launching a successful nursing home dialysis program · launching a successful nursing home...
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www.mcguirewoods.com
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www.mcguirewoods.com
Launching a Successful Nursing Home Dialysis Program
Curt Anliker Chief Operating Officer
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McGuireWoods | 2 CONFIDENTIAL
An Under-Served, Significant Market
• 430,000 ESRD patients in U.S. • 5,500 Home dialysis patients in U.S. (2011 USRDS)
• We estimate 12% of ESRD reside in skilled nursing
facilities
51,000 Patients $2.0+ Billion market
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McGuireWoods | 3 CONFIDENTIAL
Benefits of Nursing Home Dialysis
Stakeholder Benefits
Patient Survival Convenience & lifestyle Consistency of meds, meals & therapy
Nursing Home Marketing tool & census builder Acuity drives in overall reimbursement Eliminate transportation costs & logistics Daily dialysis can therapy minutes
Payors Cost (fewer meds & hospitalizations) Zero transportation costs
Physician Improved care for patients & their families Potential source of new patients
Hospitals Ability to discharge patients Discharge destination becoming a more data-driven event. Quality home dialysis is a factor. Think ACOs.
ESRD Provider Growth opportunity in a slow-growth industry
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McGuireWoods | 4 CONFIDENTIAL
There is One Loser
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McGuireWoods | 5 CONFIDENTIAL
There is One Loser
Transportation Companies
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McGuireWoods | 6 CONFIDENTIAL
Basic Business Model & Requirements
• ESRD Provider certified for Home Hemodialysis Training & Support
• Skilled nursing facility considered patient’s home - even the resident on a 100-day Part A rehabilitation stay
• Billed as home dialysis • Coordination agreement b/t ESRD Provider and SNF
outline the responsibilities and the economic terms • Ensuring caregiver staffing costs are covered is the key to
a program’s financial viability • Understand both your Fiscal Intermediary and your state’s
Medicaid policy for reimbursement of additional treatments
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McGuireWoods | 7 CONFIDENTIAL
Regulatory Environment
• ESRD Conditions of Coverage (CMS 2008)
• 2004 Survey Guidance Letters – S&C 04-24 (March 19, 2004) – S&C 04-37 (July 8, 2004) – Issued to State Survey Agencies – Defined the relationship b/t the ESRD provider and the SNF – Defined the staffing requirements
• States retain right to impose more stringent regulations than the CMS’ Conditions of Coverage or Guidance Letters
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McGuireWoods | 8 CONFIDENTIAL
The Go / No Go Decision to Launch
• Quantify the market need with market analysis
• Is your ESRD provider certified for Home Dialysis? If not, what investment is required?
• What is the reimbursement policy of both your fiscal intermediary (Medicare) and your state (Medicaid) vis á vis > 3 treatments per week?
• Are there any additional state regulations?
• Don’t underestimate the sales, management requirement & resources, and the added level of operational complexity
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McGuireWoods | 9 CONFIDENTIAL
The Go / No Go Decision to Launch
• Clarify your business objective 1. Add the service as an incremental offering for patient-
centered modality?
A Noble Goal
The Right Thing To Do
Go For It
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McGuireWoods | 10 CONFIDENTIAL
The Go / No Go Decision to Launch
• Clarify Your Business Objective 1. Add the service as an incremental offering for patient-
centered modality?
A Noble Goal
The Right Thing To Do
Go For It
2. Create a business with a standalone enterprise value?
Go Big or Go Home
Multiple SNF locations
50-100 patients minimum
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McGuireWoods | 11 CONFIDENTIAL
Viable Operational Models
NxStage Daily Dialysis
Conventional Thrice Weekly
Bedside
YES
NO
Den
YES
YES
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McGuireWoods | 12 CONFIDENTIAL
Which Business Model To Use?
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McGuireWoods | 13 CONFIDENTIAL
Which Business Model To Use?
It Depends
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McGuireWoods | 14 CONFIDENTIAL
Which Business Model To Use?
It Depends
Factors Include: • SNF empty bed capacity • SNF footprint • State regulatory environment • Staffing availability • ESRD Provider resources
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McGuireWoods | 15 CONFIDENTIAL
Program Responsibilities
ESRD Provider SNF
Patient caregivers OR Patient caregivers
Caregiver Training & Skills Verification Physical space build-out (Treatment & storage)
Dialysis equipment & supplies Dialysis chairs
Dialysis related drugs Digital scale
Medical oversight (Med Director & Qualified Home Training RN)
On-site licensed RN (trained by ESRD provider)
Labs Medical waste disposal
Regular in-servicing of SNF staff Cleaning & utilities
Social worker & dietician Medication administration
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McGuireWoods | 16 CONFIDENTIAL
Other Operational Considerations
• Remember, the ESRD provider is a guest in the SNF • Align goals with the SNF and be aware of the potential
tension of operating within their facility • Exceptional communication needed for effective
coordination of care • Continual in-servicing is required due to high staff
turnover in SNFs • On-site QAPI meetings • Bio-medical staff support • Nephrologist credentialing: open or closed unit?
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McGuireWoods | 17 CONFIDENTIAL
Given the most recent 10 years of focused effort serving this niche market, compelling clinical outcome data is starting to emerge.
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McGuireWoods | 18 CONFIDENTIAL
Recent Data Studies Demonstrate Proven Patient Benefits for Nursing Home Dialysis
• Affiliated Dialysis Centers recent data releases: – Annual Dialysis Conference (Atlanta - Feb 2014) – National Kidney Foundation (Las Vegas - April 2014)
• Analyzed outcomes of nearly 4,000 patients over 6 years • P < .001
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McGuireWoods | 19 CONFIDENTIAL
Recent Data Studies Demonstrate Proven Patient Benefits for Nursing Home Dialysis
• Affiliated Dialysis Centers recent data releases: – Annual Dialysis Conference (Atlanta - Feb 2014) – National Kidney Foundation (Las Vegas - April 2014)
• Analyzed outcomes of nearly 4,000 patients over 6 years • P < .001 • Key results released to date:
1. Clinical outcomes at 3 months were consistent with the trend and quality of care to the general ESRD population
2. Daily dialysis improves mortality rate. Median survival increases from 30 months to 50 months.
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McGuireWoods | 20 CONFIDENTIAL
Nursing Home Patients – Mortality Comparisons
Source 3 month
6 month
12 month
USRDS 50% 26% 14%
Tamura et al 39% 13%
Affiliated Dialysis 86% 80% 71%
Nursing Home ESRD Patient Survival Probability - Incident
USRDS 2010 Annual Data Report Tamura et al NEJM 2009
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McGuireWoods | 21 CONFIDENTIAL
Daily Dialysis Shows Improved Survival Rates
Patients on Daily Dialysis vs. Conventional Demonstrated: 1. Improved health status 1. Lower monthly mortality rates 1. Significantly longer median survival
(50 mo vs. 30 mo)
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McGuireWoods | 22 CONFIDENTIAL
Summary
• Nursing home dialysis is a growing segment and patients are worthy to be served by quality home dialysis programs
• The nursing home dialysis niche plays perfectly into the developing ACO model of care and the need for cost controls in our national health care system
• Affiliated Dialysis is committed to serving, promoting, and educating the industry on this critical service
• Access our website for additional information, including our recent data study press releases
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McGuireWoods | 23 CONFIDENTIAL
Questions?
www.affiliateddialysis.com
Curt Anliker Chief Operating Officer