After an unprecedented year, kidney care providers, including nephrologists, dialysis facilities, and care extenders are expecting 2021 to follow suit. We will see an overhaul in reimbursement and major industry shifts, partly led by CMS, that will require providers to advance their capabilities in a way that will usher in more widespread innovation. These new models encourage a shift in treatment approach that will deliver earlier interventions and better outcomes.
The following are likely trends we will see in the new year.
Value-based Incentives Impact Kidney Care in 2021
Tying revenue to volume —a fee-for-service reimbursement model — has long been the standard for treating kidney disease. This payment model has led to high hospital utilization, lack of financial accountability, and siloed care management, ultimately leading to increased costs and an uncoordinated patient journey.
In 2017, Medicare spending for chronic kidney disease (CKD) patients totaled $84 billion. That same year, spending for end-stage renal disease (ESRD) patients totaled $35.9 billion. Less than 1% of Medicare beneficiaries have ESRD, yet the condition accounts for more than 7% of overall Medicare spending. The per-person, per-year spend on treating ESRD patients averages nearly $80,000. These unsustainable costs are driving kidney care innovation and prompting several new value-based care models.
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To address both the high cost of care and quality of life, the Advancing American Kidney Health executive order was signed in 2019, with a goal to reduce the number of patients progressing to late-stage kidney failure and improving the cost and experience involved with ESRD care.
In September, the Centers for Medicare & Medicaid Services (CMS) released a final rule for the ESRD Treatment Choices (ETC) model, a mandatory approach impacting approximately 30 percent of kidney care providers, beginning January 1st, 2021. This model aims to bring the U.S. up to world benchmarks for both in-home dialysis and transplant rates.
Reimbursement rates will be adjusted for physicians and dialysis facilities based on home dialysis and transplant rates, first with a positive adjustment to home dialysis claims, then gradually introducing penalties.
Source: Hit Consultant