CMS Mandatory ESRD Model Looks to Accelerate Home Dialysis and Kidney Transplants

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The agency’s End-Stage Renal Disease Treatment Choices (ETC) Model, set to launch January 1, will impact approximately 30% of kidney care providers for an estimated $23 million cost savings over the next few years. David White of the American Society of Nephrology discusses the model’s positives and challenges, particularly with the added impact of COVID-19.

The urgent need for alternatives to in-center hemodialysis for end-stage renal disease (ESRD) in the US, including home dialysis and kidney transplantation, is finally gaining traction in Medicare, with the COVID-19 pandemic and its dramatic impact on kidney disease adding fuel to an already raging fire.

On September 18, CMS announced the final ruling for a new mandatory payment model, ESRD Treatment Choices (ETC), designed to overcome some of the existing obstacles to real change in this challenging space. Its provisions include improving access to home dialysis and kidney transplantation by adjusting payment incentives for managing clinicians and ESRD facilities, and, in the process, saving Medicare $23 million over the next five and a half years. Under the new model being implemented on January 1, 2021, Medicare will enroll about a third of US ESRD patients “in a system that rewards more convenient, comfortable options like home dialysis and incentivizes rather than discourages transplants,” according to HHS Secretary Alex Azar in a CMS release.

Market Pathways spoke with David White, Regulatory and Quality Officer at the American Society of Nephrology (ASN), to get his take on CMS’ finalized ETC Model, and the rapidly evolving ESRD space, particularly in light of the COVID-19 pandemic. He notes that ASN is hopeful and encouraged by CMS’ increased focus on the difficult problem of ESRD, and that the agency is trying to incentivize specific, more realistic benchmarks. However, he says that these major shifts are not going to be smooth, as “there’s not much that’s easy in kidney care. But we're very excited to see the movement of innovation happening in this critical space,” he says. Additionally, he points out that CMS has signaled to expect more mandatory models like this one.


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