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CMS Finalizes Models to Address Chronic Kidney Disease, Cancer

Analysis  |  By Jack O'Brien  
   September 18, 2020

The End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model follows up on President Donald Trump's kidney care executive order signed in July 2019.

The Centers for Medicare & Medicaid Services (CMS) announced that two new care models to address chronic kidney disease and cancer were finalized Friday morning. 

The End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model aims to increase the usage of home dialysis and kidney transplants, with Medicare payments shifting from fee-for-service payments to value-based care payments.

The new model also "incentivizes transplantation," financially benefiting ESRD facilities and clinicians based on "their transplant rate calculated as the sum of the transplant waitlist rate and the living donor transplant rate."

CMS estimates that the model will deliver savings of $23 million over five and a half years.

Friday's announcement follows up on President Donald Trump's kidney care executive order signed in July 2019, which focused on increasing the availability of kidney transplants.

Related: Trump Administration Launches Kidney Health Initiative

"Over the past year, the Trump Administration has taken more action to advance American kidney health than we’ve seen in decades," HHS Secretary Alex Azar said in a statement. "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."

Meanwhile, Kidney Care Partners, a coalition comprised of more than 30 organizations focused on addressing chronic kidney disease, issued a statement thanking the Trump administration for its continued efforts to improve kidney care quality.

"The Administration’s efforts to improve patient access and choice, namely encouraging use of home dialysis and access to – and better coordination of – available organs for transplants, has long been a top priority of the kidney community," the statement read. "Incentivizing living kidney donors by providing financial support for recovery time, childcare and eldercare expenses is critical to improve the pool of available organs for transplant, which are in very short supply in this country for the 100,000 individuals on the transplant waiting lists."

The group did express concerns about the effects the rule could have on patients who do no choose the home dialysis option.

"It remains critical that the patient and physician voice be in the forefront regarding access and choice for care settings – such as home care – that are most desirable and appropriate for the patient given the healthcare needs and associated co-morbidities, their home support and the home environment itself," the group stated.

Related: In Face of COVID Threat, More Dialysis Patients Bring Treatment Home

CMS also announced the new finalized Radiation Oncology (RO) Model, which will begin on January 1, 2021.

The RO model provides bundled payments for 90-day episode of care to "participating radiotherapy providers and suppliers furnishing radiotherapy for 16 different cancer types."

The agency stated that participant-specific payment amounts are determined by several factors, including "national base rates, trend factors, and adjustments for each participant’s case-mix, historical experience, and geographic location."

CMS estimates that the new RO model will save Medicare $230 million over five years.

Related: Court Upholds CMS' Hospital Price Transparency Final Rule

The Trump administration's health policy announcements came days after CMS withdrew the proposed Medicaid Fiscal Accountability Regulation rule.

Related: Citing Stakeholder Concerns, CMS Withdraws the MFAR

Editor's note: This article has been updated to include commentary from Kidney Care Partners.

Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.

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