Reimbursement


New Medicare Pay Incentives for Kidney Care

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September 5, 2019

New Medicare Pay Incentives for Kidney Care

The Centers for Medicare & Medicaid Services (CMS) is planning new payment incentives—and new payment models—to encourage changes in care for late-stage chronic kidney disease (CKD) and end-stage renal disease (ESRD). One proposal, which would be mandatory for kidney care providers in many parts of the country, would provide extra payment for providers who increase the rate of home dialysis and kidney transplantation. It would run from 2020 through 2026. CMS is seeking comment on this proposal. CMS is also introducing voluntary payment models that provide capitated payments for managing kidney care. These would run from 2020 through 2023.  

Highlights:

Model

Summary

Details

ESRD Treatment Choices Model
CMS would adjust payments to kidney care centers and clinicians to encourage greater use of home dialysis and kidney transplants as alternatives to ongoing in-center hemodialysis.
  • CMS would increase payments for 3 years on home dialysis and home dialysis-related services.
  • CMS would also make payment adjustments, positive or negative, for dialysis facilities and clinicians based on the rates of home dialysis use and kidney transplantation.
Mandatory for kidney care providers in regions to be selected by CMS.

Timeline: January 1, 2020, through June 30, 2026.

CMS has not finalized the proposal and is seeking public comment.
Kidney Care First Model
Kidney Care First Model CMS will pay a set fee—sometimes called a bundled payment or capitated payment—to cover the costs of caring for patients with late-stage CKD and patients with ESRD. The focus will be on delaying the progression of CKD to ESRD and managing the transition to dialysis and transplantation. The payment would be adjusted up or down on the basis of patient health outcomes and quality measures. Also, the participating practices would receive a bonus for every patient who receives a kidney transplant.
Participation is voluntary.

Timeline: January 1, 2020, through December 31, 2023.

Telehealth could be used without being limited to rural areas.

Expected to qualify as an Advanced Alternative Payment Model (AAPM) under Medicare’s Quality Payment Program.
Comprehensive Kidney Care Contracting Model
This model is the same as the Kidney Care First Model, but with three optional payment structures.
  • Graduated: Providers would share in savings that occur and gradually phase-in greater risk and reward 
  • Professional: Providers could earn 50% of shared savings or be liable for 50% of shared losses based on the total costs of care for all Medicare Parts A and B services provided to patients.
  • Global: Providers could take on 100% risk of the total costs of care for all Parts A & B services provided to patients.
Participation is voluntary.

Timeline:
1/1/20 – 12/31/23

Telehealth could be used without being limited to rural areas.

Professional and Global model options expected to qualify as Advanced Alternative Payment Model (AAPM) under Medicare’s Quality Payment Program.