CMS Re-Opens Applications For Participation in End-Stage Renal Disease Payment Model

Over the past years, CMS has been actively engaged in the creation of various accountable care payment models. In doing so, CMS seeks in part to promote changes in the delivery of care from a fragmented system to a coordinated system, to improve outcomes for the benefit and protection of Medicare beneficiaries, and to develop working partnerships with providers through the alignment of clinical and financial interests.

One such accountable care model is the Comprehensive ESRD Care (CEC) Model, which began in 2015 with the goal of improving outcomes for Medicare beneficiaries with end-stage renal disease (ESRD) and reducing related Medicare Part A and B expenditures. CMS has recognized that the care needs of ESRD patients are often complex due to their multiple co-morbidities, which require coordination of care services that such patients do not routinely receive. The CEC Model is a new payment model that tests the delivery of care and payment for Medicare fee-for-service beneficiary population with ESRD.

To that end, CMS is again seeking applications for ESRD Seamless Care Organizations (ESCOs) to participate in the CEC for performance year 2017. An ESCO is a legal entity whose owners must include at least one dialysis facility and at least one nephrologist or nephrology practice. Once the ESCO applies and is accepted into the CEC Model, CMS will align beneficiaries to the ESCO, who will receive dialysis services for the dialysis facility participating in the ESCO. The ESCO will be clinically and financially accountable to CMS in meeting certain quality and performance measurements in the ESCO’s treatment of its beneficiaries. Like a typical Accountable Care Organization (ACO), the ESCO will receive a portion of Medicare’s savings, and share financial responsibility for losses, that are associated with Medicare’s expenditures for the ESCO’s beneficiaries. The ESCO may have relationships with non-owner providers who may also share in the ESCO’s savings and losses. However, durable medical equipment suppliers, ambulance suppliers, and drug/device manufacturers are not eligible to participate in the CEC Model.

Presently, the CEC Model has approximately 16,000 Medicare beneficiaries who are aligned to 13 ESCOs. CMS is now accepting new applications from new ESCOs that wish to participate in the CDC Model starting January 1, 2017. CMS aims to add at least 7 ESCOs and 6,000 more beneficiaries to the Model. The deadline for the applications is July 15, 2016, although CMS could elect to extend that deadline.

As one would expect, there are numerous requirements and details related to the eligibility to participate, creation and operation of the ESCO, and quality and financial performance standards. Further information on the CEC Model and the current Request for Applications can be found here: https://innovation.cms.gov/initiatives/comprehensive-esrd-care/