CMS plans shared-savings program for renal care

The CMS is bringing its care-coordination and shared-savings model to end-stage renal disease in a program that aims to extract cost savings and improve quality.

The initiative comes one month after the New Year's Day fiscal cliff compromise, which called for $4.9 billion in cuts to dialysis providers.

Under the Comprehensive ESRD Care initiative, healthcare providers will manage a group of Medicare beneficiaries with late-stage kidney disease. And like CMS' accountable care organization program, groups that successfully lower costs and improve outcomes will be able to share in those savings. Participants may also be required to return any losses to Medicare.

Yet the program includes conditions that are different from ACOs, such as the requirement that the provider network include a dialysis facility, a nephrologist and one other Medicare provider or supplier.

Applications to participate in the program are due May 1.

The costs of treating end-stage renal disease came into the spotlight in December after a Government Accountability Office report found that the CMS may be overpaying for the condition. The report noted that the current bundled payment uses a calculation that overestimates the use of expensive anemia drugs.

Although late-stage kidney disease patients represent only 1.3% of beneficiaries, they accounted for 7.5%, or $20 billion, of expenditures in 2010, according to a CMS news release.

In a call about the program, the CMS outlined how savings would be calculated, but the program itself is separate from any rebasing of the bundled payment rate, which would need to be addressed through rule making.

Kidney Care Partners and the National Renal Administrators Association, which represent dialysis patients and providers, did not respond to requests for comment by deadline.



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