Kidney Care First: What you need to know about the new model

DATE: 08/20/2020

Chronic kidney disease impacts more than 37 million people in the United States and is the ninth leading cause of death. To help treat patients dealing with CKD, in 2019, the Centers for Medicare and Medicaid Services announced its new Kidney Care Choices model, which features two different payment models.

One of those models, Kidney Care First, offers financial incentives to participants to accomplish several goals:

  • manage care for patients with CKD and end-stage renal disease;
  • delay the onset of dialysis for patients; and
  • incentivize kidney transplantation.

This optional program is only open to nephrology practices and their nephrologists. Participating practices are responsible for aligned beneficiaries’ kidney care from late stage CKD or ESRD through dialysis, kidney transplantation and post-transplant care. To participate, qualifying practices must have a minimum of 500 aligned Medicare beneficiaries with late-stage CKD and 200 aligned Medicare ESRD beneficiaries.

Kidney Care First avoids the potential for providers to deliver less care than would optimally benefit patients. Risk adjustment, the application of quality measures and monitoring activities ensure beneficiaries receive needed services — while retaining patient freedom of choice of providers.

Participating practices will receive payments through the following four means:

  1. CKD quarterly capitation payment: KCF practices will receive the CKD QCP payment instead of regular payments for those services included in the development of the CKD QCP. This means KCF practices and nephrologists have a more stable revenue stream, which helps them deliver advanced care for aligned CKD beneficiaries with late-stage CKD. It also means that patients may get improved access to nephrologist care, a better patient experience and a more efficient, coordinated means to address health issues.
  2. Adjusted monthly capitation payment: KCF practice nephrologists will continue to bill the monthly capitated payment, but will receive the adjusted monthly capitated payment (AMCP) amount in lieu of the MCP amount for aligned beneficiaries with ESRD that they see at least once a month. According to CMS, using “an AMCP payment rate that is the same amount regardless of the number of beneficiary visits reduces provider/supplier burden and enables them to focus on quality of care, rather than the number of visits.”[i]
  3. Kidney transplant bonus: This is in place to incentivize kidney transplants, which can reduce fatality rates and improve patient quality of life. Practices can earn up to 15k distributed over three years. CMS believes that this payment could better incentivize healthcare providers to get more beneficiaries onto the waitlist, assist beneficiaries with the living donation process and support beneficiaries maintain the health of the transplanted organ.

KCF performance-based adjustment: This is calculated using a combination of quality measures (with performance thresholds, designated to reflect appropriate clinical care and patient experience for the affected population) and utilization measures (aimed at incentivizing efficient and appropriate provision of healthcare services for the patient population). CMS believes that this risk structure, along with the frequency of assessment, will provide an incentive for continuously improving health outcomes for aligned beneficiaries and reduce unnecessary utilization.

CMS delayed the start of the first performance period to April 1, 2021, and announced a second cohort beginning Jan. 1, 2022, with the option for one or two additional performance years at CMS’ discretion.

Effective, actionable data analysis can be the difference between success and failure in this and other alternate payment models. To learn more about how you can prepare effectively for the first performance period, contact DataGen today to schedule a free consultation.