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.
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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