Exploring New Models for CKD

Administrator Seema Verma announced that the new CMS Center for Medicare and Medicaid Innovation (CMMI) https://innovation.cms.gov payment models are going to transform kidney care so that patients with Chronic Kidney Diseases (CKD) have access to high quality, coordinated care.

There are more than 450,000 Medicare Fee-for-Service beneficiaries with ESRD who spend 12 hours a week on the average to receive in-center hemodialysis. The Government Accountability Office (GAO) https://www.gao.gov reports that in-center hemodialysis is the most common type of dialysis used by about 88 percent of dialysis patients in 2018.

The CMMI Models are designed to help healthcare providers reduce the cost and improve the quality of care for patients with late stage chronic kidney disease and End Stage Renal Disease (ESRD). These Models aim to delay the need for dialysis and encourage kidney transplantation.

CMS is proposing the ESRD Treatment Choices (ETC) Model to encourage greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD to enhance the quality of care and reduce Medicare expenditures

Kidney Care First (KCF) and the Comprehensive Kidney Care Contracting (CKCC) Models will test new Medicare payment options. The KCF model will enable participating nephrology practices to receive adjusted fixed payments on a per patient basis for managing the care of patients with late stage chronic kidney disease and patients with ESRD.

The payments will be adjusted based on health outcomes and utilization as compared to the practice’s own experience and national standards as well as performance on quality measures.

In addition, participating practices will receive a bonus payment for every patient aligned to them that receives a kidney transplant based on the transplant remaining healthy for up to three years after the surgery.

The Comprehensive Kidney Care Contracting (CKCC) Graduated, CKCC Professional, and Global Models are designed to help health care providers reduce the cost and improve the quality of care for patients with late-stage chronic kidney disease and ESRD. The CKCC Models will make capitated payments similar to the capitated payments under the KCF Model.

However, the Kidney Contracting entities consisting of nephrologists, transplant providers, and other healthcare providers including dialysis facilities will take responsibility for their total cost and quality of care for their patients and in exchange receive a portion of the Medicare savings achieved.

Lastly, CMS is exploring how telehealth services would be allowed to be used for populations not classified as rural. Telehealth would provide flexibility for beneficiaries to communicate with their providers and suppliers when necessary and medically appropriate.

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