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.
The new payment model goes into effect on January 1.
“The current Medicare payment system and a lack of beneficiary education may encourage in-center hemodialysis as the default treatment for patients beginning dialysis. This value-based payment model will encourage participating care providers to invest in and build their home dialysis programs,” CMS said in a statement.
The ETC model rewards ESRD and clinicians financially to increase transplant waitlisting and avoid dialysis when suitable. According to the agency, only about 30% of people with ESRD had a functioning kidney transplant, and just 3% had a transplant before starting dialysis.
A bipartisan group of Congressional lawmakers in October urged CMS to scale back the pilot because it would have affected half of all ESRD patients, upending ESRD care before the model was proven to work.
“CMS will select ESRD facilities and managing clinicians to participate in the model according to their location in randomly-selected geographic areas, stratified by region, so as to account for approximately 30% of adult ESRD beneficiaries in all 50 states and the District of Columbia,” according to a CMS fact sheet.
Home dialysis or a kidney transplant might not work for many patients, especially if they’re frail or elderly. Older patients often rely on their elderly partners to help them, but home dialysis is too hard for many of them to handle on their own.
Providers and patient advocates worry the new treatment model could create financial impediments to recommend and deliver the best treatment option for many people on Medicare. The model rewards home dialysis and kidney transplants while holding back the use of in-center dialysis and leaving out alternative treatment options like hospice. Advocates think it’s a one-size-fits-all approach that could harm people by limiting patient choice.