Last month the US government Centers for Medicare & Medicaid Services (CMS) announced a “new initiative designed to identify, test, and evaluate innovative ways to improve care for Medicare beneficiaries with End-Stage Renal Disease.” Through the initiative, CMS 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.”
Increased level of care benefits kidney community and reduces Medicare budget.
This will greatly benefit the people on Medicare who have ESRD and who, according to the CMS, “have significant health care needs” and “accounted for an estimated 7.5% of Medicare spending, totaling over $20 billion in 2010.” According to the CMS, “These 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.”
Titled, the Comprehensive ESRD Care Initiative, CMS will enter into agreements with groups of health care providers and suppliers, called ESRD Seamless Care Organizations. Providers and CMS will work together to provide beneficiaries with a more patient-centered, coordinated care experience. Participating organizations must include at least a dialysis facility, a nephrologist, and one other Medicare provider or supplier. This initiative is being run through the CMS Innovation Center, which was created by the Affordable Care Act to test new models of delivering health care that can potentially lower costs and improve patient care.
Results based incentive.
Although it is much too early in the process to even speculate on what may come of the federal government’s renewed interest in improving options for Medicare recipients with ESRD, this is an initiative deserving of support. The current approach to treating ESRD appears to be less than cost-effective, and an initiative aimed at improving ESRD service and reducing Medicare cost is a positive occurrence for individuals with ESRD, care providers, and the general public.
CMS notes that under the initiative, “participating organizations will assume clinical and financial responsibility for a group of beneficiaries with ESRD, based on where these beneficiaries receive services." Though beneficiaries will retain the right to see any Medicare provider they choose, organizations will be evaluated on performance and quality measures, including beneficiary health and experience. Providers successful in improving beneficiary health outcomes and lowering the per capita cost of care for beneficiaries will have an opportunity to share in Medicare savings with CMS.
The bottom line.
This Comprehensive ESRD Care Initiative is incentive based and appears promising because it rewards results of care rather than methodology. If successful, this program will benefit late stage kidney disease sufferers as well as the health of the Medicare system. KidneyBuzz will continue to follow this program as new developments unfold.