CMS just lately printed the First Annual Analysis Report (the “Report”) highlighting its most important observations within the first 12 months following implementation of the Kidney Care Selections Mannequin (the “KCC Mannequin”). By the use of background, the KCC Mannequin is a fee mannequin which creates sure incentives for suppliers which are supposed to enhance care administration for Medicare sufferers with continual kidney illness (“CKD”) (Stage 4 or 5) or end-stage renal illness (“ESRD”). The KCC Mannequin is meant to, amongst different issues, delay the dialysis development and improve use of house dialysis, whereas additionally aiming to cut back the price of care and enhance high quality of outcomes.
Suppliers taking part within the KCC Mannequin interact in one among two (2) mannequin choices, together with both:
- Kidney Care First Mannequin (the “KCF Mannequin”): Obtainable to nephrology practices, nephrologists, and different nephrology professionals who voluntarily elect to take part.[1] Members obtain capitated funds in return for managing the care of sure affected person populations, offered that such capitation funds are topic to adjustment primarily based on the outcomes of high quality and utilization metrics.[2] As well as, bonus funds can be found for profitable transplantations.[3]
- Complete Kidney Care Contract Mannequin (“CKCC Mannequin”): Obtainable to nephrology practices that companion with transplant suppliers and sure different elective companions, reminiscent of dialysis services and residential care suppliers, to type Kidney Contracting Entities (every a “KCE”).[4] The CKCC Mannequin adopts a complete price of care method for Medicare Components A and B companies, and is characterised by assessments of ranges of danger to the person KCEs.[5]
Participation in both the KCF Mannequin or CKCC Mannequin is voluntary for suppliers.
Key Findings
The Report recognized quite a lot of key findings for the KCC Mannequin’s first 12 months, together with that it:
- Elevated the proportion of latest ESRD sufferers who additionally acquired a deliberate begin of renal alternative remedy, doubtless bettering the standard of care finally offered.
- Had no materials affect on high quality measures which stay largely unchanged, besides that:
- Below the KCF Mannequin, CMS noticed a decline in arteriovenous fistulas of 5.3 share factors (or 9%); and
- Had no materials affect on the entire funds beneath Medicare Components A and B per affected person per thirty days, nor did it lead to a statistically vital internet financial savings or loss for the Medicare program, besides that nephrology practices taking part within the KCF Mannequin skilled a probably significant decline of $134 (or 3%) in complete Medicare Components A & B per affected person per thirty days funds.[8]
- Resulted in a small improve in analysis and administration funds of roughly $1 per affected person per thirty days and complete dialysis funds $28 per affected person per thirty days beneath the CKCC Mannequin.[9]
- Elevated the proportion of sufferers with ESRD receiving dialysis therapy at house, whereas additionally considerably rising use of peritoneal dialysis.[10]
- The KCF Mannequin didn’t have an effect on kidney transplant charges, however the CKCC Mannequin elevated the variety of sufferers with an energetic waitlist standing.[11]
As well as, the Report famous that members within the KCC Mannequin typically acquired sure profit enhancements, elevated screens for social wants, participated in studying system actions, developed stronger companion relationships, and improved low affected person energetic scores.[12]
Trying Forward
CMS concluded the Report with optimism, citing that it is going to be very important to proceed evaluations to find out whether or not early traits persist.[13] The KCC Mannequin is at the moment set to run for five years and CMS will proceed to observe traits and efficiency. In consequence, present members may have extra alternatives to check the viability of the KCC Mannequin.
FOOTNOTES
[1] Report, at p. 10.
[2] Id.
[3] Id.
[4] Id.
[5] Id. KCEs are organizations shaped by nephrology practices, transplant suppliers, and different choices companions.
[6] Id. at p. 16.
[7] Id.
[8] Id.
[9] Id. at p. 15.
[10] Id. at p. 12.
[11] Id. at p. 15.
[12] Id. at p. 10.
[13] Id. at p. 19.