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CMS releases ESRD Treatment Choices payment model for increasing home dialysis, transplant

Published: 07/12/2019

HHS released a proposed rule on July 10 that would provide incentives of up to 3% in adjusted payments to nephrologists and dialysis providers who improve the number of patients treated with home dialysis or who achieve a higher rate of kidney transplantation.

The proposed ESRD Treatment Choices Model (ETC) will be published in the Federal Register on July 18. Interested parties will have 60 days beyond that date to provide comments on the proposal.

The ETC is “focused on encouraging greater use of home dialysis and kidney transplants, in order to preserve or enhance the quality of care furnished to Medicare beneficiaries while reducing Medicare expenditures,” CMS said in the proposed rule published in the Federal Register. The ETC model would include ESRD facilities and certain clinicians – called managing clinicians – who are caring for beneficiaries with ESRD located in selected geographic areas as participants. CMS would assess the performance of participating managing clinicians and ESRD facilities on their rates of home dialysis and kidney and kidney-pancreas transplants during each measurement year (MY), and would subsequently adjust certain of their Medicare payments — from 3% in the first year down to 1% in the third year — during the performance payment adjustment period based on their home dialysis rate and transplant rate, CMS said in the document.

The payment adjustments under the ETC model would occur under the ESRD Prospective Payment System (PPS) for ESRD facilities and under the Medicare Physician Fee Schedule (PFS) for nephrologists, and would begin Jan. 1, 2020, and end on June 30, 2026.

For both managing clinicians and ESRD facilities, HHS is proposing to calculate the rates of home dialysis and kidney and kidney-pancreas transplants among attributed ESRD beneficiaries. For managing clinicians, the agency would include attributed beneficiaries who receive preemptive transplants in the calculation of the transplant rate.

In his remarks before signing the executive order that created the Advancing American Kidney Health program, President Donald J. Trump touted dialysis at home as the best choice for patients. “Crucially, our new system will ensure that more patients undergoing dialysis can do so from the comfort of their own home. And doing this from the home is a dramatic, long-overdue reform — something that people have been asking for for many, many years,” he said. “It sometimes amazes me that it never got done … Right now, only 12 percent of patients on dialysis receive care at home. My executive order will change that and reduce cost, transform care, and greatly improve the quality of life for kidney patients all across the nation.”

Sending more patients home to dialyze as part of the Advancing American Kidney Health initiative was applauded by providers like DaVita Kidney Care, Fresenius Medical Care, Baxter Renal Care, and nursing home dialysis company Dialyze Direct.

“We share the U.S. administration’s commitment to expanding access to home dialysis, transplantation and new models of value-based care for chronic kidney disease, and we see it as an endorsement of our initiatives … We welcome reimbursement reforms that facilitate investments in care models designed to improve outcomes and help reduce costs, two goals to which more use of home dialysis and transplants can equally contribute,” Rice Powell, CEO of Fresenius Medical Care, said in a release. The dialysis provider recently completed its acquisition of home hemodialysis machine manufacturer NxStage Medical for $2 billion.

Added Laura Angelini, general manager of Baxter’s Renal Care business. “Our extensive home dialysis infrastructure, pioneering innovation in home therapies and deep expertise in driving PD adoption around the world will help make the administration’s innovative vision a reality,” she said in a release.