ASN Releases Kidney Care First (KCF) Model Calculator to Estimate Reimbursements

By David White

January 13, 2020

The American Society of Nephrology has developed and released the Kidney Care First (KCF) Model Calculator for nephrologists and nephrology practices to help them evaluate how they might perform in the voluntary payment program. The calculator is a guide only and does not calculate every variable that a practice might face; however, it is designed to examine the difference in nephrology practice reimbursement in the status quo versus the KCF Option in the Kidney Care Choices (KCC) Model. This device is intended for practices already considering the KCF Option.

The KCC Model, along with the KCF option, was created to support the objectives of the Advancing American Kidney Health (AAKH) Executive Order (EO). It is a voluntary payment model designed to focus on upstream treatment of kidney diseases in support of the EO’s stated goal of reducing the number of Americans developing kidney failure by 25 percent by 2030.

First, the calculator compares your practice's current Monthly Capitated Payment (MCP) reimbursement to an Adjusted MCP (AMCP) reimbursement in the KCF option. This requires an estimate of your practice's Medicare ESRD patient population's current average MCP that you receive and your practice's current MCP rate for patients visited 2 or 3 times per month. The calculator allows two options for estimating these figures:

1. If the user selects "CMS National Average" to estimate their MCP, the calculator will assume that the practice's average MCP payment for their patients and their 2-3 monthly visit MCP rate will both equal the National Averages as estimated by CMS.

2. If a user knows both their average MCP and their 2-3 monthly visit MCP rate, then they can select "Enter My Practice's MCPs" and proceed to enter those figures.

The calculator will use those figures instead of the National Average.

Second, the calculator will compare the current reimbursement your practice receives for their CKD 4 and 5 patients to the CKD Quarterly Capitated Payment (QCP) created for use in the KCF model. The value of the KCF QCP will be equal to the MCP 2-3 monthly visit level determined in the inputs section described above. The calculator allows three options for the user to estimate their current reimbursement for CKD 4 and 5 beneficiaries:

1. If the you know the Fee for Service (FFS) claim amounts for your CKD 4 and 5 patients, then you can enter that figure.

2. If the you know the volume of your E&M monthly visits, you can enter this figure, the model will estimate their CKD 4 and 5 reimbursement, assuming $90 per E&M visit.

3. If you do not know either your reimbursement amounts or your average E&M visits per month for your CKD 4 and 5 patients, then you can select "CMS National Average" and the model will use the National Average of $15 PBPM to estimate CKD 4 and 5 reimbursement.

The calculator allows you to make some assumptions about how you will perform in the Quality Metrics portion of the program as well as the general outline for calculating the kidney transplant bonus in the program. Since the program qualifies as an Advanced Alternative Payment Model under the Quality Payment Program, the calculator provides adjustment for that practice payment as well. The calculator does not address the Comprehensive Kidney Care Contracting (CKCC) options in the KCC Model.

The application process closes on Wednesday, January 22, 2020.

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David White
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The American Society of Nephrology has developed and released the Kidney Care First (KCF) Model Calculator for nephrologists and nephrology practices to help them evaluate how they might perform in the voluntary payment program. The calculator is a guide only and does not calculate every variable that a practice might face; however, it is designed to examine the difference in nephrology practice reimbursement in the status quo versus the KCF Option in the Kidney Care Choices (KCC) Model. This device is intended for practices already considering the KCF Option.

The KCC Model, along with the KCF option, was created to support the objectives of the Advancing American Kidney Health (AAKH) Executive Order (EO). It is a voluntary payment model designed to focus on upstream treatment of kidney diseases in support of the EO’s stated goal of reducing the number of Americans developing kidney failure by 25 percent by 2030.

First, the calculator compares your practice's current Monthly Capitated Payment (MCP) reimbursement to an Adjusted MCP (AMCP) reimbursement in the KCF option. This requires an estimate of your practice's Medicare ESRD patient population's current average MCP that you receive and your practice's current MCP rate for patients visited 2 or 3 times per month. The calculator allows two options for estimating these figures:

1. If the user selects "CMS National Average" to estimate their MCP, the calculator will assume that the practice's average MCP payment for their patients and their 2-3 monthly visit MCP rate will both equal the National Averages as estimated by CMS.

2. If a user knows both their average MCP and their 2-3 monthly visit MCP rate, then they can select "Enter My Practice's MCPs" and proceed to enter those figures.

The calculator will use those figures instead of the National Average.

Second, the calculator will compare the current reimbursement your practice receives for their CKD 4 and 5 patients to the CKD Quarterly Capitated Payment (QCP) created for use in the KCF model. The value of the KCF QCP will be equal to the MCP 2-3 monthly visit level determined in the inputs section described above. The calculator allows three options for the user to estimate their current reimbursement for CKD 4 and 5 beneficiaries:

1. If the you know the Fee for Service (FFS) claim amounts for your CKD 4 and 5 patients, then you can enter that figure.

2. If the you know the volume of your E&M monthly visits, you can enter this figure, the model will estimate their CKD 4 and 5 reimbursement, assuming $90 per E&M visit.

3. If you do not know either your reimbursement amounts or your average E&M visits per month for your CKD 4 and 5 patients, then you can select "CMS National Average" and the model will use the National Average of $15 PBPM to estimate CKD 4 and 5 reimbursement.

The calculator allows you to make some assumptions about how you will perform in the Quality Metrics portion of the program as well as the general outline for calculating the kidney transplant bonus in the program. Since the program qualifies as an Advanced Alternative Payment Model under the Quality Payment Program, the calculator provides adjustment for that practice payment as well. The calculator does not address the Comprehensive Kidney Care Contracting (CKCC) options in the KCC Model.

The application process closes on Wednesday, January 22, 2020.

Date:
Monday, January 13, 2020