2018 is shaping up to be the year for designing and proposing integrated care models for testing by the Centers for Medicare & Medicaid Services (CMS). There are three major factors driving this trend:
Physician-Focused Payment Model Technical Advisory Committee (PTAC).
Request for Information (RFI) by the Centers for Medicare and Medicaid Services Innovation Center.
Perception that the train is leaving the station.
With further examination of these three factors, it becomes clearer how closely tied they are to one another.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) created new pathways for the Medicare program to
Nephrologists will see payment increases in some services starting January 1, 2021, according to the proposed rule on the annual physician fee schedule released last month by the Centers for Medicare & Medicaid Services (CMS). In general, nephrology will see an overall 6% increase with an approximately 30% increase for home dialysis services.
Anupam Agarwal, MD, FASN, ASN President, praised the move by CMS: “Finally, after years of advocacy by ASN, Medicare is supporting nephrologists with rates that better reflect our work. Most importantly, this is a big win for home dialysis, a top priority for ASN.”
Kidney health care has been constrained for decades by silos of care: chronic kidney disease (CKD), kidney failure and dialysis, and kidney transplant. ASN and its members have long advocated for a change in payment policy and care delivery approaches to disrupt a system that traditionally placed most all the financial incentives on kidney failure treatment. “The current Medicare End-Stage Renal Disease benefit program has long focused on dialysis at the expense of going upstream to slow CKD progression and focusing on pre-emptive transplantation,” said Susan E. Quaggin, MD, FASN, ASN President.
When Kidney News went to print, the U.S. House of Representatives had passed H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. Passed with bipartisan support, H.R. 6 combines provisions from more than 50 bills approved individually by the House.
The bill is designed to help overall efforts to combat the opioid crisis by advancing treatment and recovery initiatives, bolstering prevention efforts, and trying to counter deadly illicit synthetic drugs like fentanyl.
A last-minute addition to the legislative package in the House would extend by three months the period
On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) released a combined proposed rule for the Physician Fee Schedule (PFS) and the Quality Payment Program (QPP) for performance year 2019. Led by its Quality Committee, the American Society of Nephrology (ASN) has been reviewing the proposed changes, meeting with peer societies and coalitions, and drafting comments and recommendations. Most readers will have heard about one particular aspect of the proposed changes: recommendations by CMS to simplify Evaluation and Management (E/M) coding documentation requirements with the stated goal of providing relief from regulatory burden for clinicians. CMS has
In a fast-paced Kidney Week 2018 session titled “Reshaping Relationships and Transforming Care Delivery,” Janis M. Orlowski, MD, MACP, chief health care officer of the Association of American Medical Colleges (AAMC), captured the dynamic environment of healthcare in the United States when she led the session with “Consolidation: Friend or Foe?”—the Christopher R. Blagg, MD, Lectureship in Renal Disease and Public Policy.
Orlowski captured the situation with a comparison of the 2008 merger of Mercy Hospital of Pittsburgh, a 160-year-old institution with 428 beds, with the University of Pittsburgh Medical Center, compared with the recent signed letter of intent to
Creation of payment models is a critical component of the Executive Order on the Advancing American Kidney Health (AAKH) initiative issued by President Donald J. Trump on July 10, 2019. At the time this article was written, the Innovation Center of the Centers for Medicare and Medicaid Services (CMS) had only released the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model, a mandatory model that tests using payment policy to drive higher rates of home dialysis and kidney transplantation. The proposed payment policies will affect the managing clinicians and dialysis facilities assigned to the model. The four voluntary models to
On Sunday, November 10, at Kidney Week, the final policy session of the week, “Hot off the Press,” drew an unprecedented packed crowd to hear the latest details on kidney care policy, with a strong focus on the Advancing American Kidney Health (AAKH) Executive Order. A wide range of policy efforts are underway to support the following objectives of the AAKH:
Reducing the risk of kidney failure.
Improving access to and quality of person-centered treatment options.
Increasing access to kidney transplants.
Kevin F. Erickson, MD, MS, and Crystal A. Gadegbeku, MD, FASN, moderated the session with presenters Tom Duvall, Acting
The American Society of Nephrology (ASN) provided comments of support and recommendations for improvement in February 2020 on the proposed rule for Organ Procurement Organizations (OPOs) Conditions for Coverage: Revisions to the Outcome Measure Requirements for Organ Procurement Organizations proposed by the Centers for Medicare & Medicaid Services (CMS). The proposed rule intends to require transparent, verifiable, and uniform metrics by which CMS can evaluate OPO performance.
ASN supported the proposal, writing “[W]ith 115,000 Americans waiting for an organ, ASN supports the proposed rule to establish both transparent, uniform metrics to help assess the performance of each of the 58
The legislative effort to repeal the Affordable Care Act (ACA) suffered a stunning setback when the bill designed to replace the ACA, the American Health Care Act (AHCA), was withdrawn from consideration on the floor of the House of Representatives on March 24. After seven years of Republicans in Congress promising to strike the signature health care law of former President Barack Obama, this strategic legislative undoing so rapidly and publicly left many in Washington scratching their heads. How did it happen and what comes next? How it happened is becoming clearer. What comes next is still difficult to see.