The Center for Medicare & Medicaid Innovation’s (CMMI) Kidney Care Choices (KCC) Model demonstration has increased utilization of dialysis in the home and has fostered greater clinician training in addressing related conditions.
However, more time and data are needed to evaluate the reimbursement model’s impact on quality and cost, according to the first annual model evaluation report from the U.S. Centers for Medicare & Medicaid Services (CMS) .
The report includes the agency’s analysis of KCC model results during the first performance year since its launch on Jan. 1, 2022. Having this reimbursement path available could ease pressures for palliative care patients making decisions about their serious illness care options.
“Given the challenges of increasing home dialysis and transplant rates and the early stage of the model implementation, it is too early to form conclusions about possible longer-term impacts of the model,” the agency stated in a summary of the report. “There was no evidence of impacts on overall Medicare payments, net savings or losses to Medicare, or unintended consequences.”
CMMI launched the KCC model to improve coordinated care and education to patients with chronic kidney disease and end-stage renal disease (ESRD). These patients can often receive fragmented care and expensive treatments. They also tend to receive little to no education about their health trajectories, or serious illness and end-of-life care options.
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. The model also includes incentives designed to improve care management. Goals of the KCC model include delaying the progression of dialysis, increasing access to kidney transplant services and reducing the cost of care.
About 30% of eligible Medicare fee-for-service beneficiaries received care from providers participating in the KCC model during its first year, which spanned 33 states and the District of Columbia, CMS reported.
The model includes four payment tracks: the Kidney Care First (KCF) option, and graduated, professional and global options under Comprehensive Kidney Care Contracting (CKCC). The CKCC option is available to nephrology practices collaborating with transplant providers and dialysis facilities to form kidney contracting entities (KCE).
The KCC model’s first year included providers from 30 nephrology practices participating in the KCF option, and 55 KCE entities participating in the CKCC model, according to CMS.
Though most quality measures showed no significant impacts, patients reported an increased ability to manage their health care within both the KCF and CKCC payment options, the agency reported.
The number of patients enrolled with an active status on the kidney transplant waitlist rose by 15% in the CKCC option. The payment option also yielded a 16% increase in patients with ESRD who received a planned start of renal replacement therapy, meaning these individuals had earlier access to treatment.
Dialysis utilization also climbed/swelled among patients with kidney and renal diseases. CMS’ report found that the proportion of patients receiving ESRD dialysis at home increased by 20% within the KCF model, with rises of these services also occurring among 32% of patients in the CKCC model.
In terms of cost, evaluation and management payments saw a modest 2% increase in per-patient, per-month spending, while total dialysis payments rose by 1% in the CKCC option. The report found no impact of the reimbursement model on Medicare Part A or B spending or on Part D costs per-patient, per-month.
CMS also reported that the KCC model had no impact on the frequency of hospitalizations, readmissions, emergency department visits or outpatient dialysis utilization during the 2022 performance year. The model likewise did not affect kidney transplant rates.
Geographic distribution of the KCC model was uneven nationwide, with the Midwest and West regions underrepresented. Findings were compiled in collaboration with the Virginia-based analytics and consulting firm The Lewin Group Inc., Arbor Research and the University of Michigan’s Kidney Epidemiology and Cost Center.
The reimbursement model’s first evaluation will help inform some of its implementation challenges and potential opportunities to address them, according to CMS.
“Several potentially consequential differences did emerge. This assessment of participants in the model’s first cohort allows us to begin to understand these issues,” the agency stated in its report. “We identified structural differences that may affect the model’s scalability. Model participants operated in areas with larger and denser populations. As such, there may be limits to the model’s scalability, and potential improvements in care delivery driven by the model may be less accessible for patients in rural and less densely populated areas.”
