The dawn of new payment systems to treat individuals with kidney disease is here. The good news is that the notion of providing comprehensive clinical care with built-in savings for both payer and provider is being discussed as a goal. The details, however, are a bit more elusive. There are already 154 Medicare-driven Accountable Care Organizations in the United States. Can they make one that works specifically for renal care?

At the Renal Physicians Association meeting this past weekend, program director Chet Amedia, MD, assembled a panel of speakers representing physicians and payers to discuss the next steps in the integrated care model for nephrology care. That included discussion of the new Comprehensive ESRD Care Initiative launched by the Centers for Medicare & Medicaid Services on Feb. 4

(ESRD Seamless Care Organizations: Can everybody play?)

The RPA panel included Dylan Steer, MD, of Fresenius Health Partners/Balboa Nephrology Associates; Michael Shapiro, MD, of Denver Nephrology, and Robert Jansen, MD, executive vice president of Wellstart Health System, and nephrologist Gerald Stephanz from Provo, Utah.

Jansen, a nephrologist, detailed the complexity of blending ACO models and hospital administration. "We have to change physician payment, and payers should eliminate fee-for-service" as part of their payment structure with physicians, Jansen said. He and others compared the ACO model to the HMO of the 1990s, although speakers on the panel agreed that HMOs were focused on denying claims to help save money, while the ACO's focus was improving quality care with shared savings.

Shapiro talked about his practice group's Caremore staff model. "Extensivists" see patients in the hospital and outside. Denver Nephrology also employs physician assistants and uses nurse practitioners. Steer reiterated the role of ACOs compared to the HMOs of old: the ACO model, when done correctly, will lead to improvements in patient care.

There is no accountability requirement within the ACO model for patients, the panelists agreed. Patient compliance can influence the success of an ACO, clinically as well as financially.