The Kidney Care Choices (KCC) model is among the reimbursement streams that is widening payment for palliative care services. It could also help improve utilization of serious illness and end-of-life care.
Patients with chronic kidney disease can often receive fragmented care and expensive treatments. They also receive limited to no education about their health trajectories, or serious illness and end-of-life care options.
These were the main reasons that the Center for Medicare & Medicaid Innovation (CMMI) cited for the KCC model, which is aimed at improving coordinated care and education to patients with kidney disease. The payment model includes a waiver that allows patients to receive treatments such as kidney dialysis and transplant services concurrently with hospice and palliative care.
Having this reimbursement path available could ease pressures on patients when making decisions about their serious illness care options while likewise improving cost barriers to palliative and hospice care, according to Ellen Lukens, deputy director at CMMI, speaking at the Palliative Care Conference.
“In the Kidney Care Choices model, we essentially have a waiver. So if a clinician is, for example, responsible for a beneficiary in a total cost of care model, that beneficiary may want to elect hospice, but they may not feel like they can elect hospice because then they couldn’t get dialysis,” Lukens told Palliative News. “The Kidney Care Choices Model does offer a waiver so that a beneficiary can be in hospice, but can also receive dialysis. And that was really, really important to hear from beneficiaries and also from clinicians and other stakeholders on what some of the issues are, and how the models are really preventing that.”
Reimbursement for palliative care exists in varied payment models, but often lacks the full scope of interdisciplinary services entailed.
A lack of sufficient reimbursement for palliative care is often a barrier to providing these services. But more payment models are carving out palliative components, such as the KCC model.
The KCC model is built on similar frameworks as existing payment structures such as the Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) model. These models allow dialysis facilities, nephrologists and other kidney care clinicians to collaborate with other health care providers and accountable care organizations (ACOs) to manage the overall cost of care for Medicare beneficiaries.
Through the KCC model, nephrologists and other kidney care clinicians can collaborate with health care providers to take on costs associated with services for patients with late-stage chronic kidney disease or ESRD. This includes palliative care providers, as well as hospices.
The model includes four payment options: The U.S. Centers for Medicare & Medicaid Services (CMS) Kidney Care First (KCF) Option, Comprehensive Kidney Care Contracting (CKCC) Graduated Option, a CKCC Professional Option and a CKCC Global Option.
This structure adds “strong financial incentives for health care providers to manage the care for Medicare beneficiaries with chronic kidney disease,” from the early onset through ESRD, CMMI stated.
Participating providers are also encouraged to provide patients with education about their serious illness and end-of-life care options “to help empower them to be more active in their care,” and to allow patients to “receive needed services while retaining the freedom to choose providers,” CMMI indicated.
“The premise of models like these is that they should improve quality and maintain costs, or ideally, improve quality and reduce costs,” Lukens said. “That really signals where the palliative care sector is going, to think about engagement and value-based care because it’s an important context as we think about the future of palliative care.”
The premise of models like these is that they should improve quality and maintain costs, or ideally, improve quality and reduce costs. That really signals where the palliative care sector is going, to think about engagement and value-based care because it’s an important context as we think about the future of palliative care.
— Ellen Lukens, deputy director, Center for Medicare & Medicaid Innovation (CMMI)
