CMMI unveils ESRD payment model to improve health equity

CMS on Thursday unveiled its first value-based payment model directly addressing health equity, a top Biden administration priority.

The pay model is part of the agency’s 2022 end-stage renal disease prospective payment system proposed rule. CMS plans to modify the ESRD Treatment Choices Model‘s benchmarking and scoring methodology to encourage dialysis providers to reduce disparities in home dialysis and kidney transplant rates among ESRD patients from disadvantaged communities. The proposed rule would also update payment rates and make changes to the ESRD Quality Incentive Program.

“Health equity is at the center of our work here at CMS,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “When CMS encourages dialysis providers to offer more options for Medicare patients to receive dialysis treatments, it can be life-changing and lead to better health outcomes, greater autonomy and better quality of life for patients with kidney disease.”

Under the proposal, dialysis providers could boost their score if they increase home dialysis and transplant rates among dual-eligible beneficiaries or people that get extra help from Medicare to pay for prescription drugs. CMS also wants to adjust benchmarks for providers that see a high share of low-income Medicare beneficiaries to ensure they don’t face financial penalties because they care for more vulnerable patients.

The proposed rule would increase Medicare payments to all ESRD facilities by 1.2% compared to 2021. But hospital-based ESRD facilities would see their payments fall 1.3%, while freestanding dialysis centers would get a 1.2% boost. CMS expects to pay $8.9 billion to about 7,700 ESRD providers in 2022.

CMS may also allow a variety of new ETC Model waivers related to kidney disease education, including the ability to provide it via telehealth.

The agency also plans to give dialysis providers until Sep. 1 to report 2020 data for its ESRD Quality Incentive Program and adopt other policies to avoid penalizing providers for issues related to the COVID-19 pandemic.

“Under these proposals, we would modify the scoring and payment methodologies to provide that no facility would receive a payment reduction for PY 2022,” CMS said in a fact sheet.

The Biden administration also included several requests for information addressing COVID-19, health equity, digital health quality and beneficiary experience with home dialysis care.


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