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
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References
- 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.)
- Medicare Coverage of End-Stage Renal Disease (ESRD).Congressional Research Service, 2018: 23sgp.fas.org/crs/misc/R45290.pdfDate accessed: January 4, 2022
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.
- Final rule. “Medicare program; specialty care models to improve quality of care and reduce expenditures”.Fed Regist. 2020; 85: 61114-61381
- Final rule. “Medicare program; specialty care models to improve quality of care and reduce expenditures”.Fed Regist. 2020; 85: 61265-61273
- Volume 2, Chapter 11: International comparisons.USRDS, 2018: 576 (Figure 11.15) (Accessed April 18, 2022)
- 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
- Final rule. “Medicare program; specialty care models to improve quality of care and reduce expenditures”.Fed Regist. 2020; 85: 61265
- Final rule. “Medicare program; specialty care models to improve quality of care and reduce expenditures”.Fed Regist. 2020; 85: 61266
- Volume 2, Chapter 11: International Comparisons.USRDS, 2018: 578 (Figure 11.16) (Accessed April 18, 2022)
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.
- Final rule. “Medicare program; specialty care models to improve quality of care and reduce expenditures”.Fed Regist. 2020; 85: 61278-61284
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.
- Final rule. “Medicare program; specialty care models to improve quality of care and reduce expenditures”.Fed Regist. 2020; 85: 61293
- Final rule. “Medicare program; specialty care models to improve quality of care and reduce expenditures”.Fed Regist. 2020; 85: 61299
Centers for Medicare & Medicaid Services. ESRD Treatment Choices (ETC) Model. https://innovation.cms.gov/innovation-models/esrd-treatment-choices-model. Accessed January 4, 2022.
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.
- Proposed rule. “Medicare and Medicaid programs; regulatory provisions to promote program efficiency, Transparency, and burden reduction”.Fed Regist. 2018; 83: 47704-47706
- 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
Article Info
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc.
