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CMS approves chronic kidney disease payment model

CMS on Friday unveiled its alternative payment model for patients with chronic kidney disease.

The End-Stage Renal Disease ESRD Treatment Choices—ETC—model encourages increased home dialysis use and kidney transplants. According to the agency, it will affect nearly a third of kidney care providers and save the federal government about $23 million over five and a half years.

“This new payment model helps address a broken set of incentives that have prevented far too many Americans from benefiting from enjoying the better lives that could come with more convenient dialysis options or the possibility of a transplant,” HHS Secretary Alex Azar said in a statement.

The new payment model goes into effect on January 1.

“The current Medicare payment system and a lack of beneficiary education may encourage in-center hemodialysis as the default treatment for patients beginning dialysis. This value-based payment model will encourage participating care providers to invest in and build their home dialysis programs,” CMS said in a statement.

The ETC model rewards ESRD and clinicians financially to increase transplant waitlisting and avoid dialysis when suitable. According to the agency, only about 30% of people with ESRD had a functioning kidney transplant, and just 3% had a transplant before starting dialysis.

A bipartisan group of Congressional lawmakers in October urged CMS to scale back the pilotbecause it would have affected half of all ESRD patients, upending ESRD care before the model was proven to work.

“CMS will select ESRD facilities and managing clinicians to participate in the model according to their location in randomly-selected geographic areas, stratified by region, so as to account for approximately 30% of adult ESRD beneficiaries in all 50 states and the District of Columbia,” according to a CMS fact sheet.

CMS’ Innovation Center can still validate the ESRD model’s effects with the smaller patient population, CMS Deputy Administrator Brad Smith said during an interview with Modern Healthcare.

“Our hope would be to scale it nationally across the country as soon as we have the data to do so,” he said.

Since ESRD patients can enroll in Medicare Advantages plans starting next year, the agency would like Advantage plans to follow their lead by encouraging in-home dialysis and transplants, CMS Administrator Seema Verma said during an interview.

Home dialysis or a kidney transplant might not work for many patients, especially if they’re frail or elderly. Older patients often rely on their elderly partners to help them, but home dialysis is too hard for many of them to handle on their own.

“While we appreciate the decision to reduce the scope of the model from the proposed 50 percent to 30 percent, we remain concerned over fears voiced by patient organizations and providers about patients who do not select home dialysis being disadvantaged by the model have not been addressed in a way to allay their anxieties,” said Kidney Care Partners, a coalition group focused on chronic kidney disease.

Providers and patient advocates worry the new treatment model could create financial impediments to recommend and deliver the best treatment option for many people on Medicare. The model rewards home dialysis and kidney transplants while holding back the use of in-center dialysis and leaving out alternative treatment options like hospice. Advocates think it’s a one-size-fits-all approach that could harm people by limiting patient choice.

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