CMS releases first-year results of ESRD Treatment Choices model
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Key takeaways:
- The demonstration aims to increase the number of patients placed on the waitlist for a kidney transplant or choosing home dialysis.
- Results showed no reduction in hospitalization costs in the first year.
A report released by CMS on first-year results for the End-Stage Renal Disease Treatment Choices model showed no Medicare cost savings but an increase in patients on the waitlist for transplant and trained for home dialysis.
According to the report, which was prepared for CMS by the consulting firm Lewin Group, 663 patients were added to the kidney transplant waitlist among dialysis facilities participating in the End-Stage Renal Disease Treatment Choices (ETC) model, representing a 4% increase compared with waitlist rates prior to the start of the demonstration.
The demonstration aims to increase the number of patients placed on the waitlist for a kidney transplant or choosing home dialysis. Image: Adobe Stock.
“Overall kidney transplants also increased in ETC areas by an additional 225 transplants, corresponding to a 10% increase over pre-ETC transplant rates,” according to the report.
The report showed no increase in the use of home dialysis in the first year of the ETC model. “While there has been recent growth in home dialysis use nationally, the ETC model did not lead to faster growth in home dialysis use in ETC areas.
“The ETC model resulted in an additional 546 patient months with home dialysis training in ETC areas, corresponding to a 9% increase over pre-ETC home dialysitraining rates,” according to the report.
Financial incentives
CMS launched the ETC model in January 2021 to determine if financial incentives would encourage greater use of home dialysis and kidney transplantation among Medicare beneficiaries with ESRD, while cutting Medicare costs and addressing health equity issues. The agency selected 3,522 dialysis facilities and “managing clinicians” from 31% of Hospital Referral Regions nationwide to participate in the demonstration, which will be completed in June 2027. Approximately 100,000 Medicare beneficiaries are part of the ETC model, which required mandatory participation among dialysis facilities selected.
Payment adjustments
Payment adjustments to participating ESRD facilities and managing clinicians for home dialysis are provided during the first 3 years of the model, according to CMS. A “uniformly positive adjustment” on Medicare claims for home dialysis provides an additional payment to selected facilities and clinicians for supporting beneficiaries who dialyze at home. The second adjustment applies to both home and in-center dialysis and related claims and could be either positive or negative. “These adjustments, either upward or downward, are made to the per treatment payment for dialysis based on the rate of home dialysis and transplant rate calculated as the sum of the transplant waitlist rate and the living donor transplant rate,” according to the ETC website. “Greater positive and negative adjustments for model participants would be phased in over the performance period of the model.”
Other findings in the Lewin Group report covering the first year of the program include the following:
- no reduction in the number of hospitalizations or changes in the use of other types of acute care services, including hospital readmissions and use of the outpatient emergency department;
- no improvement in cost savings, either under Medicare Parts A and B payments per patient per month; and
- patients treated in the ETC model did not have a change in experience of care.
References:
ESRD Treatment Choices model. https://innovation.cms.gov/innovation-models/esrd-treatment-choices-model. Accessed Aug. 15, 2023.
Negrusa B, et al. End-Stage Renal Disease Treatment Choices model: First evaluation report. https://innovation.cms.gov/data-and-reports/2023/etc-1st-eval-report-app. Accessed Aug. 15, 2023.