1. Initiatives & Update

2. Agenda  Background of FSN  Current Initiatives & Programs  Looming Legislative Issues  Nephrology Workforce in Florida

3. Mission Statement  FSN represents and serves the interests of Florida nephrologists in their pursuit and delivery of quality care for patients with kidney disease.

4. Strategic Priorities  Education  Regulatory & Legislative Advocacy  Practice Management Success  Patient Care  Grassroots Communication  Collaboration – Partnerships

6. Advocacy

7. FSN FRAA FRC RPAASNNKFFFMA

8. Association Update  Founded in 1990  Currently over 285 members  Active Members are Nephrologists  Associate Member category for PAs/ARNPs  Corporate Membership Program

9. Expand Existing Collaborations

10. Engage Future Leaders - 6 New Applicants to Executive Committee in 2015

12. ESCO Education Defining ESCOS: Medicare's Comprehensive ESRD Care Initiative Tom Duvall, CMMI Team Leader Jul 07, 2015

13. RPA Collaborations

14. RPA Continued  2016 Combined Coding & Reimbursement Conference  Taking place at start of the 2016 FSN Annual Meeting in Delray Beach, FL

15. Regional Meetings  2014 December Events Pensacola Jacksonville  2015 Events August 17 th in Fort Lauderdale August 18 th in West Palm Beach October 1 st in Miami

17. House Health Care Initiatives  Independent Practice of ARNPs – FSN remains opposed  Non-Contracted Emergency Services – tied to Medicare – FSN opposed  Medicaid Expansion – FSN remains supportive  New issues in 2016 – Certificate of Need Tort Reform

18. RPA Statement Collaborative Practice  RPA believes it is critically important that within the renal care team, the nephrologists must maintain the primary leadership role and assume ultimate responsibility.

20. The US Nephrology Workforce: Developments and Trends Prepared for The American Society of Nephrology 2014

21. Only 323 individuals applied for 403 nephrology fellowship positions in 2014, a ratio of 0.8 applicants per position. The same trend is demonstrated in unfilled nephrology fellowship positions with the proportion of unfilled positions increasing from 5.9% in 2010 (22 unfilled positions of 374) to 24.1% in 2014 (97 unfilled positions of 403). The number of unfilled fellowship program positions doubled in just one year—from 47 in 2013 to 97 in 2014.

22. Accelerated Decline 20102011201220132014 Total Positions 374380397416403 Filled Positions 352345360369306 Unfilled Positions 2235374797

23. Red = USMGs Green = IMGs

24. Florida Physician Workforce Analysis: Forecasting Supply and Demand Safety Net Hospital Alliance of Florida 2015

25. Critical Shortfall of Physician Specialties The supply of specialists in Florida is insufficient to provide a level of care consistent with the national average, after taking into consideration differences in the demographics and health risk factors between Florida and the nation. The current 18% shortfall is likely to persist. By 2025, a 19% shortfall is projected.

26. Nephrology Data 2025 Supply 2025 Demand 2025 Deficit Gap Nephrology700730(30)-4%

29.  Identify why more US Medical Graduates are not selecting Nephrology Reimbursement Opportunity Quality of Life  Advocacy Targeted Loan Forgiveness Expanded utilization of non-physician providers under physician supervision Telemedicine Advancement with Safeguards  Engagement Outreach to medical students