CMS proposes changes to ESRD treatment choice model to improve equity of care


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Under a rule proposed by CMS, dialysis clinics in the ESRD Treatment Choices demonstration will receive higher payments if the centers refer more socially and economically disadvantaged patients to transplant or home dialysis.

The proposed changes, detailed in a file of 345 pages available here, “Would aim to encourage dialysis providers to reduce disparities in rates of home dialysis and kidney transplants in patients with end-stage renal disease (end-stage renal disease) of lower socioeconomic status, making the model the first The agency’s CMS innovation center model to directly address health equity, ”CMS said in a press release.

The changes are part of a larger settlement proposal by CMS on July 1, which includes an increase in Medicare’s pooled payment for dialysis treatments and changes to the quality incentive program.

ETC model

As part of the ETC model, which began on January 1, participating dialysis facilities and clinicians who manage patients (clinician managers) receive positive or negative adjustments on certain claims for dialysis and dialysis-related services, based on home dialysis and transplant rates among their beneficiaries.

The model includes two payment adjustments for clinics. The home dialysis payment adjustment is an upward adjustment on home dialysis and home dialysis-related claims in the first 3 years of the demonstration. The second adjustment, the Performance Payment Adjustment (PPA), creates a performance-based adjustment up or down on all dialysis requests and monthly capitation payments to nephrology practices based on performance. participant on home dialysis rate and ETC model transplant rate among assigned beneficiaries. at the ETC.

The event will end on June 30, 2027.

Proposed changes

The payment adjustments offered by CMS are as follows:

  • a health equity incentive to improve scoring methodology for home dialysis rate and transplant rate. Dialysis clinics that demonstrate significant improvement in dialysis or home transplant rates among their beneficiaries who are doubly eligible for Medicare and Medicaid or low-income grant (LIS) recipients may earn additional points of improvement ; and
  • a restratification of benchmarks of success by the proportion of beneficiaries who are doubly eligible for Medicare and Medicaid or who are beneficiaries of LIS, so that ETC clinics that see a high volume of these patients would not suffer negative financial consequences as a result .

“Taken together, these two proposed changes recognize that socioeconomic disparities in access to alternative renal replacement modalities exist and may impact the ability of ETC participants to perform well in the ETC model, while providing incentives for all ETC participants reduce these disparities among their Medicare patients, ”CMS said in the release.

The agency said disadvantaged Medicare patients suffer from ESRD at higher rates. “They are also more likely to undergo hospital readmissions and higher costs, as well as to receive in-center hemodialysis … Studies also indicate that patients with ESRD [of color] are less likely to receive kidney care, be on a transplant waiting list or receive a kidney transplant, ”CMS said in the release

CMS is also seeking comments on the proposed rule on opportunities to collect and exploit various datasets on race, ethnicity, Medicare / Medicaid dual eligibility status, disability status, LGBTQ + and status. socioeconomic. He is also interested in new methodological approaches to advance equity through the ESRD Quality Incentive Program.

Comments are due on proposed changes to CMS by August 31st.

The references:
https://edit.cms.gov/newsroom/fact-sheets/end-stage-renal-disease-esrd-prospective-payment-system-pps-calendar-year-cy-2022-proposed-rule-cms
www.cms.gov/newsroom/fact-sheets/end-stage-renal-disease-esrd-prospective-payment-system-pps-calendar-year-cy-2022-proposed-rule-cms
www.federalregister.gov/public-inspection

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