The CMS Innovation Center in February unveiled the first Medicare accountable care program for specialty care with the Comprehensive ESRD Care Initiative, which targets patients with end-stage renal disease.
While previous Medicare ACOs have focused on the general Medicare population, the ESRD Seamless Care Organizations, or ESCOs, tackle one of the most expensive and challenging patient groups.
ESCOs have the same goals as Medicare ACOs—to improve quality of care and reduce costs by giving providers financial incentives to meet cost and quality targets. But they're geared toward a patient group that makes up only about 1% of Medicare beneficiaries while accounting for more than 7% of total Medicare expenditures. These are very sick patients, many of whom have complex physical and behavioral health problems.
ESCOs require collaboration between at least one dialysis facility, a nephrology group and at least one other Medicare-enrolled provider or supplier, and must have at least 500 Medicare ESRD patients under care. Applications to participate were due May 1.
It's not yet known how many organizations have applied to serve as an ESCO. The CMS plans to announce participants in January 2014.
The program has received criticism for not yet providing the performance measures and baseline data to potential participants. In addition, the CMS said it plans to rebase payment rates in the fourth and fifth years, creating question marks over whether shared savings are achievable. DaVita among others has criticized this.
Dr. Jonathan Himmelfarb, director of the Kidney Research Institute at the University of Washington, said there are technical details of the ESCO program that raise concerns, such as whether the quality targets are attainable for patients with very advanced disease. “The idea of ESCOs is good,” he said. “The devil is in the details.”
One of the larger criticisms is the CMS' decision to focus on the end-stage of chronic kidney disease, and not include patients in earlier stages to prevent progression.
Dr. Amy Williams, a nephrologist at the Mayo Clinic, said the program could pose challenges for healthcare systems that don't have expertise in population health management. “I think the goal of seamless, quality care is spectacular,” she said. But “for the rural systems and the systems that are not well-connected, it's going to be very costly.”
Follow Beth Kutscher on Twitter: @MHbkutscher
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