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Researchers propose pilot program to reform Medicare payments for care of patients with CKD
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In an editorial published in the Journal of the American Society of Nephrology, researchers proposed a pilot program that would reform Medicare payments regarding the care of chronic kidney disease.
“We are suggesting a pilot program that reforms nephrologist payments for advanced CKD patients not on dialysis that pays nephrologists more in alignment with the [monthly capitated payment] MCP they receive for dialysis care, but that also holds them accountable for costs and quality,” Tonya L. Saffer, MPH, a co-author of the editorial and vice president of health policy at the National Kidney Foundation, said in a press release from the NKF. “We believe this will reduce expenditures to Medicare due to delayed progression, avoidance of hospitalizations, and better ESRD starts.”
According to the release, CMS currently pays 80% of the cost of dialysis for most patients. One patient on dialysis costs the program about $88,000 annually. Nephrologists who oversee patients on dialysis are reportedly paid more through a monthly capitated payment under Medicare for each patient they oversee. However, doctors who treat patients with late-stage CKD who are not on dialysis are not equally resourced by Medicare or private payers. According to the release, this gives providers a financial incentive to focus more on patients who receive dialysis.
The authors of the editorial wrote, “The payment disparity could create an adverse incentive for nephrologist[s] to recommend starting dialysis early, even when it might not be necessary or in the patients’ best interest.”
The authors offered a possible service structure that could be required and monitored for CKD care that includes the following:
face-to-face office visits or telehealth services to manage certain comorbidities;
dietitian services;
pharmacy services and medication reconciliation;
care coordination with primary care providers and other specialists;
screening for depression and anxiety;
access to social services;
recommended immunization;
CKD, dialysis modality and transplant education;
advance care planning with palliative/conservative care coordination if indicated;
vascular or peritoneal dialysis access placement;
transplant evaluation; and
outpatient dialysis initiation when appropriate.
“A pilot program would also allow CMS to determine the feasibility of these programs in different types of nephrology practices,” the authors wrote in the journal. “Given the disproportionate share of ESRD costs in Medicare, a trial with Medicare patients seems justifiable, although such an approach could easily be undertaken by other payers.”
References:
Berns JS, et al. J Am Soc Nephrol.2018;doi:10.1681/ ASN.2018040438.