A bipartisan group of lawmakers on Thursday urged the CMS to reconsider its proposed pay model for end-stage renal disease, warning it could prevent patients from choosing the care they want.
While the 74 representatives support the Center for Medicare and Medicaid Innovation's proposed End-Stage Renal Disease Treatment Choices Model and its effort to change kidney care delivery, the current plan may be too broad and affect too many providers.
As it stands, the pay model would affect half of the ESRD patients and could significantly disrupt care, as well as prevent patients from choosing the right type of care. The model doesn't account for patients' interest or ability to use home dialysis, the letter said.
The lawmakers think that the test is too big because it includes so many patients. They asked the Innovation Center to limit the number of patients involved in the model. With half the ESRD patients in the country part of the proposed test, it would upend how ESRD care is provided nationwide before it was proven to work.
"We fear that without the changes presented … the demonstration will not achieve its desired goals we all share," said the letter addressed to HHS Secretary Alex Azar and CMS Administrator Seema Verma.
Home dialysis or a kidney transplant might not work for a lot of patients, especially if they're frail or elderly. Older patients often rely on their elderly partners to help them, but home dialysis is too hard for many of them to handle on their own, according to Dale Lupu, an associate research professor at the George Washington University Center for Aging, Health and Humanities.
The representatives called on the Innovation Center to grant ESRD providers waivers from Stark and anti-kickback laws so they won't have roadblocks from working together on coordinated care.
The letter also took aim at a different financial hurdle for the providers. Under the demonstration, providers would be financially accountable for transplant rates, even though there's a shortage of available kidneys. The lawmakers requested that the Innovation Center develop new referral metrics for facilities and hold organ procurement organizations accountable for their performance to prevent providers from being held responsible for something outside their control.
The CMS is "carefully reviewing all comments" and will respond to the representatives' concerns, a CMS spokesperson wrote in an email.
Providers and patient advocates have been worried that the new treatment model will create financial impediments to recommend and deliver the best treatment option for many people on Medicare. The model rewards the use of home dialysis and kidney transplants while holding back the use of in-center dialysis and leaving out alternative treatment options like hospice.
It could cut Medicare spending and deliver better kidney care for many patients. But providers and patient advocates think it's a one-size-fits-all approach that could harm a lot of people by limiting patient choice.