Efforts Progress in the Creation of a Comprehensive Kidney Care Model for Medicare Testing

By David White and Zachary Kribs

Ongoing efforts at the American Society of Nephrology (ASN) to develop a Comprehensive Kidney Care (CKC) Model received a boost last week after Senator Bill Cassidy, MD (R-LA), met with Crystal A. Gadegbeku[i], MD, FASN, and Daniel E. Weiner[ii], MD, FASN, co-chairs of a joint working group leading development of the model.

During the meeting, Dr. Cassidy discussed the challenges facing development of a CKC model with Dr. Gadegbeku and Dr. Weiner and offered his feedback on several concepts, as well as his support in the submission process. The working group co-chairs described the meeting as “an engaging and encouraging conversation with Dr. Cassidy who clearly understood the challenges we face” and emphasized their appreciation towards Dr. Cassidy for his support. 

ASN members have often described the challenges faced by kidney patients in the current paradigm of care, which can incentivize silos of care and hamper patient outcomes. Breaking down these silos to provide continuous kidney care with smoother transitions between stages of kidney diseases is a priority of ASN and the focus of the Comprehensive Care Model.

The goals of the model are:

  • Slow progression of kidney diseases
  • Manage care across the spectrum of kidney diseases, reducing silos to improve care coordination
  • Reduce hospitalizations
  • Facilitate transplantation
  • Deliver patient-centered care
     

The model will eventually be submitted for review by the Physician-Focused Payment Model Technical Advisory Committee (PTAC).

The PTAC was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which also created the Quality Payment Program (QPP) and is comprised of 11 members – who are individuals with national recognition for their expertise in physician-focused payment models (PFPMs) and related delivery of care. The PTAC must forward its evaluation of a potential model to the Secretary of HHS whether it recommends the model for testing or not. The HHS Secretary is required to review the comments and recommendations submitted by the PTAC and post a detailed response to these recommendations.

In June, HHS Secretary Alex Azar responded to recommendations from the PTAC on 12 proposed payment models. The Secretary did not commit to implementing any of the models but indicated particular interest in the two serious illness models proposed by the Coalition to Transform Advanced Care (C-TAC) and the American Academy of Hospice and Palliative Medicine (AAHPM). The lack of a specific endorsement for any of the 12 models has caused some concern among potential submitters. However, the Secretary recommended that future submitters take the following factors into consideration as they develop their proposals:

  • HHS seeks models that demonstrate potential for significant impact on the Medicare population in ways where the agency can conduct a robust evaluation.
  • Use of proprietary tools or tools that are not already developed in a proposed alternative payment model (APM) is an obstacle to HHS’ testing of the model.
  • Providing care in accord with current standards of practice or accelerating adoption of emerging standards of care does not require an APM.
     

We will provide updates on the development of a CKC model as the effort progresses.

 

[i] Dr. Gadegbeku is Chair of the ASN Policy and Advocacy Committee

[ii] Dr. Weiner is Chair of the ASN Quality Committee.

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David White and Zachary Kribs
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Ongoing efforts at the American Society of Nephrology (ASN) to develop a Comprehensive Kidney Care (CKC) Model received a boost last week after Senator Bill Cassidy, MD (R-LA), met with Crystal A. Gadegbeku[i], MD, FASN, and Daniel E. Weiner[ii], MD, FASN, co-chairs of a joint working group leading development of the model.

During the meeting, Dr. Cassidy discussed the challenges facing development of a CKC model with Dr. Gadegbeku and Dr. Weiner and offered his feedback on several concepts, as well as his support in the submission process. The working group co-chairs described the meeting as “an engaging and encouraging conversation with Dr. Cassidy who clearly understood the challenges we face” and emphasized their appreciation towards Dr. Cassidy for his support. 

ASN members have often described the challenges faced by kidney patients in the current paradigm of care, which can incentivize silos of care and hamper patient outcomes. Breaking down these silos to provide continuous kidney care with smoother transitions between stages of kidney diseases is a priority of ASN and the focus of the Comprehensive Care Model.

The goals of the model are:

  • Slow progression of kidney diseases
  • Manage care across the spectrum of kidney diseases, reducing silos to improve care coordination
  • Reduce hospitalizations
  • Facilitate transplantation
  • Deliver patient-centered care
     

The model will eventually be submitted for review by the Physician-Focused Payment Model Technical Advisory Committee (PTAC).

The PTAC was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which also created the Quality Payment Program (QPP) and is comprised of 11 members – who are individuals with national recognition for their expertise in physician-focused payment models (PFPMs) and related delivery of care. The PTAC must forward its evaluation of a potential model to the Secretary of HHS whether it recommends the model for testing or not. The HHS Secretary is required to review the comments and recommendations submitted by the PTAC and post a detailed response to these recommendations.

In June, HHS Secretary Alex Azar responded to recommendations from the PTAC on 12 proposed payment models. The Secretary did not commit to implementing any of the models but indicated particular interest in the two serious illness models proposed by the Coalition to Transform Advanced Care (C-TAC) and the American Academy of Hospice and Palliative Medicine (AAHPM). The lack of a specific endorsement for any of the 12 models has caused some concern among potential submitters. However, the Secretary recommended that future submitters take the following factors into consideration as they develop their proposals:

  • HHS seeks models that demonstrate potential for significant impact on the Medicare population in ways where the agency can conduct a robust evaluation.
  • Use of proprietary tools or tools that are not already developed in a proposed alternative payment model (APM) is an obstacle to HHS’ testing of the model.
  • Providing care in accord with current standards of practice or accelerating adoption of emerging standards of care does not require an APM.
     

We will provide updates on the development of a CKC model as the effort progresses.

 

[i] Dr. Gadegbeku is Chair of the ASN Policy and Advocacy Committee

[ii] Dr. Weiner is Chair of the ASN Quality Committee.

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Date:
Thursday, July 26, 2018