The Centers for Medicare & Medicaid Services has announced the participants for the Comprehensive ESRD Care (CEC) Model, a new accountable care organization (ACO) model. The CEC Model is designed specifically for beneficiaries with ESRD and builds on experiences from other models and programs with ACOs, including the Pioneer ACO Model and the Medicare Shared Savings Program. In 2012, ESRD beneficiaries comprised 1.1% of the Medicare population and accounted for an estimated 5.6% of total Medicare spending.
Medicare ACO results: down, but not out
The results from CMS’ second year of the Pioneer and Shared Savings Accountable Care Organization demonstration suggest that some work needs to be done to help providers reduce the risk, but the outcomes show some promise.
In the CEC Model, dialysis facilities, nephrologists, and other providers have joined together to form ESRD Seamless Care Organizations (ESCOs) to coordinate care for ESRD beneficiaries. ESCOs will be financially accountable for quality outcomes and Medicare Part A and B spending, including all spending for dialysis services, for their ESRD beneficiaries.
CMS released the details of the demonstration to the renal community more than two years ago, on Feb. 5, 2013, with an original launch date of January 2014. By July 2013 it had granted three extensions for applications after dialysis providers raised concerns about the financial risk and the size of the patient population needed by small providers to participate. CMS agreed to loosen some of the restrictions on organizing the ESRD Seamless Care Organizations, the entities that would participate in the demonstration, and released a new set of applications in January of last year. A final round of deadlines took place last July for large dialysis organizations and in September for small dialysis providers.
CMS said the model is designed to encourage dialysis providers to think beyond their traditional roles in care delivery and support beneficiaries as they provide patient-centered care that will address beneficiaries’ health needs in and out of the dialysis facility.
“This new ACO model represents a paradigm shift in care for beneficiaries with end-stage renal disease; it promotes a patient-centered approach to their dialysis and non-dialysis care needs that will help accomplish our delivery system reform goals of better care, smarter spending, and healthier people,” said Patrick Conway, MD, MSc, acting deputy administrator and chief medical officer, CMS.
The CEC Model includes separate financial arrangements for ESCOs with large and small dialysis organizations. ESCOs with participation by a dialysis facility or facilities owned by a large dialysis organization, defined as an organization that owns 200 or more dialysis clinics, will be eligible to receive shared savings payments, but will also be liable for shared losses, and will have higher overall levels of risk compared with their smaller counterparts.
ESCOs with participation by a dialysis facility or facilities owned by a small dialysis organization will be eligible to receive shared savings payments, but will not be liable for shared losses. The following applicants were selected to participate in the model:
Large dialysis organizations
The CEC Model is part of the Department’s efforts to create opportunities for providers to enter into alternative payment models and meet the Secretary’s goal, announced on January 26th, to have 30% of traditional Medicare payments paid through alternative payment models by the end of 2016 and 50% by the end of 2018. CMS issued an open call for applications for the CEC Model in April 2014.