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CMS releases more details on Kidney Care First, other payment models
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In a recent webinar, CMS offered more details on four new voluntary kidney payment models that are part of the Advancing American Kidney Health initiative.
Officials said requests for applications will be made for the Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) graduated, professional and global models at the end of the summer. The payment models are designed to work alongside the ESRD Treatment Choices (ETC) model, which was released as a proposed rule on July 10. Published in the Federal Register, the rule (CMS-5527-P) is available for download at www.federalregister.gov/documents/2019/07/18/2019-14902/medicareprogram-specialty-care-models-to-improve-quality-of-care-and-reduce-expenditures. The deadline for submitting comments on the proposed rule is no later than 5:00 p.m. EST on Sept. 16, 2019 at www.regulations.gov.
The ETC model, which HHS plans to launch in January, will be mandatory for 50% of U.S. nephrologists and enroll more than 200,000 patients.
Focus on CKD
The voluntary payment models offer a number of changes over current reimbursement for dialysis care, with a greater focus on incentivizing nephrologists and dialysis providers to care for patients during earlier stages of CKD and to steer more patients to transplantation and home dialysis. Goals include “later and better starts on dialysis for beneficiaries with CKD, better coordination of care for beneficiaries with CKD and ESRD to reduce total cost of care, more beneficiaries receiving kidney transplants and staying off of dialysis for longer, and offering different financial risk options for nephrologists and other providers and suppliers to take on financial accountability,” agency officials said during the webinar.
The models will build upon the existing Comprehensive ESRD Care (CEC) Model structure – in which dialysis facilities, nephrologists and other health care providers form ESRD-focused accountable care organizations to manage care for beneficiaries with ESRD. The CEC model, now being tested in a 5-year demonstration that includes more than 30,000 patients with ESRD, began in October 2015 and will run through Dec. 31, 2020. Results from the model to date “showed lower spending relative to benchmark group and improvements on some utilization and quality measures,” CMS said in its presentation.
Patients who qualify under the new KCF and the CKCC payment models must be:
- Medicare beneficiaries with CKD stages 4 and 5;
- Medicare beneficiaries with ESRD receiving maintenance dialysis; or
- Medicare beneficiaries who were aligned to a KCF practice or kidney contracting entities (KCE) by virtue of having CKD stage 4 or 5 or ESRD and receiving dialysis, then later receiving a kidney transplant.
Kidney Care First, CKCC models
Under the KCF model, participating nephrology practices will receive adjusted fixed payments on a per-patient basis for managing the care of patients with late-stage chronic kidney disease and patients with ESRD. The payments will be adjusted based on health outcomes and utilization compared to the participating practice’s own experience and national standards, as well as performance on quality measures. In addition, participating practices will receive a bonus payment for every patient aligned to them that receives a kidney transplant based on the transplant remaining healthy for up to 3 years.
The three CKCC models include the graduated, professional and global models. The models will include capitated payments similar to those offered under the KCF pathway, but the kidney contracting entities (KCEs) — which consist of nephrologists, transplant providers and other health care providers, including dialysis facilities — will take responsibility for the total cost and quality of care for their patients. In exchange for accepting that accountability, the entities can receive a portion of the Medicare savings they achieve.
KCEs participating in the CKCC models are required to include nephrologists or nephrology practices and transplant providers, while dialysis facilities and other providers and suppliers are optional participants in KCEs.
As in the KCF Model, KCEs will receive adjusted payments for managing beneficiaries with CKD Stages 4 and 5, and ESRD, along with the kidney transplant bonus payment.
Payment under the CKCC models includes the following three options:
- The graduated model is based on the existing CEC model one-sided risk track that allows certain participants to begin under a lower-reward one-sided model and incrementally phase in greater risk and greater potential reward.
- The professional model is based on the professional population-based payment option of the direct contracting model with an opportunity to earn 50% of shared savings or be liable for 50% of shared losses based on the total cost of care for Part A and B services.
- The global model is based on the global population-based payment option of the direct contracting model, with risk for 100% of the total cost of care for all Parts A and B services for aligned beneficiaries.
The models are expected to run from Jan. 1, 2020, through Dec. 31, 2023, with the option for one or two additional performance years at the discretion of CMS. Health care providers can apply to participate this fall and if selected, begin using the model in January 2020. However, financial accountability will not begin until 2021. During 2020, or Year 0, model participants will focus on building necessary care relationships and infrastructure, according to CMS.
References:
https://innovation.cms.gov/initiatives/voluntary-kidney-models/
https://innovation.cms.gov/resources/voluntary-kidney-models-overview.html