Last year the Kidney Care Provider Chief Medical Officers (CMOs) offered a perspective on the State of Kidney Care in 2016. Some issues have remained the same in 2017, but the fast pace of change in many areas warranted an update. Health care in the US is undergoing transformation as Medicare moves from volume-based fee-for-service to value-based payment systems. In the next two years, it is possible that more than 50% of Medicare payments could be made in Advanced Alternative Payment Models (APMs) regardless of what happens as a result of efforts to repeal and replace the Affordable Care Act. There currently are 561 Accountable Care Organizations (ACOs) (120 of these are risk bearing) with a total of 12.3 million patients receiving care in an ACO. In 2017, 85 new ACOs were started.
For kidney care, 24 new ESRD Seamless Care Organizations (ESCOs) started in 2017, bringing the total to 37. Currently, 46,000 patients receive care in an ESCO and 1291 physicians are owners in ESCOs. All but three of these ESCOs are Advanced APMs, allowing for the possibility of nephrologist owners to receive a 5% bonus payment from Medicare in 2019. Should the Center for Medicare and Medicaid Innovation (CMMI) choose to extend and expand the ESCO program after 2018, as many as 15% of all Medicare ESRD patients could be enrolled in an ESCO over the next 5 years.
In addition, we see increasing appearance of Medicare Advantage Special Needs Plans (cSNPs) for ESRD patients and the attempt to create additional opportunities to deliver value-based care through the PATIENTS ACT, an alternative value-based care model to ESCOs and cSNPs.
This rapid pace of innovation in kidney care creates an incredible opportunity for the discipline of nephrology and the nephrologist to help shape care delivery and payment for kidney patients as well as other complex chronically ill populations, creating significant improvements in patient outcomes, while responsibly stewarding resources. There are a number of challenges and opportunities in the coming year from the perspective of the dialysis provider CMOs.