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HHS Issues Rules for New ESRD Treatment Choices Payment Model 

by Colin Luke

Published: September, 2020

Submission: October, 2020

 



The Department of Health and Human Services (HHS) has implemented a new Medicare payment model, the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model.


The ETC Model was developed to test whether the greater use of home dialysis and kidney transplantation for Medicare beneficiaries with ESRD will reduce Medicare expenditures, while also preserving or enhancing the quality of care furnished to beneficiaries with ESRD. The Model also seeks to incentivize the provision of additional resources to support greater utilization of home dialysis and kidney transplantation.


It is a mandatory payment model with a performance period beginning January 1, 2021, and ending June 30, 2027.


The rationale for a mandatory model for ESRD facilities and Managing Clinicians within selected geographic areas is to test the effect of payment incentives on availability and choice of treatment modality among a diverse group of providers and suppliers.


The ETC Model adjusts certain payments to nephrologists and other clinicians managing beneficiaries with ESRD and ESRD facilities selected to participate in the Model. In particular, the Model will apply payment adjustments to the adjusted ESRD Prospective Payment System per treatment base rate under the ESRD PPS to ESRD facilities required to participate, as well as the monthly capitation payment to Managing Clinicians required to participate.


These payment adjustments will offer the incentive to participating ESRD facilities and Managing Clinicians to work with beneficiaries and caregivers in the choice of treatment modality.


CMS has acknowledged that there may be instances of overlap with this program and other CMS programs, particularly dialysis programs. Yet, the release states that HHS believes the ETC Model is compatible with existing programs that provide opportunities to improve care and reduce spending, and HHS will work to resolve any overlapping issues, such as repetitive services or duplicative payment of services, should they arise.


The new ETC Model was released in tandem with a new Radiation Oncology (RO) payment model, discussed here.


In its release, HHS states, “We believe that these two models will test ways to further our goals of reducing Medicare expenditures while preserving or enhancing the quality of care furnished to beneficiaries.”


HHS notes that these two focus areas, radiation oncology and ESRD care, were chosen because participants in these models will have a significant opportunity to redesign care and improve the quality of care furnished to beneficiaries receiving these services.


To read more about these new care models, visit the HHS release here.


Click here to read more.


 


 

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