ratio (SMR)

– Standardized Hospitalization Ratio (SHR)

– Percentage of adult hemodialysis (HD) patients who had enough wastes removed

from their blood during dialysis

– Percentage of pediatric hemodialysis (HD) patients who had enough wastes removed

from their blood during dialysis

– Percentage of adult peritoneal dialysis (PD) patients who had enough wastes

removed from their blood during dialysis

– Percentage of adult dialysis patients who had hypercalcemia

– Percentage of adult dialysis patients who received treatment through

– Percentage of adult patients who had a catheter left in vein longer than 90 days for

their regular hemodialysis treatment

NOTE: URR and Hemoglobin measures currently reported on DFC were not included in the

star rating calculation because they are topped out (national averages are 99% and < 1%

respectively).

DFC 5 Star Rating

Description of Rating Methodology

Star Rating based on the average of the QM’s, with some measures weighted more

heavily than others

Weights come from an analytic method called factor analysis that identifies groups of

correlated QM’s

Different weights are used in order to avoid counting some measures too heavily

– For instance, if 4 related QM's measure a certain aspect of care and only1 QM

measures a second aspect of care, a simple average of the 5 QM's would count

the first aspect of care much more heavily than the second.

Systematic empirical methods (factor analysis) were used to identify groups or

domains of correlated QM's based on January 2014 DFC data

• The resulting groups or domains were labeled

– Standardized Outcomes (SHR, SMR, STrR)

– Other Outcomes 1 (AV fistula, tunneled catheter)

– Other Outcomes 2 (Kt/V, hypercalcemia)

DFC 5 STAR Reports

DFC 5 STAR Reports

RSE ICH CAHPS Preferred Vendors

ADVOCACY

ADVOCACY

�

FUTURE MEETINGS