HHS Unveils 5 New Payment Models to Transform Kidney Disease Care

Jaime Rosenberg

Following an executive order from President Donald Trump, HHS announced the launch of Advancing American Kidney Health, an initiative to improve the health of the 37 million Americans living with kidney disease, by releasing 5 new payment models.

According to HHS Secretary Alex Azar, the effort is the most significant initiative taken for kidney disease by any president and the single biggest change to how the disease is treated since Medicare began covering patients with end-stage renal disease (ESRD) in 1973.

The initiative outlines 3 goals for improving kidney health: (1) reduce the number of Americans developing ESRD by 25% by 2030; (2) have 80% of new ESRD patients in 2025 either receiving dialysis at home or receiving a transplant; and (3) double the number of kidneys available for transplant by 2030. There are currently more than 700,000 Americans with ESRD and nearly 100,000 waiting for a kidney transplant.

In pursuit of these goals, HHS proposed a mandatory model that would encourage greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD and 4 voluntary models that would test new Medicare payment options to improve care for patients with kidney disease.

“The way we currently pay for chronic kidney disease and kidney failure isn’t working well for patients,” CMS Administrator Seema Verma, said in a statement. “Under President Trump’s leadership, we are focused on strengthening Medicare and protecting the program for the individuals it was meant to serve. These historic initiatives aim to improve the quality of life for kidney disease patients by preventing disease progression, encouraging transplants over dialysis, and if dialysis is needed, more convenient home based dialysis to improve health outcomes.”

The proposed mandatory ESRD Treatment Choices (ETC) Model, which would account for approximately 50% of Medicare beneficiaries with ESRD, would apply payment adjustments to the adjusted ESRD Prospective Payment System per treatment base rate to selected facilities, as well as the monthly capitation payment to selected clinicians, based on their home dialysis and kidney and kidney-pancreas transplant rates. It would also include risk adjustments to account for providers treating sicker patients. 

According to CMS, the payment adjustments would offer incentives to work with beneficiaries and caregivers in choosing ESRD treatment setting and support greater utilization of home dialysis and kidney transplants. The adjustments would run from January 1, 2020, through June 30, 2026.
The 4 voluntary models, which include The Kidney Care First (KCF) Model and 3 Comprehensive Kidney Care Contracting (CKCC) Models, would aim to delay the need for dialysis and promote kidney transplantation.

Under the KCF Model, participating nephrology practices would receive adjusted fixed payments on a per-patient basis for managing patients with late-stage chronic kidney disease and patients with ESRD. Payment adjustments would be based on health outcomes and utilization compared with the practice’s own experience and national standards, we all as quality measure performance. Practices would be able to receive bonus payments for every patient that receives a kidney transplant on the condition that the transplant remains healthy for up to 3 years following surgery.

The CKCC Models—Graduated, Professional, and Global—would utilize capitated payments similar to those used under the KCF Model, but the participating providers and facilities would be responsible for the total cost and quality of care for patients, and in exchange, could receive a portion of their Medicare savings.

The 4 models are expected to run from January 1, 2020, through December 31, 2023, and would include the option for 1 or 2 more performance years.

Trump’s executive order also calls for HHS to:
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