Speaker: CMS optimistic about outcomes from Kidney Care Choices model
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Key takeaways:
- CMS is gathering data on first year results from the Kidney Care Choices model.
- CMS is contemplating a capitated payment for CKD care because of the up-front costs that kidney contracting entities experience in participating in the model.
NEW ORLEANS — CMS is optimistic that results from its Kidney Care Choices model will show improved outcomes and cost savings to the Medicare program when completed in 2026, according to a speaker here.
“We have been trying to improve all our programs for Medicare beneficiaries ... (and) figure out how to improve care through better financial incentives, and align our efforts more” with physicians, Pauline J. Lapin, MHS, director of the Seamless Care Models Group at the Center for Medicare and Medicaid Innovation (CMMI), said at the Renal Physicians Association Annual Meeting.
Medicare covers 65 million people in the United States, including more than 500,000 patients with kidney disease, Lapin said. CMMI has set a goal to have all Medicare beneficiaries in an accountable care program by 2030.
“That is an ambitious goal,” Lapin said. “The [Kidney Care Choices] KCC model is helping us to reach that goal, along with Medicare shared savings and other payment models.”
Lapin said CMMI, which is managing the KCC and the End-Stage Renal Disease Treatment Choices Model (ETC), will see first-year outcomes data for the KCC model by the fall. Lapin said the success of the Comprehensive ESRD Care Model, launched in 2015 as the first capitated payment model developed by CMS for patients with kidney disease, showed improved outcomes over standard fee-for-service reimbursement. The model set a capitated rate for all services related to patient care.
“We were so close with that model,” Lapin said. “We had such great quality outcomes ... the problem was the financial model we designed didn’t work.”
Lapin said that according to statue, CMMI must demonstrate budget neutrality or savings to the Medicare trust fund, and based on the ESRD care model, it did not demonstrate savings.
“We went back and retooled the financial model, and that’s why we have the KCC,” Lapin said.
Lapin said the KCC model cannot be expanded unless it shows savings to the Medicare trust fund. Additionally, the challenge is many physicians are not interested in participating in value-based care, she said.
“They want the status quo,” Lapin said. “That’s why it is important to hear from patients who are in these programs and hear those stories.”
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Lapin PJ. Improving patient care within existing KCC frameworks. Presented at: Renal Physicians Association Annual Meeting; March 30-April 2, 2023; New Orleans.
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