News: CMS announces new ESRD care model, encourages transplants, at-home dialysis

CDI Strategies - Volume 14, Issue 44

CMS announced that the End-Sage Renal Disease (ESRD) Treatment Choices (ETC) Model has been finalized. The goal of the model is to “improve or maintain the quality of care and reduce Medicare expenditures for patients with chronic kidney disease.”

The ETC Model comes after an executive order for advancing kidney health, encouraging increase of kidney transplants and at-home dialysis for those Medicare beneficiaries with ESRD. CMS says that the finalized model will impact roughly 30% of kidney care providers and will be implemented January 1. It is an estimated savings of $23 million over five and a half years.

According to CMS, approximately 20% of traditional Medicare dollars ($114 billion annually) are spent on Americans with kidney disease. In their press release, CMS says that “the current Medicare payment system and a lack of beneficiary education may encourage in-center hemodialysis as the default treatment for patients,” and that having to travel to dialysis centers also increases patients’ risk of COVID-19 exposure.

The ETC Model will test shifting Medicare payments from fee-for-service to payments where providers are incentivized for encouraging receipt of kidney transplants and at-home dialysis. The new model will also incentivize transplants by financially rewarding ESRD facilities based on their transplant rate, calculated as the sum of the transplant waitlist rate and the living donor rate.

Editor’s note: The full CMS press release can be found here. For more information about documentation opportunities related to ESRD, click here.

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