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CMS releases details for new renal accountable care organization demonstration

Agency hosting an open forum on project

February 04, 2013
KEYWORDS ACO / dialysis / medicare
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Slides from the CMS Open Door Forum held Feb. 5 are available here.  An audio replay of the Open Door Forum is available  through April 8 by calling 855. 859.2056 and using Conference ID: 91692836.

The Centers for Medicare and Medicaid Services released the details of a new demonstration that would test the accountable care organization model for kidney disease.

Through the Comprehensive ESRD Care initiative, CMS said it will partner with health care providers and suppliers to “test the effectiveness of a new payment and service delivery model in providing these beneficiaries with patient-centered, high-quality care.” The agency hosted an Open Door Forum  Feb. 5. Slides from the forum are available for download. The forum will also be available for replay at innovation.cms.gov, under the webinars/forum section.

“This initiative puts Medicare beneficiaries living with end-stage renal disease at the center of their care,” said CMS acting administrator Marilyn Tavenner. “Through enhanced care coordination, these beneficiaries will have a more patient-centered care experience, which will ultimately, improve health outcomes.”

In the 53-page application for health care organizations, the agency sets specific goals for the renal ACO: reduce hospitalizations and readmissions, improve access to kidney transplantation and home dialysis modalities in an effort to reduce morbidity and mortality, and reduce the use of catheters.

Medicare beneficiaries with ESRD constituted 1.3% of the Medicare population and accounted for an estimated 7.5% of Medicare spending, totaling over $20 billion in 2010. CMS says those high costs are often the result of underlying disease complications and multiple co-morbidities, such as coronary artery disease and hypertension, which often lead to high rates of hospital admission and readmissions, as well as a mortality rate that is much higher than the general Medicare population.

How it works
Through the Comprehensive ESRD Care Initiative, CMS will enter into agreements with groups of health care providers and suppliers called ESRD Seamless Care Organizations (ESCOs). Participating organizations must include at least a dialysis facility, a nephrologist, and one other Medicare provider or supplier, but each applicant must have access to at least 500 patients under their care.

Each participating organization will be clinically and financially responsible for all care offered to a group of matched beneficiaries––not only dialysis care or care specifically related to a beneficiary’s kidney disease. Additionally, CMS does not intend to reimburse ESCOs for non-Medicare covered services.
The ultimate goal, CMS says, is to provider better quality care while lowering costs in Part A––hospitalizations––and Part B, which covers outpatient care and physician services. ESCOs that succeed in offering high quality care that lowers the total Parts A and B cost of care for those beneficiaries will share in Medicare savings with CMS.

Payment models
The renal ACO model offers three payment tracks, depending on the size of the dialysis facility participating in the model.  ESCOs that include at least one dialysis facility owned by a large dialysis organization (an organization with more than 200 dialysis facilities) must participate in a risk-based payment arrangement over the life of the model.  Other participating organizations may join in one of two other payment tracks.

Interested applicants are required to file non-binding letters of intent, which are due on March 15. Applications to participate in the model are due May 1, 2013. For more information on the Comprehensive ESRD Care initiative, visit: innovation.cms.gov/initiatives/comprehensive-ESRD-care/.

 

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