"The American Society of Nephrology (ASN) welcomes the introduction of the voluntary Kidney Care Choices (KCC) Model, and its four kidney care payment options, addressing key aspects of the Executive Order on Advancing American Kidney Health (AAKH). This voluntary model will be a true game changer and brings desperately needed, sweeping changes to care for people with kidney diseases. ASN has long advocated for key elements of this model, and I thank HHS Secretary Azar and his entire team for putting forward such a visionary approach for the future of kidney care. 

The voluntary model released yesterday, particularly the Kidney Care First option, aligns closely with the kidney care and payment changes ASN has long advocated for the Center for Medicare and Medicaid Innovation (CMMI) to test. The model’s four options have a much greater focus on kidney diseases before a person progresses to kidney failure. These options also offer several changes over current Medicare payment for dialysis care, with a greater focus on incentivizing nephrologists and dialysis providers to care for patients during earlier stages of kidney diseases and to reward nephrologists for getting patients a transplant and keeping that graft healthy.

ASN has historically called for a more comprehensive approach to kidney care that breaks down silos and aligns incentives across the spectrum of a patient’s care. Both the 37,000,000 Americans with kidney diseases and the nation’s 10,000 nephrologists are keenly aware of how disjointed kidney care incentives have become and how perilous transitions of care can be for people with kidney disease.  As such, ASN believes that both the KCC Model and ESRD Treatment Choices (ETC) Model together – along with the other components of the AAKH initiative – represent a unified approach to transforming kidney care.

In terms of the ETC Model, ASN stands ready to help HHS ensure this mandatory model succeeds and encourages HHS to consider the society’s comments on the proposed role, particularly related to delaying the start date from Wednesday, January 1, 2020.

Numerous components of these models, designed to achieve comprehensive kidney care, are long-standing policy priorities of ASN:

• Going upstream to slow progression of kidney disease incentivized by the Quarterly Capitated Payment (QCP).
• Creating flexibility for nephrologists to focus on providing high-quality, patient-centered care instead of the number of visits or care environment by decoupling how often a nephrologist sees a dialysis patient from the amount they are paid to care for the patient over the course of a month and creating parity between in-center and home payments.
• Enhancing Medicare Benefits to support improved utilization of skilled nursing facilities and hospice care, telehealth services, and the kidney disease education benefit.
• Creating payment options with pathways to improve performance and pay along with down-side risks.
   

ASN’s more than 21,000 members, leadership, and staff are grateful to Secretary Azar, CMS Administrator Verma, Acting CMMI Director Bassano and former CMMI Director Boehler for their visionary leadership and work to develop these bold care models. We look forward to working with CMMI to educate the US nephrology community—particularly the nation’s nephrologists—about these exciting new opportunities and to transform kidney health together."

For more information, see the ASN Policy Team breakdown of the KCC model.