overview of renal services exchange fraa july 26, 2014...hie/hit • deployment of the nraa qapi...
TRANSCRIPT
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 [email protected].
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
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FUTURE MEETINGS