The model encourages increased use of home dialysis and kidney transplants to help improve the quality of life.
Jeff Lagasse, Associate Editor SEP 18, 2020
The Centers for Medicare
and Medicaid Services announced today that it has finalized the End-Stage Renal
Disease (ESRD) Treatment Choices (ETC) Model, meant to improve or maintain
quality of care and reduce Medicare expenditures for patients with chronic
kidney disease.
The ETC Model is a
component of President Trump's Advancing Kidney Health Executive Order and
encourages increased use of home dialysis and kidney transplants to help
improve the quality of life of Medicare beneficiaries with ESRD. The ETC Model
is expected to impact about 30% of kidney care providers, and will be implemented
on January 1, 2021 at an estimated savings of $23 million over five and a half
years.
"President Trump is
tackling a longstanding problem for people with kidney disease because they
deserve better than a system that perpetuates costly care and poor
outcomes," said CMS Administrator Seema Verma. "He challenged us to
deliver a new model that focuses on prevention and better quality of life for
our Medicare beneficiaries, so they can spend less time in dialysis centers and
more time living fuller lives."
Roughly 20% of dollars in
traditional Medicare – $114 billion a year – are spent on Americans with kidney
disease, according to CMS. While more than 100,000 American begin dialysis to
treat end-stage renal disease each year, one in five will die within a year.
WHAT'S THE IMPACT?
Many beneficiaries with
ESRD suffer from poor health outcomes and face increased risk of complications
with underlying diseases. For example, those with ESRD who contract COVID-19
have higher rates of hospitalization. The current Medicare payment system, and
a lack of beneficiary education, may encourage in-center hemodialysis as the
default treatment for patients beginning dialysis. Having to travel to dialysis
centers for their treatment also potentially exposes those with ESRD to
illnesses like the coronavirus.
The ETC Model will test
shifting Medicare payments from traditional fee-for-service payments
to payments in which providers are incentivized for encouraging the receipt of
home dialysis, and of kidney transplants. This value-based payment model is
intended to encourage participating providers to invest in and build their home
dialysis programs, which allow patients to receive care in the comfort and
safety of their home. Home dialysis gives patients the freedom to choose the
therapy that works best with their lifestyles, without being tied to the
dialysis facility's schedule.
The ETC Model also
incentivizes transplantation by financially rewarding ESRD facilities and
clinicians based on their transplant rate, calculated as the sum of the
transplant wait-list rate and the living donor transplant rate. Transplant
wait-listing means that a beneficiary becomes eligible to get a kidney when one
becomes available at their transplant center.
Transplantation is widely
viewed as the optimal treatment for most patients with ESRD, generally
increasing survival and quality of life while reducing medical expenditures. In
2017 only 29.9 % of people with ESRD in the U.S. had a functioning transplant
kidney, and only 2.9 % of such patients received a transplant before needing to
start dialysis. The model provides financial incentives to increase transplant
wait-listing and avoid instead of dialysis, when appropriate.
Providers are encouraged
to have early conversations with patients about treatment options. All
beneficiaries attributed to participants in the ETC Model will maintain freedom
of choice among healthcare providers, and all current beneficiary protections
under Medicare are maintained in the model. The model's incentive structure
encourages clinicians to care for the whole person and make real improvements
to the beneficiaries' quality of life. CMS will monitor the financial impact
over the course of the ETC Model.
A fact sheet on the ETC
Model is available here, and more
information is available here.
THE LARGER TREND
CMS proposed changes to
the ESRD Prospective Payment System in July, which CMS said
at the time encouraged the development of certain new and innovative home
dialysis machines.
Refinements to
eligibility for the transitional drug add-on payment adjustment to better
target the additional payment to innovative renal dialysis drugs and biological
products is based on the Food and Drug Administration's New Drug Application
Classifications.
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