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.

CMS Tacks on New Provider Payment for Home Dialysis Machines

The CMS on Monday proposed paying physicians and providers additional money if they use home dialysis machines to treat end-stage renal disease patients. Medicare beneficiaries with end-stage renal disease are in the most at-risk group for COVID-19. CMS data released last month showed there were 1,341 hospitalizations per 100,000 people in this category. They often have other comorbities such as diabetes and heart failure, and are unable to shelter-in-place due to dialysis and other treatment requirements, the agency said. Monday’s proposed rule would expand a transitional add-on payment to cover home dialysis machines. About 750,000 Americans have ESRD and 530,000 have Medicare benefits. Approximately 85% of ESRD patients travel three times a week or more to receive dialysis treatment.

Nationwide Network of Kidney Health Providers Launched to Improve the Future of Patient Care

Nephrology Associates, P.C. has announced its participation and investment in a new entity aimed at improving healthcare outcomes for Americans living with kidney disease. This new population health management company, InterWell Health, is an alliance currently consisting of over 650 nephrologists and the nation’s leading provider of kidney care products and services, Fresenius Medical Care North America. InterWell Health participants are many of the most influential in their field, and more provider groups will be invited to join. This partnership was formed to support nephrologists nationwide towards a more rapid adoption of value-based care models in an environment that promotes the full continuum of care for renal patients. The focus spans the CKD and ESRD populations with collaboration on care models to slow progression, to maximize the availability of transplant and home therapies, as well as prioritize optimal starts on dialysis.

New Physician Practice Affiliated with Nephrology Practice Solutions

Nephrology Practice Solutions, a subsidiary of DaVita Inc., is now affiliated with Partners in Nephrology and Endocrinology, a large Pittsburgh-based physician practice with 34 physicians and advanced practitioners. Partners in Nephrology and Endocrinology (PINE) has been acquired by NPS Physicians Pittsburgh, LLC. “PINE’s commitment to holistic kidney care aligns with our vision for the future,” Javier Rodriguez, CEO for DaVita Inc., said in a statement. “Making real progress toward value-based care for patients with kidney disease will require us to create fundamentally different partnership models with nephrologists and payers, and we are excited to innovate with PINE.” With this transaction, PINE will have access to the practice management expertise, data and technology of NPS to help the practice rapidly transform its value-based care delivery infrastructure.

The Impact of Millennial Nephrologists on the Group Practice Partnership Model

Many nephrology group practices of all sizes are facing an existential crisis driven by a confluence of factors. The first, and most notable, factor fueling this issue is the result of a significant decline in the number of physicians choosing to pursue a career in nephrology. In 2018, for example, the percentage of unfilled nephrology training tracks was 57.7% (up from 10.6% in 2009) and the number of unfilled nephrology positions was 39.9% (up from 5.2% in 2009). This declining interest in nephrology has been attributed to lower compensation (as compared against many other specialties), increasing student loan debt and lifestyle_related considerations, among other factors. As a result of this trend, many nephrology group practices around the country have experienced increasing difficulty recruiting nephrologists to fill open positions as more senior physicians retire and move into different organizational roles.

Dialysis Companies to Feel Squeeze from Calif. Reimbursement Bill

California’s governor dealt a blow to dialysis companies over the weekend when he signed into law a bill that limits the reimbursement they receive for kidney disease patients who get insurance premium assistance from third-party organizations. Gov. Gavin Newsom signed the bill, known as Assembly Bill 290, in the face of intense opposition from dialysis companies DaVita and Fresenius Medical Care, which together control most of California’s dialysis clinics. A similar measure was vetoed by then-Gov. Jerry Brown last year. The companies have argued the legislation would increase patients’ out-of-pocket medical costs and hinder their access to care.

End-Stage Renal Disease Alternative Payment Model Shows Promise

An annual report about the Center for Medicare & Medicaid Innovation’s Comprehensive End Stage Renal Disease Care (CEC) model, said it led to lower spending, improvements in some utilization measures, and no obvious indicators of unintended or adverse consequences. The CEC Model is an Advanced Alternative Payment Model (A-APM) that creates financial incentives for dialysis facilities, nephrologists, and other Medicare providers to coordinate care for Medicare beneficiaries with ESRD. Because the CEC Model was deemed an A-APM, participating nephrologists could exempt themselves from reporting requirement and payment adjustments under MACRA’s Merit-based Incentive Payment System (MIPS).

Feds Pave the Way to Expand Home Dialysis Ñ but Patients Hit Roadblocks

Home dialysis for older adults will become more common in the years ahead, experts predict Ñ but not without overcoming significant challenges. By 2025, the Trump administration wants 80% of people newly diagnosed with kidney failure to receive home dialysis or kidney transplants, according to an executive order issued in July. Currently, more than 85% of such patients are treated at dialysis centers. In a notable move, retail health giant CVS Health has said it will enter the dialysis business, while the companies that dominate this market Ñ Fresenius Medical Care and DaVita Ñ have confirmed plans to expand their home dialysis offerings. Home dialysis has several advantages over dialysis in treatment centers: Patients can get therapy more frequently, which puts less stress on their bodies; it’s more convenient; it’s less expensive; and patients’ quality of life is generally better, according to numerous studies. On the downside, doing this therapy at home can be isolating, fraught with anxiety, technologically challenging and burdensome for patients and caregivers.

CVS Launches Home Hemodialysis Device Clinical Trial

CVS Health announced on Wednesday the start of a clinical trial of up to 70 patients to evaluate the safety and performance of a home hemodialysis device the company intends incorporate into its CVS Kidney Care initiative. The HemoCare Hemodialysis System, developed in partnership with the DEKA Research & Development Corp., aims to be part of the shift from delivery of dialysis from clinics to the home setting. The move comes a week after President Donald Trump signed an executive order to incentivize the use of home dialysis to cut down on health spending. Currently, nearly 90% of dialysis care is rendered at clinics, but HHS hopes to flip that number; the department wants 80% of Americans receive dialysis at home or receive a viable organ transplant by 2025.

CMS Announces New Payment Models for Kidney Care

The Department of Health and Human Services and the Centers for Medicare & Medicaid Services on July 10 announced the agency’s plan to rework payment for kidney care, including for dialysis. A press release posted to CMS’s website began, “Today, delivering on President Trump’s Advancing American Kidney Health Executive Order, the U.S. Department of Health and Human Services (HHS) Secretary Alex Azar and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced five new CMS Center for Medicare and Medicaid Innovation payment models that aim to transform kidney care so that patients with chronic kidney disease have access to high quality, coordinated care. The proposed required End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model would encourage greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD in order to preserve or enhance their quality of care while reducing Medicare expenditures, and the Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) Models will test new Medicare payment options that aim to improve the quality of care for patients kidney disease.”