When the CMS last year called for kidney-care providers to participate in a new accountable care demonstration for end-stage renal disease, only a few applied. Many small, independent providers said they couldn't afford the investment needed to establish a program that would meet the federal cost savings and quality targets. But others saw the program as a way to prepare for the inevitable future of value-based payment and delivery.
“I know being in a fee-for-service environment is not going to be sustainable,” said Diane Wish, CEO of the not-for-profit Centers for Dialysis Care in Shaker Heights, Ohio, which has 18 facilities and 1,850 patients.
The CMS' accountable care model will be known as an ESRD seamless care organization, or ESCO, and the shared-savings program will begin Jan. 1. Because of the shortage of applications, the CMS postponed the program until 2015, and Wish's not-for-profit center has reapplied.
Wish's center plans to borrow $1.3 million from its charitable foundation to enhance its electronic health-record system to connect with two local hospital systems, so dialysis patients can be tracked in case of hospitalization. It also is adding care managers who will work to keep patients out of the hospital. About 400 of its patients are expected to qualify for the ESCO. Any shared savings the center earns from the ESCO program will be used to pay back the foundation.