COVID-19 Adjustments to CMS Alternate Payment Models

CMS has published a web page on CMS Innovation Center COVID-19 Flexibilities detailing current and future changes to their proposed alternate payment models (Comprehensive ESRD Care, Kidney Care Choices) as a result of COVID-19.  Find the page at https://innovation.cms.gov/innovation-models/covid-19-flexibilities.

ASN KidneyNewsOnline also has an article on the subject, Significant Update from CMS on Voluntary Models and ESCOs Including Q&A, at https://www.kidneynews.org/policy-advocacy/leading-edge/significant-update-from-cms-on-voluntary-models-and-escos-including-qa.

New CMS ACO and ESCO Resources

CMS has added many new tools to it’s Accountable Care Organization home page, including several on ESRD Seamless Care Organizations.  Examples from February 2020 include these Case Study PDFs:

• Keystone ACO’s Health Navigator Program to Identify and Close Care Gaps.
• Atlantic Dialysis Management Services’ Patient Navigator Program.
• Centers for Dialysis Care’s Patient Advisory Committees.

The Comprehensive ESRD Care Model page has also been recently updated.  Find links to all these and more at https://innovation.cms.gov/initiatives/aco/.

12/19 Webinar on Innovative Payment Models

CMS will present a December 19, 2019 Cross-Model Office Hours Session on their new Innovative Payment Models – the Primary Care First Model Options, the Direct Contracting Model Options, and the Kidney Care Choices Model.  Each Model team will discuss aims, timelines, eligibility, and more.  The Session will include a live Q&A portion.  Find more details and register at https://cmslearningevents.cosocloud.com/cmscmoh/event/registration.html.

Find additional information about each model at:

• Primary Care First: https://innovation.cms.gov/initiatives/primary-care-first-model-options/.
• Direct Contracting: https://innovation.cms.gov/initiatives/direct-contracting-model-options/.
• Kidney Care Choices: https://innovation.cms.gov/initiatives/kidney-care-choices-kcc-model/.

New CMS Payment Models

CMS has proposed five new experimental ESRD and CKD payment models:

• Four models will be voluntary:

• • The KCF (Kidney Care First) Model would capitate and incentivize payments to nephrology practices for care of CKD and ESRD patients.
  • Three different CKCC (Comprehensive Kidney Care Contracting) Models would allow the creation of Kidney Contracting Entities (KCEs), which would take full responsibility for the cost and quality of care for ESRD patients in return for capitated payments, with a share of any cost savings rebated.  KCEs would consist of nephrology practices, transplant providers, dialysis providers, and other healthcare providers.
  • These programs would run for four to six years, beginning January 1, 2020.  Find more information on the KCF and CKCC Models at https://www.cms.gov/newsroom/fact-sheets/kidney-care-first-kcf-and-comprehensive-kidney-care-contracting-ckcc-models.

• The fifth model, the ETC (ESRD Treatment Choices) Model, would be mandatory in randomly selected geographic areas that would cover fifty percent of the US, and run for six and a half years beginning January 1, 2020.  It would incentivize transplants and home dialysis, and interact with the current ESRD PPS and QIP in yet-to-be-determined ways.  Find more information on the ETC Model at https://www.cms.gov/newsroom/fact-sheets/proposed-end-stage-renal-disease-treatment-choices-etc-mandatory-model and https://innovation.cms.gov/initiatives/esrd-treatment-choices-model/.  The ETC Model is part of a draft Proposed Rule that can be found at https://www.hhs.gov/sites/default/files/CMS-5527-P.pdf.