CMS makes move to drive value-based reimbursement for cancer and chronic kidney disease (CKD) and end stage renal disease (ESRD) with a new final rule. The End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model uses value-based care payments to encourage the usage of home dialysis and kidney transplants. The new model also benefits dialysis centers and nephrologists financially based on “their transplant rate calculated as the sum of the transplant waitlist rate and the living donor transplant rate.”
The release of this model program follows an executive order from President Trump signed back in July with the intent of increasing organ transplant availability. Read the Hertel Report coverage from July.
CMS estimates that the model will deliver savings of $23 million over five and a half years.
Kidney Care Partners, a national group comprised of patient advocates, dialysis professionals, care providers, researchers, and manufacturers, said this in part:
The Administration’s efforts to improve patient access and choice, namely encouraging use of home dialysis and access to – and better coordination of – available organs for transplants, has long been a top priority of the kidney community. Incentivizing living kidney donors by providing financial support for recovery time, childcare and eldercare expenses is critical to improve the pool of available organs for transplant, which are in very short supply in this country for the 100,000 individuals on the transplant waiting lists.
Read the story from HealthLeadersMedia
MedPageToday reports that CMS Administrator Seema Verma noted that although ESRD patients comprise only 1% of Medicare beneficiaries, they cost the program $35.9 billion per year, or 7% of Medicare spending, and they have the highest rate of COVID-19 among Medicare beneficiaries. Nationwide, more than 37 million Americans — about 11% of the population — have chronic kidney disease, and 800,000 have progressed to ESRD, she said. Currently, only about 12% of dialysis patients receive their care at home, while the other 88% go to dialysis centers.
Kidney Care Partners, which includes dialysis giants DaVita and Fresenius, also voices concern over patient choice and potential for discrimination against patients that choose dialysis centers over home dialysis. “It remains critical that the patient and physician voice be in the forefront regarding access and choice for care settings – such as home care – that are most desirable and appropriate for the patient given the healthcare needs and associated co-morbidities, their home support and the home environment itself,” the group stated.
See more from the CMS Press Release
Read the CMS Fact Sheet on ETC Model
Also included in this final rule is the Radiation Oncology (RO) Model, which provides bundled payments for 90-day episode of care to participating radiotherapy providers and suppliers furnishing radiotherapy. The rule covers 16 different cancer types and the demonstration is set to require participation from providers in randomly selected locations across the country. the cancers include: anal cancer, bladder cancer, bone metastases, brain metastases, breast cancer, cervical cancer, CNS tumors, colorectal cancer, head and neck cancer, liver cancer, lung cancer, lymphoma, pancreatic cancer, prostate cancer, upper gastrointestinal cancer, and uterine cancer.
The agency stated that participant-specific payment amounts are determined by several factors, including “national base rates, trend factors, and adjustments for each participant’s case-mix, historical experience, and geographic location.
CMS estimates that the new RO model will save Medicare $230 million over five years.
Radiation Oncologists want more time. They vowed to go to Congress if CMS doesn’t delay its plans to kick off the mandatory radiation oncology 90-day pay bundle demonstration, as they say starting a new model during the pandemic is a problem. Read that story from Inside Health Policy (subscription required).
Read the CMS Fact Sheet on RO Model
Read the CMS Final Rule which addresses both ETC and RO.
Here’s another story from MedScape