President Trump recently signed the Executive Order on Advancing American Kidney Health. The purpose of this Executive Order (EO) is to improve kidney health and promoting increased treatment options for Americans suffering from kidney disease. The kidney health initiative seeks to prevent kidney failure through better diagnosis, treatment, and preventative care; increase affordable alternative treatment options, educate patients on treatment alternatives, and encourage the development of artificial kidneys; and increase access to kidney transplants by modernizing the transplant system and updating counterproductive regulations. Under the executive order, Medicare will test adjusting payment incentives to encourage preventative kidney care and the use of home dialysis and kidney transplants.
Following the issuance of this EO, the Centers for Medicare and Medicaid Services (CMS) announced in a press release five new CMS Center for Medicare and Medicaid Innovation (CMMI) payment models that aim to transform kidney care in order for patients with chronic kidney disease to have access to high quality, coordinated care. One of the models, the proposed End-Stage Renal Disease Treatment Choices (ETC) Model, would encourage greater use of home dialysis and kidney transplants for Medicare beneficiaries with end-stage renal disease (ESRD) in order to enhance their quality of care while reducing Medicare expenditures. Under the proposed ETC Model, CMS would make certain payment adjustments that would encourage participating ESRD facilities and Managing Clinicians to ensure that ESRD beneficiaries have access to, and receive education about, their kidney disease treatment options. CMS would positively adjust certain Medicare payments to participating ESRD facilities and Managing Clinicians for the first three years of the model for home dialysis and dialysis-related services. The payment adjustments under the proposed ETC model would begin January 1, 2020, and end June 30, 2026.
The other optional models announced by CMS are the Kidney Care First (KCF) Model and the Comprehensive Kidney Care Contracting (CKCC), which includes the Graduated, CKCC Professional, and Global models that are designed to help health care providers reduce the cost and improve the quality of care for patients with late-stage chronic kidney disease and ESRD. These models also aim to delay the need for dialysis and encourage kidney transplantation. The final model announced by CMS is the Radiation Oncology (RO) model aimed at improving the quality of care for cancer patients receiving radiotherapy treatment. This model, which would involve required participation, would test whether prospective site neutral, episode-based payments to physician group practices (PGPs), hospital outpatient departments (HOPD), and freestanding radiation therapy centers for radiotherapy (RT) episodes of care would reduce Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries.
Contact RCPA Director of Rehabilitation Services, Melissa Dehoff, with questions.