As Kidney Week Ends, Providers Are Urged to Join New Care Models

As Kidney Week closed, nephrologists gathered to hear policy updates and information about forthcoming payment models from CMS and seemed pleased with what they heard.

Tom Duvall, the acting director for the Division of Special Populations and Projects within CMS’ Center for Medicare and Medicaid Innovation (CMMI), discussed the different models that the administration unveiled in July 2019 and what sorts of questions providers and practices should consider asking themselves before they make a decision about the options available under Kidney Care Choices (KCC).

The KCC model is expected to run from 2020 to December 31, 2023, with the option to apply for an additional year or two at the discretion of CMS. Although the model participation starts next year, financial accountability will not start until 2021. During the implementation period, participants will have to focus on their infrastructure and building care partnerships, he said.

KCC is part of the HHS initiative, Advancing American Kidney Health, which aims to improve the health of the 37 million Americans living with kidney disease. The initiative outlines 3 goals for improving kidney health: (1) reduce the number of Americans developing ESRD by 25% by 2030; (2) have 80% of new ESRD patients in 2025 either receiving dialysis at home or receiving a transplant; and (3) double the number of kidneys available for transplant by 2030. There are currently more than 700,000 Americans with ESRD and nearly 100,000 waiting for a kidney transplant.

The Kidney Care First (KCF) model is aimed at nephrology practices, with the goals of later and better starts on dialysis, better coordination of care in order to reduce the total costs of care, more patients receiving transplants and staying off dialysis for longer, and offering different levels of financial risk. Under KCF, which is based on the Primary Care First model, nephrologists will be eligible for bonus payments.

Under Comprehensive Kidney Care Contracting (CKCC) models, there are 3 choices, and they are meant for larger kidney entities; the models each have a different mix of risk and reward.

“Do you think you can do it on your own, on your individual practice level, or do you think you want to partner with some larger organizations? Maybe it's dialysis companies, maybe it's insurance companies, maybe it's your local transplant provider, to really take on this accountability for beneficiary care," Duvall said of the considerations that should be factored into any decision making.

Duvall said CMS wanted to be flexible in order to “meet people where they are with the goal of giving people different opportunities to improve care.”

Encouraging practices to apply, he noted that even though the deadline is a little more than 2 months away, he said CMS wants to hear from them if they have questions. In addition, he said, “You don’t have to make a final decision until fall of 2020, said even if you’re on the edge we would encourage to to apply.”