Policy and Politics News

In a letter released earlier this month, the Medicare Payment Advisory Commission urged CMS Administrator Seema Verma to not implement its ESRD Treatment Choices model, a program that would provide financial incentives of up to 3% to nephrologists and dialysis providers who increase the number of patients treated with home dialysis or who achieve a higher rate of kidney transplantation.

Advancing American Kidney Health, an executive order signed by President Donald J. Trump in July, has the goals of reducing the number of Americans developing ESRD by 25% by 2030; having 80% of new patients with ESRD in 2025 either receiving dialysis at home or having a transplant; and doubling the number of kidneys available for transplant by 2030. To accomplish these goals, suppliers of home dialysis equipment plan to ramp up production in the coming years.

A new report on the second performance year of the Comprehensive End-Stage Renal Disease Care Model shows improvements in patient outcomes, including reduced hospitalizations and more dialysis sessions prescribed to patients.

Despite 52 amendments added to the legislation just last week, the California Senate voted 21-19 on Sept. 9 to accept the changes and approve A.B. 290, a bill aimed at restricting dialysis provider profits in the state and limiting the use of third-party payers, like the American Kidney Fund.

When speaking at a press conference just hours before President Trump unveiled the Advancing American Kidney Health initiative, HHS Secretary Alex M. Azar II called the package of new regulations and financial incentives “the most significant initiative undertaken on kidney disease by any President, and the single biggest change to how we treat this disease since Medicare began covering end-stage renal disease patients in 1973.”1

The government took a bold step in payment reform in July with the announcement of five new Centers for Medicare and Medicaid Innovation-designed payment models for physicians and dialysis providers. Ultimately, this movement away from fee-for-service payment toward value-based reimbursement is a fundamental step in the process of aligning health care providers around the holistic care for patients, especially upstream in chronic kidney disease.

Editor’s note: HHS has set a goal of having 80% of the incident dialysis patient population treated by home dialysis or have a functioning transplant by 2025. Nephrology News & Issues asked Brent W. Miller, MD, the Michael A. Kraus Professor of Medicine and clinical chief of nephrology at Indiana University School of Medicine, as well as a Nephrology News & Issues Editorial Advisory Board Member, whether the plan can be successful.

At first glance, it is hard to say how the Advancing American Kidney Health initiative payment models will affect the operations or the finances of kidney transplant centers. While increasing the total number of kidney transplants performed is heavily incented in both the mandatory ESRD Treatment Choices and voluntary payment models, the financial carrots and sticks in this regard are directed only at general nephrologists and dialysis providers.

States that implemented Medicaid expansion under the Affordable Care Act saw greater increases in covered preemptive kidney transplants than did non-expansion states, according to a recently published study.

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.