An audio recording and transcript are available for the August 20 Medicare Learning Network Call on the ESRD QIP CY2020 ESRD PPS Proposed Rule. Find them at https://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2019-08-20-ESRD-QIP.html.
CMS will hold a September 11, 2019 Open Door Forum on the New Medicare Cards and MBIs (Medicare Beneficiary Identifiers), which become mandatory on January 1, 2020. For details on the Forum see https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/Downloads/09112019NewMedicareCardODFAgenda.pdf. HIC numbers will no longer be valid after December 31, 2019. If you do not have an MBI for any of your patients, or you have other questions, see the CMS MLN Matters booklet on New Medicare Beneficiary Identifier (MBI): Get It, Use It, at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE18006.pdf.
CMS will present an August 20, 2019 National Provider Call on ESRD QIP: CY 2020 ESRD PPS Proposed Rule. Find more information, slides, and (after the Call) recordings, and register, at https://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2019-08-20-ESRD-QIP.html. The Call will avoid Questions, because they are to be handled through the standard Preview process (see https://nwrnbulletins.wordpress.com/2019/07/22/8-23-py2020-qip-preview-period/).
CMS will publish in the Federal Register on August 6, 2019 a Proposed Rule that includes changes to the CY2020 ESRD PPS, ESRD QIP, AKI payments, and many other details, including adjustments to the PY2022 NHSN and STrR measures, and provisions for new and innovative treatments. The Proposed Rule also includes requests for public comment on the case-mix adjustment model and wage indices. Comments will be due by September 27, 2019. Find:
- A pre-publication version of the Proposed Rule at https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-16369.pdf.
- A comprehensive Fact Sheet on it at https://www.cms.gov/newsroom/fact-sheets/end-stage-renal-disease-esrd-and-durable-medical-equipment-prosthetics-orthotics-and-supplies-dmepos.
- The Press Release announcing it at https://www.cms.gov/newsroom/press-releases/new-cms-proposals-strengthen-medicare-unleash-innovation-and-promote-competition-provide-kidney.
Home Dialysis Central has posted a thorough review of the proposed new ESRD reimbursement models discussed at https://nwrnbulletins.wordpress.com/2019/07/12/new-cms-payment-models/. Find the review at https://homedialysis.org/news-and-research/blog/318-what-the-em-advancing-american-kidney-health-initiative-em-aakhi-executive-order-may-mean-for-you.
The ETC payment model has been published in the Federal Register, and public comments are due by September 16, 2019. Find the Notice at https://www.federalregister.gov/documents/2019/07/18/2019-14902/medicare-program-specialty-care-models-to-improve-quality-of-care-and-reduce-expenditures. The Executive Order that triggered the new payment models is published at https://www.federalregister.gov/documents/2019/07/15/2019-15159/advancing-american-kidney-health.
The Preview Period for the PY2020 ESRD QIP begins July 22, 2019, and ends August 23, 2019. During this Preview Period facilities are to review their PSR and submit Clarification Questions and/or a Formal Inquiry if their PSR does not appear to meet their needs. Facilities are urged to submit Questions early enough to receive answers before their Formal Inquiry is due (by August 23, 2019).
Each facility’s designated Point of Contact (POC) can log into the QualityNet Secure Portal at https://eidm.cms.gov/EIDMLogin/login?bmctx=8727EC73D09EAFE3069C64044C620D9C&contextType=external&username=string&contextValue=%2Foam&password=secure_string&challenge_url=https%3A%2F%2Feidm.cms.gov%2FEIDMLogin%2Flogin&request_id=-5754072723998271983&authn_try_count=0&locale=en_US&resource_url=%252Fuser%252Floginsso to download their Preview Performance Score Report (PSR), ask Clarification Questions, or send a Formal Inquiry. CMS encourages each dialysis facility to generate and review its Preview PSR during the preview period before this information is made available to the public in December 2019 and payment reductions are finalized.
For more information see:
- QIP Preview general overview: https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier3&cid=1228776130396.
- Additional QIP Resources: https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1228776130562.
- QIP Q&A Tool: https://cms-ocsq.custhelp.com/app/homeesrdqip/p/960.
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.