Chronic Kidney Disease (CKD) Patient-Based Funding Framework
Frequently Asked Questions
Section A: Bundled vs. Unbundled Services, Service Volumes, Service Definitions
1
What is an annualized patient count and how is this calculated?
The annualized patient count is performed internally at the ORN and is based upon the sum of the duration of active treatment days divided by
365. Duration refers to the number of days a patient is on active treatment. In general, the following methodology can be used to determine
annualized patient count:
Step 1: Identify the period of interest. For fiscal year funding purposes, the period is one fiscal year (365 days).
Step 2: Identify the number of patients who are actively receiving the bundled type of dialysis treatment under the care of staff affiliated with
your nephrology program for the period.
Step 3: Examine the patients start dates over the period; and then sum the length of stay (in days) that the patients spend in the particular
modality.
Step 4: Divide the total number of patient days by 365 days to calculate the annualized patient count.
2
How did we arrive at volumes for 2013/14?
The 2013/14 patient volumes were estimated based on a combination of: SRI data; each program’s historical service achievements; and ORRS
data from Q2. 2013/14 SRI volumes were estimated using the 2012/13 year-end provider-submitted service projections at Q2 of 2012/13. These
volumes were then validated through the Q2 Quarterly Meetings. The ORN then applied an individual growth rate to each program’s 2012/13 year
end projections as of Q2 (Note: the minimum growth rate applied to a given provider is 0%). A program’s growth rate was determined based on
historical service volume achievements and the ORN’s knowledge of the program. The final adjustment made to the 2013/14 volumes was
completed in mid-December 2012 based on ORRS 2012/13 Q2 annualized patient information.
3
How were 2014/15 forecasts achieved?
A growth rate was applied to 13/14 Q3 Year End Projections, to forecast 14/15.
4
If bundled service volumes are not achieved, will funding be clawed back?
Funding will not be clawed back, the same standard bundle reimbursement rate will be provided for every annualized patient, based upon best
practice. Bundled reimbursement is tied to and based upon the count of annualized patients in each bundle, not on the delivery of specific
components or services within the bundles. Reported volumes will continue to be monitored. Bundles will continue to be evaluated and refined
based upon new and up-to-date data and clinical expertise.
5
What are the criteria upon which some services remain unbundled?
Unbundled services are those services that will continue to be reimbursed on a fee-for-service basis. The following criteria is used for unbundling
a service:
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6
Volumes per patient vary considerably across providers (e.g., home nursing visiting hours per home dialysis patient);
It can't be predicted which patients will be receiving the service (e.g., HD treatments for peritoneal dialysis (PD) patients, or in-hospital
PD exchanges);
The service tends to take place in facilities that are different from where the patient usually receives dialysis services, making it
difficult to align patients and providers of care (e.g., vascular procedures); or
Services are provided to patients visiting from other hospitals, but not recorded as transfers (short vacations or admissions to other
hospitals).
Can programs count home visits for pre-dialysis patients who will be potentially starting on home dialysis in the near future?
Yes, these may be counted as Nursing Home Visit Hours.
7
If more than one person goes on the home visit, can it be recorded as hours/travel for both individuals?
Yes, both team members would be reimbursed. There should be a max of 2 members traveling (e.g., nurse and technician) at a time to visit a
home dialysis patient.
8
Through the ORN funding model is it the intention to fund non-OHIP patient activities (whether in a bundle or not).
Currently, ORN uses the data field identified in the Ontario Renal Reporting System (ORRS) as “Province of Health Card Number” as the main
eligibility criteria for reimbursement. More precisely, patients with a Province of Health Card Number identified as “Ontario” or “Blank/Missing”
(once there is confirmation from the provider that there is no HCN) are eligible for reimbursement while patients with a Province of Health Card
Number listed as AB, BC, MB, NB, NL, NS, QC, SK are considered ineligible for reimbursement. The ORN is working to confirm that the current
eligibility criteria are appropriate for 2014/15 Reimbursement File.
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9
In 2013/14, how did other regional sites recover the nursing and tech support funding from the satellites? Did the regional site absorb the
impact of the rate?
Nurse and technician home visits were previously over-reimbursed due to a historical calculation error. The 2013/14 reimbursement rate reflects
the real cost. Costs associated with nurses and technicians travelling to satellites are being redistributed within in-facility bundles. Previously,
nurses and technicians traveling to satellites were reimbursed within the 2012/13 “Nurse/Technician Hours of Service‟ unbundled service. In
2013/14, the satellite component of these unbundled services has been redistributed to the new in-facility or satellite bundles (Bundles E and F),
as one of the many components included in the updated reimbursement rate for a hemodialysis treatment. This updated rate includes total direct
costs, allied health expenses and travelling time to and from the satellite.
10
Nursing Home Visits are an assessment of the patient’s home: space, cleanliness, electrical, lighting, water, etc. If they are not an appropriate
candidate for home dialysis after this assessment, can we still count the home visit hours? Can we count home visits for In-Facility
Hemodialysis patients in this section as well? (i.e. Dietitian to look at cupboards/fridge)
Yes, these may be counted as Nursing Home Visit Hours. No, the in-facility hemodialysis patient bundles (Bundles E and F) include dialysis-related
services, which includes all multidisciplinary care and follow-up visits.
11
Under the Pre-Dialysis Clinic Visit definition, can two nurses be counted as part of the 3 of the following health professionals: Nurse, Dietitian,
Social Worker, Pharmacist/Pharmacy Technologist, or Physician?
Yes, 2 nurses fulfilling distinctly different roles may be counted as part of the pre-dialysis clinic visit (e.g., ID or BA nurse and clinic nurse).
12
If seen by 4 health professionals, and one of these (a nurse) does a one-on-one individualized session, can we count as Pre-Dialysis Clinic Visit
and then a One-on-One session in the same day?
Yes, if these are clearly distinct clinic visits that meet separate criteria, as per the 2013/14 CKD Funding Guide.
13
Will the home training day funding apply should a patient receive home training for home therapy but is unsuccessful at the end of the training
and revert back to in–facility dialysis?
Yes, funding will apply. We will be collecting data with regards to the length of training and proportion of patients who stay at home.
14
Under the current definition of Education Visit, can we record more than one visit per patient per year?
Yes more than one education visit per patient per year can be recorded.
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15
What if you have scheduled several patients for the group education session, but only one patient shows up? Can this still be counted as group
education?
Yes, this can still be counted as a group education visit.
16
What about funding patients who don’t meet the definition of pre-dialysis patients, but to try and keep them out of the hospital, they are still
being seen by an RN, RD or Nephrologist
In the 2013/14 CKD Funding Guide, a pre-dialysis clinic visit is intended as an interdisciplinary clinic dedicated to the optimal care of patients with
a progressively declining eGFR <30. Recognizing there are several factors that may affect the accuracy of GFR estimates (e.g., temporary patient
conditions such as hydration levels), a deviation of +/-10% from the eGFR threshold of <30 may be expected. Given the overall goal of the predialysis clinic visits is to slow progressive GFR decline, to prevent, monitor and treat the multisystem complications of CKD and to prepare for renal
replacement therapy, a CKD program providing a Pre-dialysis Clinic Visit to a patients within an eGRF<30 +/-10% would be reimbursed within the
pre-dialysis patient bundle. It is also important to keep in mind, an outpatient clinic visit dedicated to the management of nephrological
conditions but does not qualify as a pre-dialysis clinic visit, would be considered a Nephrology Clinic Visit, as per the 2013/14 CKD Funding Guide.
17
We do IPD exchanges for patients within the peritoneal dialysis area but they are out-patients. They occupy a bed for 8 - 10 hours in the unit.
Would we count the IPD exchanges with the CAPD in-patient exchanges?
If training is initiated during these exchanges then reimbursement for Initial Training would be provided.
18
Where do we capture a PD patient who has a PD catheter and is no longer attending pre-dialysis but his home dialysis training has not started
yet?
A pre-dialysis patient who has a PD Catheter but has not yet started training is still considered a pre-dialysis patient under Bundle A. The modality
switch to a PD Home Bundle does not happen until training for the modality has begun. In general, the patient remains on the initial bundle until
the start of training for the new bundle.
19
We are required to report acute patients as Chronic Hemodialysis when they have been under our care for over 28 days. There are
circumstances where those patients are still in the ICU receiving 1:1 care after the 28 days. In these situations, are we then required to stop
submitting individual acute treatments, and only report them as in-facility and receive funding for them in the bundle?
CKD providers should report all modality switches in ORRS as it occurs regardless of the length of stay in a previous modality. This means that
acute treatments provided to patients can be reported as long as necessary until they switch to another modality.
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20
How should a home PD or HD patient be counted if the patient is undergoing PD or HD in the hospital?
A Home PD or HD patient who receives hospital PD or HD treatment would be captured in ORRS with a change in modality code. During
hospitalization, the home PD or HD patient is not counted as a maintenance patient and is reimbursement on a fee-for-service basis, i.e., an inhospital CAPD exchange or in-hospital CCPD (APD) through SRI.
21
The funding bundle associated with conventional in–facility hemodialysis equates to thrice weekly. Variations in complexity requires
additional unscheduled visit. If treated in the emergency department (ED), this would be funded as level 3 (or acute), however, for the same
ED avoidance strategy, the program, through capacity planning will treat the patient in the CKD program once triaged in the ED. Will this
receive incremental funding outside the in–facility bundle?
As long as there is a direct patient care staff to patient ratio of 1:1, then the additional unscheduled HD treatment will be funded as an Acute Level
III treatment regardless of where it occurs (i.e. in the dialysis unit, the ER, ICU, CCU, etc.). However, if the conventional in-facility hemodialysis
patient does not meet the requirements of an acute level III, the patient would continue to be reimbursed as per their respective in-facility
bundle. The bundles within the CKD funding framework are meant to provide payments aligned to the appropriate level of care for a patient
requiring the average quantity of services. Certain patients may require more or less of a particular CKD service (or may miss treatments), but the
total annual volume of services provided to their patients should average out to the number estimated by best practice.
22
Our allied health (social worker, dietitian) travel to our satellites twice per year to see our hemodialysis patients. During their visits they also
call PD and PRI patients to come in and see them in the hemodialysis unit. What should these visits be counted as and are they eligible for
reimbursement as they are not only for satellite but home/PRI patients as well?
Home PD patients coming in to see an allied health professional in-person at a satellite are covered with the reimbursement of the home PD
bundles.
23
What if a Program does not do Carbon Tank Exchanges and instead, we do carbon filter exchanges (3 filter/month/per machine). Does funding
for Carbon Tank Exchanges apply to Filter exchanges?
Other carbon adsorption media, other than carbon tanks, may be used by CKD providers to ensure total chlorine concentrations are within CSA
standard dialysis water requirements. For this reason, the definition for Carbon Tank Exchanges will be modified in the 2014/15 CKD Funding
Guide to be inclusive of other types of technologies. With these adjustments, CKD providers will receive equivalent funding, regardless of the
choice of carbon adsorption media chosen.
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24
The new water testing services are for home patients only. What about these tests for acute treatments and at off-site acute treatments? This
should include acute treatments as they have the same CSA Standards as in in-facility or Home dialysis.
Beginning in 2013/14, the ORN will provide additional funding for water testing related to the home hemodialysis patient, only. Currently, more
evidence is required to assess the impact of water testing services on Acute Level III treatments. The ORN continues to monitor Acute Level III
treatments.
25
Our vendor - Gambro, does not perform the municipal water testing (feed water testing) upon machine installation; they use the data provided
by the city. So, some work is being done - technician is going online and checking and reporting feed water data, but not actually doing a test.
How is this funded?
The reimbursement rate for a feed water test is intended for CKD providers performing the feed water test, and does not include monitoring of
municipality feed water test reports.
26
How are unbundled water services funded for each existing home patient?
Reimbursement is not tied to best practice for unbundled water services. Reimbursement for these 3 unbundled services will be on a fee-forservice basis. It is also through reporting that we will be able to assess any practice patterns and support forecasting in the future.
27
What if a patient requires more services than are defined by best practice?
The bundles within the CKD funding framework are meant to provide payments aligned to the appropriate level of care for a patient requiring the
average quantity of services. Certain patients may require more or less of a particular CKD service (or may miss treatments), but the total annual
volume of services provided to their patients should average out to the number estimated by best practice. ORN will continue to monitor the
annual number of each CKD service on an on-going basis to determine if the best practice volumes need to be reassessed.
28
Is there funding for de-clotting, angiogram, angioplasty?
Currently, several Body Access procedures s are being collected in SRI for planning purposes and are under consideration for future rate
development. Some of these Body Access services include: Surgical Revision of AV Fistula or Graft; Surgical Declotting of AV Fistula or Graft;
Declotting plus Angiogram plus Plasty of Dialysis Vascular Access with TPA and without TPA; Angiogram only of Dialysis Vascular Access;
Angiogram plus Angioplasty of Dialysis Vascular Access; and Manipulation or Removal of Peritoneal Dialysis Catheter.
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Are vascular access services bundled or unbundled?
Vascular access services are unbundled because they tend to occur in facilities that are not necessarily the same facilities where patients receive
dialysis services and because the annual service volumes per patient are unpredictable (vary across patients and providers).
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Section B: Reimbursement Rates and Funding
1
Why are there only 26 instead of 31 Regional Renal Programs in 2014/15?
In 2014/15 ORN will shift funding from directly funded satellites their corresponding regional program. Thus in 2014/15, CCO will have
Management Agreements with 26 programs as opposed to 31.
2
For the 2013/14 carve-out, How did the ORN arrive at the stating rate of $199.50?
In 1997, the Joint Policy and Planning Committee (JPPC) determined the rate of a Chronic Hemodialysis Level II Treatment to be $199.50. The JPPC
also determined the rate for all the other dialysis services, and a relative weight was assigned to each of these services based on their rate relative
to the rate of a hemodialysis Level II treatment.
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The 1997 JPPC rate recommendations were fully implemented by 1999/2000, so all the funding was "reset" at $199.50 per weighted unit
for all CKD programs.
ORN's carve out method was based on tracking all hospital and CKD program funding increases over a 10 year period, using fiscal
2000/2001 as the starting point. This was done after confirming with the MOHLTC that no increases or other changes to CKD program
funding increases took place between 1999/2000 and 2000/2001.
­ The rate of $199.50 can only increase if a hospital received economic increases, or funding was directly received by the CKD
program (i.e., infrastructure, machine, lease funding).
3
How were the reimbursement rates for 2013/14 determined?
In 2013/14, the service weighting structure previously used to reimburse CKD services was eliminated and replaced by fixed reimbursement rates
for each CKD service. Fixed reimbursement rates are based upon hourly activity determined from best practice estimates. The rate changes also
incorporated the updated rate for an in-facility hemodialysis treatment of $323. This represents the average rate for a facility with an age mix
similar to that of the province (55% of patients below 70, 25% between70-79, and 20% above 80).
4
Will there be an increase in future funding rates to account for economic (inflationary) increase?
Historically, providers were funded through a global funding model, which meant providers received a fixed budget plus annual, across-the-board
% inflationary increases. As part of CKD’s carve-out methodology, historical CKD-specific hospital revenue and annual inflations to the global
budget of each CKD hospital were identified for carve out. This also included a 2.5% cap on all facility-level annual economic increases per annum.
In 2013/14, providers were reimbursed for the delivery of CKD services through the new CKD patient-based funding model. As part of the new
model, the ORN updated the reimbursement rates for some CKD services to better reflect ‘best practice’ resource requirements. The previous
weighting structure was replaced by a fixed reimbursement structure. The ORN intends to revisit and adjust these rates in the future to ensure
they are reflective of up-to-date costing data.
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Section C: Patient and Provider Characteristics (Adjustors)
1
Have any patient characteristics been found to impact cost (i.e., diabetes; other co-morbidities)?
In 2013/14, the ORN re-examined patient level co-morbidities (e.g., age) to determine if funding adjustments to the model were needed. This
analysis demonstrated that patients in older age groups require more nursing and allied resources to perform the in-facility hemodialysis
treatment. To date, there is insufficient data available to assess the effect aboriginal status or other comorbidities have on the cost of a dialysis
treatment. In the future, further adjustments will be made to the rates, if the available evidence supports the adjustments and as soon as better
data becomes available.
2
Could you elaborate on how the age adjustment is applied at the provider level?
Treatments provided to patients between 70 and 79 cost 4.3% more than treatments provided to patients below 70 years of age, and treatments
provided to patients over 80 years of age cost 9.9% more than treatments provided to patients below 70 years of age. Providers who have an
older age mix than the provincial average* get a slight upward adjustment to the cost of an in-facility hemodialysis treatment, while providers
who have a younger age mix get a slight downward adjustment. This means each provider will have a unique Hemodialysis Level II treatment rate
that may be higher or lower than $323 to reflect their age mix.
*Note: The provincial age mix was the following: 55% of patients below 70; 25% of patients between 70 and 78; and 20% of patients above 80
years of age.
3
How does the framework account for patients with unique challenges who require greater treatment resources? Examples include patients
with diabetes and patients with gambling and food addictions who miss appointments.
The new funding framework provides reimbursement to hospitals for treating in-facility hemodialysis patients based on a best practice annual
service volume (156 treatments per year for in-facility conventional and 260 treatments per year for in-facility daily). Missed treatments would
not result in a reduced reimbursement. This recognizes that resources are still used when patients do not show up for a treatment, and providers
should therefore be compensated accordingly. Co-morbidities are important patient-level characteristics which will be further examined as soon
as better data becomes available.
4
Other research/studies have shown that socioeconomic status may be associated with higher costs. Why has this not been addressed?
To conduct this analysis, patient-level costing data is required along with socio-economic status information. These data are not yet available;
dialysis case costing data will help shed light on this aspect of cost analysis.
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5
Have there been any changes to provider-level adjustments between 2013/14 and 2014/15?
In 2013/14, a small satellite was defined as a satellite with 5 machines in operation or less. Based on a survey circulated to CKD programs to
better understand the additional costs and diseconomies of scale associated with running a satellite, evidence was found to suggest that small
satellites were more costly than regional centers and larger satellites. As a result, a 25% adjustment factor was applied to the cost of a
hemodialysis treatment performed at a small satellite. In 2014/15 the provider characteristic adjustment for small satellites has been refined:
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Any satellite with 18 annualized patients or less (based on a three-year weighted average for annualized patient counts) will receive a 20%
increase on the rate of a hemodialysis treatment.
The refinement of the small satellite adjustment involved revisiting and validating detailed resource utilization surveys completed by differentsized satellites across the province, in order to ensure the provider characteristic adjustment is equitable and reflective of best practice. This
adjustment is being applied to address additional costs and diseconomies of scale associated with running a small satellite.
6
Are there differences in the way satellites are set up? For example, what happens with the costs host hospitals incur surrounding water,
electricity, etc.
The costs the host hospital would incur as a result of running hemodialysis stations would be part of the hospital global budget.
Section D: Carve-out and Mitigation
1
In terms of the economic increase being capped at 2.5% in 2013/14, how far back does that go?
All economic increases received by the hospital, which are translated into a percent funding increase on the base budget, are capped at 2.5%. This
is extended back to 2000/2001.
2
Will all hospitals continue to receive the same economic increase, or are there variations between hospitals? Will every hospital have the same
2.5% and will the 2.5% be the expected economic increase, or is there risk of this being less?
Each hospital’s annual economic increase was translated to a percent funding increase in the base budget of each CKD program. This percent
increase varied from hospital to hospital and year to year (2001/02 to 2011/12). In years that the percent funding increase exceeded 2.5%, it was
capped at 2.5% to account for the fact that some hospitals did not distribute general economic increases proportionally to their CKD program. The
2.5% cap on economic increases relates solely to the carve-out calculation* which was implemented in 2013/14.
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3
For Programs who exceed 10% in the difference in total estimated funding between 2012/13 and 2013/14, will the ORN reduce the funded
volume to achieve mitigated total funding?
In order to support the transition from the previous funding framework to the new one, the ORN is implementing a multi-year mitigation strategy
that will gradually redistribute funds across providers. In year 1 of the mitigation strategy, CKD Programs saw a maximum drop in funding of 5%
and a maximum increase in funding of 10%, as compared to 2012/13.These mitigation corridors were meant to ensure a smooth transition to the
new CKD funding framework for CKD providers, with the ultimate goal of establishing funding equity across service providers. Programs will
receive the remaining % in the upcoming years.
4
In 2013/14 how was the carve-out calculated?
A CKD carve-out methodology, developed in collaboration with the MOHLTC, formed the foundation of the CKD carve-out that was partially
implemented in 2012/13. A revenue-based approach to carving out these CKD services was used in 2013/14, which was based upon historical
CKD-specific hospital revenue and annual inflations to the global budget of each CKD hospital. This partial carve-out was tied to home services at
the 2012/13 interim rate of $263. The base funding available annually for CKD care that remains within hospitals’ global budgets was carved out in
2013/14. In addition, in 2013/14 two refinements were made to the previously communicated carve-out methodology for the CKD programs. To
address the concern brought forth by the LHINs that some hospitals did not distribute general economic increases proportionately to their CKD
program; all facility-level annual economic increases were capped at 2.5% per annum. In addition, some indirect costs were removed.
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What is the mitigation strategy in 2014/15?
This will be communicated to CKD Programs during their 2014/15 stakeholder engagement sessions.
Section E: ORRS-Related and Reporting Questions
1
For in-facility hemodialysis bundles, if a patient fluctuates between 4 and 5 treatments per week, how do we capture the patient days? Would
we capture the weeks when they had 5 treatments in Bundle E patient days and the weeks with 4 treatments in Bundle F? Would we need to
register these fluctuations in ORRS?
All CKD Providers should report modality switches to the ORRS as they occur. Chronic Hemodialysis Daily patients usually dialyze 5 or 6 times a
week, while chronic Hemodialysis Conventional patients usually dialyze 3 times a week.
2
What happens when patients switch modalities during the year?
The count of patients in ORRS takes into account modality changes, provider changes, transfer-outs, deaths and file closures. Prior to May 2012,
changes in modality and provider reported only after 30 days. As of May 2012, the ORRS reporting requirement is that ALL modality and provider
switches will need to be reported, including those that took place within less than 30 days.
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3
What happens if a patient receives hemodialysis treatments at another facility (outside their CKD Program) on a long-term basis?
A patient receiving hemodialysis treatments on a long-term basis (8 days or more), at another facility outside their host CKD Program, will be
treated as a program “transfer”. They would be reported in the ORRS for reimbursement based upon annualized patient count and money would
flow to the facility providing the treatment.
4
What happens if a patient receives hemodialysis treatments at another facility (outside their CKD Program) on a short-term basis?
A patient receiving hemodialysis treatments on a short-term basis (7 days or less), at another facility outside their host CKD Program, will be
treated as a “transfer-in less than 8 days”. Reimbursement is provided to both CKD providers receiving a “transfer-in less than 8 days” patient
(receiving providers), and CKD providers whose in-facility or home patients are receiving hemodialysis at another facility outside their CKD
Program (sending providers). Reimbursement for receiving providers, sending providers of in-facility patients, and sending providers of home
patients differs will be outlined in Section 17 of the 2014/15 CKD Funding Guide. The ORN will calculate reimbursement for short stay treatments
based upon ORRS submission.
5
We have had a request to accommodate a patient travelling patient from another province (New Brunswick) next month. Are there any issues
with funding? Would we register the patient in ORRS and capture the patient days for the in-facility dialysis bundle for the time the patient is
in our Program?
Out-of-province patients that receive in-facility dialysis in Ontario are reported in ORRS. Reconciliation will occur based on Ontario residents with
a valid Ontario Health Card number only and will thus, be excluded from the CKD funding framework.
6
How will you know when the patient got sick and stopped being in the Home PD modality and was in an in-patient setting?
ORN will track each patient’s start and end dates on each modality, as captured in ORRS. When a home PD patient gets sick and goes to an
inpatient setting and receives dialysis, a modality change from PD to the appropriate modality will be recorded in ORRS.
Section F: Transplant and Paediatric Patients
1
We have a 17 year old patient who is being trained for HHD. As we are not a paediatric program how will the process for funding work? Can
we register him in ORRS and capture his patient days for an annualized patient bundle? Also, how do we capture the patient’s in-facility HD up
until his HHD training started?
This pediatric patient attending an adult clinic would be registered in ORRS via an initial chronic dialysis registration. Please inform the ORRS team
to ensure the reimbursement of this patient as an adult chronic dialysis patient.
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2
How is education for transplant visits reimbursed?
CKD Programs would report this as an Education Clinic Visit and meeting the 60 minute requirement according to the data definition. Education
Clinic Visits are intended for patients at the point of making decisions regarding modality choice, and transplantation is a modality. This is an
unbundled service for reimbursement purposes.
3
Is there separate funding for post-transplant clinics? Typically post-transplant patients are followed in clinic (seen by nephrologist and RN, plus
other disciplines as needed). Would this go under nephrology clinic visit?
The ORN does not provide reimbursement for pre- or post-transplant care.
4
Transplant patients often require hemodialysis treatments after their transplant. How do we fund them, as they are not considered chronic HD
patients anymore?
A patient who receives HD treatments post-transplant is still eligible for funding. The transplant event is recorded in ORRS as a treatment change
event (TX), followed with a Returning Patient event with the HD modality code. On the last day of receiving HD treatment, this would be reported
as a Recovered treatment event. CKD providers will receive reimbursement for HD treatments reported in ORRS as part of the HD modality.
5
How will the costs programs incur by caring for patients post-transplants be addressed this year?
Currently, the ORN does not provide funding for transplant patient work-up, pre- or post- transplant.
Section G: Additional Information and Communication
1
How often are Programs communicated information about patient volume?
The ORN has historically presented, and will continue to present, this information back to Programs during Quarterly Reviews.
2
Who is my source of information on CKD funding?
ORN Regional Directors will be the first point of contact and will be able to answer many questions. Otherwise, the Regional Director will connect
with the ORN to assist in the clarification of questions and escalation of issues.
3
How is the CKD Funding Framework aligned with HBAM (Health Based Allocation Model)?
Currently, the Health Based Allocation Model (HBAM) assigns services and costs to individual patients in five care settings or care types: Acute
Inpatient & Day Surgery; Inpatient Rehabilitation; Complex Continuing Care; Emergency Department; Inpatient Mental Health. HBAM does not
currently assign patient-level services and costs to ambulatory care patients, and actual expenses are assumed to be equal to expected expenses
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in those care settings. This is why ambulatory care services are labelled as “Non Modeled” under HBAM. Therefore, the CKD funding framework
would contribute to expanding the scope of modeled services in HBAM.
4
Will the framework be assessed on a regular basis for what is working and what is not?
Yes. The ORN monitors the impact of the funding framework on providers on an ongoing basis. The services to be bundled and unbundled may
change and the best practice volumes may need to change. In addition, when new datasets become available, the model adjustors will be further
analyzed and reassessed. Throughout the process, any suggestions are welcome
5
Will reimbursement rates be assessed on an ongoing basis?
Yes, reimbursement rates will be continuously re-assessed and adjusted. The availability of case costing data will be particularly useful for this
purpose.
6
Is there any funding for data collection included in the revised reimbursement rates?
The resources associated with data collection are captured into the set price of CKD services. If data collection of SRI and ORRS is done by a data
collection clerk or administrative staff member, the associated resources are captured in the fixed direct labour component of the price. If data
collection is done by a case manager or nurse, the associated resources are captured into the variable direct labour component of the price.
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What is the CKD 2013/14 Monitoring Tool?
This tool is designed to help providers smoothly implement all aspects of the funding framework, and to transition to the 2013/14 “Planned
Volume Schedules’ by monitoring funded activity levels and assessing achieved versus expected volume funding. It is intended to support ongoing
implementation, and should not replace existing tools and processes. The target audience for this tool is each program’s clinical directors and
some financial managers associated with the CKD portfolio.
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How does the Monitoring Tool relate to ORRS expose and are we duplicating any of the work?
The Monitoring Tool is a voluntary tool to assist with development of the funding framework and is focused on the information being submitted
to ORRS. This tool is created to assist with financial planning and get you to think about patient counts.
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