CMS proposes new APMs aimed at improving care for chronic kidney disease

CMS proposed one mandatory and four voluntary alternative payment models (APM) for Medicare beneficiaries who receive treatment for chronic kidney disease and end-stage renal disease (ESRD).

As noted in a CMS press release, the current Medicare payment system for chronic kidney disease treatment encourages in-center hemodialysis as the default treatment for patients starting dialysis. The proposed required End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model is aimed at giving ESRD beneficiaries the choice of an ESRD treatment (e.g., home dialysis, kidney transplant) that will support quality care and prevent disease progression.

Specifically, the mandatory model would adjust certain Medicare reimbursements to ESRD facilities and providers managing ESRD Medicare beneficiaries through upward or downward payment adjustments based on their home and transplant rates. For the first three years of participation, CMS would positively adjust Medicare reimbursement to providers for home dialysis and dialysis-related services. The mandatory model would also protect ESRD facilities and providers who treat sicker patients by risk-adjusting home dialysis and transplant rates, according to CMS.

If the proposed mandatory model is finalized, payment adjustments under the ETC model would begin January 1, 2020, and end June 30, 2026. More information on the proposed mandatory model can be found in this CMS factsheet.

The four proposed voluntary payment models would use fixed payment mechanisms to encourage greater use of at-home dialysis and kidney transplants for patients suffering from late-stage chronic kidney disease and ESRD.

The proposed voluntary APMs include:

• The Kidney Care First (KCF) Model: Participating practices will receive adjusted fixed payments on a per-patient basis for managing the care of patients with late-stage chronic kidney disease and ESRD
• Comprehensive Kidney Care Contracting (CKCC) Models, which will have three distinct accountability frameworks:

• Graduated: based on the existing Comprehensive ESRD Care Model One-Sided Risk Track
• CKCC Professional: based on the Professional Population-Based Payment option of the Direct Contracting Model 
• Global Model: based on the Global Population-Based Payment option of the Direct Contracting Model

These models have similar payment structures to the KCF model but also hold kidney contracting entities accountable for the total cost and quality of care for their patients. In exchange, these providers will receive a portion of the Medicare savings they achieve.

If the proposed voluntary payment models are finalized, they would affect payments from January 1, 2020, through December 31, 2023. More information on the proposed KCF and CKCC Models can be found in this CMS factsheet.