New Care Model Targets Kidney Disease Patients and Their Providers
- September 30, 2020
Published September 30, 2020
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On September 18, 2020, the Centers for Medicare & Medicaid Services (CMS) announced the release of a new model of care for beneficiaries with chronic kidney disease.
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The End-Stage Renal Disease Treatment Choices (ETC) Model is designed to improve or maintain the quality of care for Medicare beneficiaries with chronic kidney disease while reducing costs at the same time.
The model, which promotes the increased use of home dialysis and kidney transplants, will be implemented on January 1, 2021, and will impact around 30 percent of kidney care providers.
The model is projected to produce Medicare savings of $23 million over five and a half years.
Medicare payment model encourages home dialysis
The new payment model steers Medicare payments away from traditional fee-for-service agreements and toward a model where providers are incentivized for investing in, building and encouraging the use of home dialysis.
Home dialysis allows patients greater flexibility with their dialysis schedule. During the COVID-19 pandemic, home dialysis has helped protect patients from possible virus exposure at dialysis centers.
Providers under the new model are also reimbursed according to their kidney transplant rate, which is viewed as the optimal treatment for kidney failure.
Medicare beneficiaries shifted to the new model will maintain freedom of choice among providers along with all Medicare protections and rights. The financial impact of the ETC model will be monitored by CMS.
“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,” said Department of Health and Human Services Secretary Alex Azar in a press release announcing the release of the model.
According to the release, approximately $114 billion per year is spent on beneficiaries with kidney disease. Of the 100,000 Americans who begin dialysis to treat ESRD each year, 20,000 will die within the year.
The ETC model expands on the Advancing American Kidney Health initiative, which has also included:
- Increased payments for new dialysis drugs and products to encourage development in transformative therapies
- Updated requirements for transplant centers to allow for greater provider flexibility in supporting patients who need transplants
- Payment adjustments to promote the innovation of equipment and supplies that provide more dialysis treatment options
- The removal of financial barriers to organ donation through the expansion of reimbursable expenses
- The introduction of the Kidney Care Choices Model, which creates financial incentives for providers to manage beneficiaries with chronic kidney disease to delay the onset of dialysis and incentivize transplantation
More information on the ETC model can be found here.
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About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
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