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ESCOs reduced hospitalizations, access issues, but no change in QoL, mortality rate
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An analysis completed on the first year of the Comprehensive ESRD Care demonstration indicated the 13 physician-provider groups that participated in the project showed improvement in vascular access management and reducing hospitalizations, but no measurable change was seen in patient quality of life or mortality. No significant increase was seen in the use of home dialysis as well.
“For the most part, CEC beneficiaries experienced fewer hospitalizations associated with complications related to poor dialysis care,” the Lewin Group wrote in its 119-page analysis. “CEC beneficiaries experienced fewer hospital admissions due to ESRD complications (P < 0.01) and vascular access complications (P < 0.10).”
On improvement in the quality of care delivered, the Lewin Group wrote, “There is no evidence that relative reductions in cost and utilization compromised quality. Among the CEC beneficiaries relative to the comparison group, use of fistulas (the preferred type of vascular access for hemodialysis) showed a small but insignificant increase, while use of catheters (the non-preferred form of vascular access) declined slightly (P < 0.10).”
Patients did see some improvements in quality of life under the CEC model, scoring higher than the comparison group on physical health, mental health, burden of kidney disease, symptoms and problems and effects of kidney disease.
“However, the differences were small in magnitude and only the physical component score attained marginal statistical significance,” the Lewin Group reported.
CMS’s Innovation Center (CMMI), which is managing the 5-year demonstration, released financial data on the performance of the participants — known as ESRD Seamless Care Organizations — in October. The data showed the 13 ESCOs helped generate $72 million in shared savings in the first year. The shared savings represent how much an ESCO retains after providing patient care in the demonstration. The ESCOs and Medicare receive a percentage of the savings.
When the Lewin Group asked dialysis providers why they decided to join the demonstration, most said it was about improving relationships with nephrologists.
“ESCO participants highlighted the potential for improving patient care in their own organizations while also influencing future payment models,” the report authors noted. “ESCO participants often cited the importance of building upon existing good relationships between dialysis providers and nephrologists and developing or strengthening relationships with other providers such as hospitals and vascular surgeons. Staff at LDOs noted that markets where they had the strongest relationships with nephrologists were the ones they selected for ESCOs.”
Eight of 12 of the participants earned between $1.45 million and $4.7 million in the first year. The remaining four earned between $5.6 million to $12.3 million — the highest earner in the group being an ESCO operated by DaVita Kidney Care in the Philadelphia area.
Since the demonstration began in the fall of 2015, the number of ESCOs has grown from the original 13 to 37, representing more than 30,000 patients. CMMI just completed the task of collecting data from the original 13 ESCOs on how they performed on quality measures in the second year. Performance on those measures, which include things like diabetic foot screenings and eye exams, evaluating patients for depression, improving medication adherence, influenza immunizations, assisting patients with smoking cessation and reducing patient falls, will impact how much each ESCO will received in shared savings. – by Mark E. Neumann
More information on the CEC is available at
https://innovation.cms.gov/initiatives/comprehensive-esrd-care.