The U.S. Centers for Medicare & Medicaid Services’ (CMS) Innovation Center is overhauling its Kidney Care Choices (KCC) payment model. Consequently, palliative care providers could see new payment pathways in certain geographic regions.
CMS is revising the financial methodology and participation options of the KCC Model while also extending its duration and geographic reach. Sunsetting the model in 2027 versus its initial expiration in 2026 will allow the agency to address early concerns about spending and implement quality improvements, according to CMS.
“The KCC Model has shown significant improvements in quality of care, including an increase in home dialysis and home dialysis training, but also an increase in net spending. The changes to the model are expected to result in the model reducing net spending,” the agency said in a statement.
The recently announced “coordinated set of changes” includes discounts for participants that meet certain benchmarks, CMS stated. Model revisions also include a reduction in the Chronic Kidney Disease Quarterly Capitation Payment and elimination of the kidney transplant bonus component.
Adjusting the financial methodology for the performance year 2026 is expected to improve the ability to test the model’s sustainability, CMS indicated.
Aside from the participation and financial changes, the KCC model starting in performance year 2026 will also expand participation in core-based statistical areas (CBSA) rules to include additional regions across the U.S. territories. All CBSAs and rural counties in Hawaii, Guam and the Northern Mariana Islands and American Samoa will be deemed contiguous to each other, as well as all CBSAs in rural counties in Alaska, California, Florida, Puerto Rico and the U.S. Virgin Islands.
“These changes reflect the Innovation Center’s foundational principle of protecting the federal taxpayer, ensuring that models are on a clear path to certification and expansion, and a renewed commitment to our statutory mandate to reduce costs while testing strategies to deliver high-quality, coordinated care to patients,” CMS said in its statement.
The KCC model is designed to improve 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.
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.
Palliative care payment avenues have widened in the KCC model since its implementation in 2020. Having this reimbursement path available has helped ease pressures on patients when making decisions about their serious illness care options while likewise improving cost barriers to palliative care, providers previously told Palliative Care News.
The KCC model’s first two years brought improved outcomes such as optimal or timely starts of End Stage Renal Disease (ESRD) treatment, increased home dialysis rates and preemptive and living donor transplants, CMS reported. Nevertheless, the payment model has resulted in “statistically significant net losses” of roughly $304 million Medicare dollars during the performance year 2023, the agency stated in the report.
Additionally, participation in the KCC model has fostered greater clinician training in addressing related conditions, CMS previously indicated.
