Advertisement

Centers for Medicare & Medicaid Services' Models to Improve Late-stage Chronic Kidney Disease and End-stage Renal Disease Care: Leveraging Nephrology Payment Policy to Achieve Value

      This article describes two new and complementary initiatives from the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services—the ESRD Treatment Choices and Kidney Care Choices Models—which focus on Medicare beneficiaries with CKD and ESRD. These models, or time-limited tests, are aimed at testing whether modifying Medicare payment methodologies, while also rewarding certain clinical outcomes, will improve treatment and outcomes and reduce costs. Together, these initiatives comprise a major part of the larger federal effort to improve the lives of people with kidney disease. The goal of the ESRD Treatment Choices Model is to maintain or improve quality while reducing cost by incentivizing greater use of home dialysis and kidney transplantation. The model aims to do so by adjusting certain payments to nephrologists and other clinicians managing beneficiaries with ESRD (managing clinicians) and ESRD facilities selected to participate in the model. The Kidney Care Choices Model aims to maintain or improve quality while reducing cost through better coordination of care across a larger spectrum of kidney disease, focusing on beneficiaries with CKD stages 4 and 5 and ESRD, to delay the onset of ESRD and improve the transition for Medicare beneficiaries facing the prospect of dialysis. The Centers for Medicare & Medicaid Services is hopeful that these models will inform the future direction of payment policy for this critical Medicare population.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Advances in Chronic Kidney Disease
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • United States Renal Data System
        USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. 2. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD2018 (End-stage Renal Disease (ESRD) in the United States, Chapter 1: Incidence, Prevalence, Patient Characteristics, pp 291, 294.)
        • Kirchoff S.M.
        Medicare Coverage of End-Stage Renal Disease (ESRD).
        Congressional Research Service, 2018: 23
        sgp.fas.org/crs/misc/R45290.pdf
        Date accessed: January 4, 2022
      1. The Lewin Group. Comprehensive End-Stage Renal Disease Care (CEC) Model. Performance Year 4 Annual Evaluation Report. Published February 2021. https://innovation.cms.gov/data-and-reports/2021/cec-annrpt-py4. Accessed January 4, 2022.

        • Centers for Medicare & Medicaid Services
        Final rule. “Medicare program; specialty care models to improve quality of care and reduce expenditures”.
        Fed Regist. 2020; 85: 61114-61381
        • Centers for Medicare & Medicaid Services
        Final rule. “Medicare program; specialty care models to improve quality of care and reduce expenditures”.
        Fed Regist. 2020; 85: 61265-61273
        • United States Renal Data System
        Volume 2, Chapter 11: International comparisons.
        USRDS, 2018: 576 (Figure 11.15) (Accessed April 18, 2022)
        • Golper T.A.
        • Saxena A.B.
        • Piraino B.
        • et al.
        Systematic barriers to the effective delivery of home dialysis in the United States: a report from the Public Policy/Advocacy Committee of the North American Chapter of the International Society for Peritoneal Dialysis.
        Am J Kidney Dis. 2011; 58: 879-885
        • Centers for Medicare &Medicaid Services
        Final rule. “Medicare program; specialty care models to improve quality of care and reduce expenditures”.
        Fed Regist. 2020; 85: 61265
        • Centers for Medicare & Medicaid Services
        Final rule. “Medicare program; specialty care models to improve quality of care and reduce expenditures”.
        Fed Regist. 2020; 85: 61266
        • United States Renal Data System
        Volume 2, Chapter 11: International Comparisons.
        USRDS, 2018: 578 (Figure 11.16) (Accessed April 18, 2022)
      2. Dartmouth Atlas Project. The Trustees of Dartmouth College, 2021. Available at: www.dartmouthatlas.org. Accessed January 4, 2022. The HRR as specified by the Dartmouth Atlas Project defines the geographic area of each provider.

        • Centers for Medicare & Medicaid Services
        Final rule. “Medicare program; specialty care models to improve quality of care and reduce expenditures”.
        Fed Regist. 2020; 85: 61278-61284
      3. Centers for Medicare & Medicaid Services. End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model. https://innovation.cms.gov/media/document/etc-hrr-report. Accessed January 4, 2022.

        • Centers for Medicare & Medicaid Services
        Final rule. “Medicare program; specialty care models to improve quality of care and reduce expenditures”.
        Fed Regist. 2020; 85: 61293
        • Centers for Medicare & Medicaid Services
        Final rule. “Medicare program; specialty care models to improve quality of care and reduce expenditures”.
        Fed Regist. 2020; 85: 61299
      4. Centers for Medicare & Medicaid Services. ESRD Treatment Choices (ETC) Model. https://innovation.cms.gov/innovation-models/esrd-treatment-choices-model. Accessed January 4, 2022.

      5. Centers for Medicare & Medicaid Services. Technical Specifications for ESRD QIP Measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/061_TechnicalSpecifications. Accessed January 4, 2022.

        • Centers for Medicare & Medicaid Services
        Proposed rule. “Medicare and Medicaid programs; regulatory provisions to promote program efficiency, Transparency, and burden reduction”.
        Fed Regist. 2018; 83: 47704-47706
        • Centers for Medicare & Medicaid Services
        Final rule. “Medicare and Medicaid programs; regulatory provisions to promote program efficiency, Transparency, and burden reduction; Fire safety requirements for certain dialysis facilities; hospital and critical access hospital (CAH) changes to promote innovation, flexibility, and improvements in patient care”.
        Fed Regist. 2019; 84: 51749