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The long push for payment models to cross the silos of kidney care – chronic kidney disease (CKD), kidney failure and dialysis, and kidney transplant – continues with newly announced modifications to the implementation timeline of the Kidney Care Choices (KCC) Model, often referred to as the voluntary model. The Center for Medicare and Medicaid Innovation (CMMI), which creates models and created the ESCOs, has extended the implementation period from March 31, 2021, until December 31, 2021. The effective performance year that was scheduled to begin April 1, 2021 will now begin January 1, 2022.
In an editorial released on June 23rd by The Hill ASN President Anupam Agarwal, MD, FASN and NKF President Kramer, MD, MPH expressed that the intersection of COVID-19 and kidney disease is fraught with potential calamities and investment for prevention and research are necessary.
“Kidney patients – including those with kidney failure receiving dialysis and transplant recipients – are more at risk from SARS-CoV-2 exposure because of their vulnerable physical conditions, weakened immune systems, and the open settings in which they receive care. Data has shown that people with kidney diseases were 2.5 times more likely to die than other hospitalized patients with COVID-19 . And recent data released from the Centers for Medicare and Medicaid Services showed that kidney disease patients undergoing dialysis were hospitalized with COVID-19 at a rate of 1,341 hospitalizations per 100,000 beneficiaries, the highest hospitalization rate among all Medicare beneficiaries. In fact, the first few deaths that occurred in the state of Washington were patients with kidney disease. Kidney disease also disproportionately affects minority populations, a population at higher risk for COVID-19 and COVID-19 associated mortality compared to non-minority populations,” states the editorial.
The American Society of Nephrology (ASN) provided comments and critique of the proposed rule on Medicare Advantage (MA) for 2021 and 2022 on April 6, 2020. In 2021, by law, MA plans will be open to patients with kidney failure as opposed to those who were already enrolled in MA plans before advancing to kidney failure and remain enrolled after kidney failure.
People with kidney diseases experience higher risk during health crises like the COVID-19 pandemic. To address the essential needs of this high-risk population, advocates from the American Society of Nephrology (ASN) and the American Association of Kidney Patients (AAKP) met with representatives, senators, and their respective staffs April 1, 2020 as part of the annual Kidney Health Advocacy Day (KHAD).
After much urging from the American Society of Nephrology (ASN) and other members of the kidney community, the Centers for Medicare and Medicaid Services (CMS) issued a sweeping interim final rule on March 30 that provides multiple waivers the community requested to provide greater flexibility during the COVID-19 public health emergency (PHE). Of particular importance for ASN members, the rule greatly expands the use of telehealth in providing care to kidney patients – especially those with kidney failure receiving dialysis – for the duration of the PHE. CMS clarified that all evaluations of dialysis patients covered under the ESRD monthly capitated payment (MCP) may now be conducted via telehealth to protect those vulnerable patients and prevent further spread of the novel coronavirus 2019.
People who receive dialysis at home, and the nephrologists who care for them, need additional options in order to receive care, and reduce risk of infection, during the COVID-19 pandemic. Thanks to the work of the American Society of Nephrology (ASN) and other members of the kidney community, important actions to protect these vulnerable patients have been enacted into law.
On Friday, March 27, 2020, the CARES Act* was signed into law. Section 3705 of this act eliminates a statutory requirement for a nephrologist to conduct a face-to-face evaluation of a home dialysis patient, allowing the Department of Health and Human Services (HHS) to issue emergency waivers so the entire visit can be conducted via telehealth. The emergency waiver authority will remain in place during the COVID-19 emergency period.
After much dialogue with the American Society of Nephrology (ASN) and other members of the kidney community, the Centers for Medicare and Medicaid Services (CMS) today clarified its guidance on deferring nonessential surgical procedures during the COVID-19 Public Health Emergency. The clarification clearly identifies Arteriovenous Fistulas, Arteriovenous Grafts, Peritoneal Dialysis Catheters, and intravenous catheters as planned procedures that are essential for establishing the vascular access that “is crucial for End Stage Renal Disease (ESRD) patients to receive their life-sustaining dialysis treatments.” Since the issuance of the original guidance, many ASN members have expressed their serious concerns that these procedures were being grouped with elective surgeries and, subsequently, being denied. Go to the ASN COVID-19 Response page for more information.
Calling attention to the unique needs of kidney patients in the COVID-19 Pandemic and advocating for specific policy changes to meet those needs was ASN President Anupam Agarwal, MD, FASN’s focus during a meeting Wednesday afternoon with President Donald Trump. The meeting also included Vice President Mike Pence, US Department of Health and Human Services Secretary Alex M. Azar, JD, Centers for Disease Control and Prevention Director Robert Redfield, MD, Centers for Medicare and Medicaid Services Administrator Seema Verma, and Coronavirus Response Coordinator Ambassador Deborah Birx, MD, as well as representatives from 15 other medical professional societies.
The approximately 500,000 Americans on dialysis and 222,000 Americans with kidney transplants are among the most vulnerable to the spread of the novel coronavirus, COVID-19. ASN is coordinating with the federal government to address the spread of COVID-19 and ensure the highest quality of care for those affected by kidney disease.
In a letter to the Secretary of Health and Human Services (HHS) Secretary, Alex Azar, ASN suggests multiple temporary policy changes in the context of this pandemic that affect those living with kidney disease including:
On February 27, Senators Bill Cassidy, M.D. (R-LA) and Dick Durbin (D-IL) introduced legislation to extend Medicare coverage of immunosuppressive drugs for kidney transplant patients. A top priority for ASN, the common-sense legislation would extend Medicare coverage of immunosuppressive medications for kidney transplant patients beyond the current 36-month limitation, ensuring that kidney transplant patients do not face losing their transplant due to an inability to afford their medications. “Our bill ensures that kidney transplant patients can afford the medication they need to survive and won’t have to skip or ration doses,” said Durbin. “Extending this coverage under Medicare is bipartisan and commonsense, and I urge my Senate colleagues to support this legislation.”
