News: CMS proposes new APMs aimed at improving CKD care

CMS proposed one mandatory and four voluntary alternative payment models (APM) for Medicare beneficiaries who receive treatment for chronic kidney disease (CKD) and end-stage renal disease (ESRD), Revenue Cycle Advisor reported.

As noted in a CMS press release, the current Medicare payment system for CKD treatment encourages in-center hemodialysis as the default treatment for patients starting dialysis. The proposed required ESRD Treatment Choices (ETC) Model is aimed at giving ESRD beneficiaries the choice of an ESRD treatment (e.g., home dialysis, kidney transplant) that will support quality care and prevent disease progression.

Specifically, the mandatory model would adjust certain Medicare reimbursements to ESRD facilities and providers managing ESRD Medicare beneficiaries through upward or downward payment adjustments based on their home and transplant rates. For the first three years of participation, CMS would positively adjust Medicare reimbursement to providers for home dialysis and dialysis-related services. The mandatory model would also protect ESRD facilities and providers who treat sicker patients by risk-adjusting home dialysis and transplant rates, according to CMS.

If the proposed mandatory model is finalized, payment adjustments under the ETC model would begin January 1, 2020, and end June 30, 2026, Revenue Cycle Advisor reported. More information on the proposed mandatory model can be found in this CMS factsheet.

The four proposed voluntary payment models would use fixed payment mechanisms to encourage greater use of at-home dialysis and kidney transplants for patients suffering from late-stage CKD and ESRD.

Editor’s note: This article originally appeared in Revenue Cycle Advisor. More information on the proposed KCF and CKCC Models can be found in this CMS factsheet. For more information about CDI specialists’ role in CKD documentation, click here.