Executive Order Aimed at Improving Care for Kidney Disease

July 2019 ~

Following the President’s signature on an executive order directing federal agencies to educate and treat people with early forms of kidney disease, CMS has proposed five new payment models for providers treating patients.

According to Department of Health and Human Services (HHS) Secretary Alex Azar, the effort is the most important initiative taken for kidney disease by any president and the single biggest change to how the disease is treated since Medicare began covering patients with end-stage renal disease (ESRD) in 1973.

As seen in the press release, the current Medicare payment system encourages in-center hemodialysis as the default treatment for patients beginning dialysis. According to the Government Accountability Office, in-center hemodialysis is the most common type of dialysis and was used by about 88 percent of dialysis patients in 2016. There are more than 430,000 Medicare Fee-for-Service beneficiaries with ESRD who spend an average of 12 hours a week receiving in-center hemodialysis. Many beneficiaries with ESRD suffer from poorer health outcomes, such as higher hospitalization and mortality rates, often the result of underlying disease complications and multiple co-morbidities.

The five proposed models include:

  • ESRD Treatment Choices (ETC) model
  • Kidney Care First (KCF) model (optional)
  • Comprehensive Kidney Care Contracting (CKCC) Graduated model (optional)
  • CKCC Professional model (optional)
  • Global models (optional)

ETC Model

The proposed ETC Model would adjust certain Medicare payments to ESRD facilities and clinicians managing ESRD beneficiaries (Managing Clinicians) that are selected for participation in the model, through upward or downward payment adjustments based on their home and transplant rates to increase utilization of home dialysis and rates of kidney and kidney-pancreas transplants.


Kidney Care First (KCF) model – participating nephrology practices will receive adjusted fixed payments on a per-patient basis for managing the care of patients with late-stage chronic kidney disease and patients with ESRD. The payments will be adjusted based on health outcomes and utilization compared to the participating practice’s own experience and national standards, as well as performance on quality measures.

Also, participating practices will receive a bonus payment for every patient aligned to them that receives a kidney transplant based on the transplant remaining healthy for up to three years after the surgery.

The CKCC Graduated, Professional, and Global models – capitated payments will be similar to the capitated payments under the KCF Model, but the Kidney Contracting Entities – which consist of nephrologists, transplant providers, and other health care providers including dialysis facilities – will take responsibility for the total cost and quality of care for their patients, and in exchange, can receive a portion of the Medicare savings they achieve.

CMS expects the KCF and CKCC Models to run from January 1, 2020, through December 31, 2023, with the option for one or two additional performance years, at CMS’s discretion.

More information on the proposed model is available, here.

Source(s): CMS Press Release; New York Times; Healthcare Finance News;