A proposal to implement a shared savings model for nephrologists’ reimbursement during the initial 6 months of dialysis care has won approval from a government advisory committee and is under review by CMS for possible implementation.

The Renal Physicians Association, which has developed the alternate payment model, presented its proposal to the Physician-Focused Payment Model Technical Advisory Committee (PTAC) on Dec. 18, 2017. The committee reviewed the RPA’s proposal and voted to recommend to the Secretary of the HHS that CMS implement the proposal.

“RPA believes that the daunting patient presentation and fiscal circumstances of the current entrance into [end-stage renal disease] ESRD (defined as ‘incident dialysis’) offer a discernible and viable opportunity to improve patient choice of treatment modality, clinical outcomes and quality of life, while reducing the overall ‘spend’ for these patients in both the Medicare program and with private insurers,” Robert Blaser, director of public policy for the RPA, wrote in an article in NN&I’s November 2017 issue. “Given that the first 6 months for adult patients transitioning from chronic kidney disease (CKD) to ESRD and facing the need for renal replacement therapy are associated with the highest mortality and complication rates, frequent hospitalizations and significantly higher costs, this period in a patient’s kidney disease journey offers the prospect of enhanced patient-centric care and cost savings through nephrology-specific medical management of their disease.”

The RPA noted its condition-specific, episode-of-care payment model (Clinical Episode Payment) would commence in the first month of dialysis therapy and would span the initial 6 months of dialysis for established Medicare primary beneficiaries.

“With pre-specified outcomes that align closely with CMS-accepted quality metrics, this model would serve to improve the processes associated with optimal transition to transplant or dialysis. This includes 1) upstream identification and engagement of CKD patients via a variety of physician practice-generated interventions, such as education and improved treatment of comorbid and causative conditions, to reduce the number of patients otherwise likely to progress to ESRD; 2) upstream preparation for dialysis; 3) equality of access to modality types and shared decision-making; 4) access to renal transplant; 5) healthy transition to dialysis; and 6) well-being during the first several months of dialysis. This model could easily be adapted to non-CMS payers as well,” Blaser wrote. – by Mark E. Neumann

Blaser R. NN&I. 2017;31(12):20-23.