Advancing American Kidney Health initiative can improve the patient-provider relationship
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Financial reforms and incentives included in the Advancing American Kidney Health initiative can offer providers an opportunity to engage with patients, according to a speaker at the virtual Annual Dialysis Conference.
“I think that most providers want to do the right thing, but even when providers are acting in patients’ interests, they're perceived to be conflicted. I think that perception is damaging to the relationship between patients and providers. If there is an underlying public policy infrastructure that encourages in-center hemodialysis and if in-center hemodialysis is the most profitable part of the entirety of kidney care, I think it creates a setup for failure in terms of the relationships that we can form between patients and providers,” Eugene Lin, MD, MS, from the Keck School of Medicine at the University of Southern California, said in the presentation. “So, policymakers have been rightfully wrestling with this.”
Recent government prioritization of the Advancing American Kidney Health (AAKH) initiative promotes more home dialysis, more transplantation, better care coordination, more innovation and research. The AAKH initiative rewards care-coordination in addition to dialysis and transplantation, Lin said.
Incentives
He noted that the AAKH initiative reformed incentives to take the focus away from in-center hemodialysis as the default modality. For example, the Kidney Care Choices model offers bonuses paid to the top 50% Kidney Care First practices in the nation and applied penalties to the bottom 50%. Similarly, Comprehensive Kidney Care Contracting models use shared savings and losses as an incentive program.
“We should see payment reform as an opportunity to reinvigorate the patient-provider relationship around better kidney care,” Lin said.
Shared spending
To create a system for shared savings, Medicare will calculate a benchmark based on past expenditures and then let the provider know the financial limit that should not be exceeded. If the provider spends less than the benchmark, the provider will split the remaining profit with Medicare. Similarly, if there are shared losses, the provider will pay CMS part of what was overspent.
However, exceeding the benchmark may not be a negative thing if the provider spent money to improve care coordination.
“Medicare wants providers to make targeted investments that pay off in the future,” Lin said. “We need to think, ‘How can we better coordinate care with other providers so that our patients stay out of the hospital?’”
Lin referenced data calculated by the Government Accountability Office that revealed increasing home dialysis rates will dramatically increase margins in the End-stage Kidney Disease Treatment Choices model. Additionally, more home dialysis uptake increases revenue for providers.
Capitated models
Included in the AAKH initiative are capitated models which allow providers to be more “creative” with their time, Lin said. Capitated models pay providers a flat fee of guaranteed revenue so that providers can spend as much time with a patient as needed without worrying about losing money. This strengthens the relationship between providers and patients, Lin said.
“In conclusion, the AAKH offers new opportunities to engage patients into holistic kidney care. We need to take this opportunity to inform patients that we're getting paid to coordinate better quality care,” Lin said in the presentation. “I think we need to reduce the perception that what we're getting paid to do is in conflict to what patients want, and we need to rethink how Medicare can be restructured.”
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Lin E. Advancing American Kidney Health improve engagement between patients and provider. Presented at: Annual Dialysis Conference; March 4-7, 2022 (virtual meeting).
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