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The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), has finalized a mandatory...
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Earlier this month CMS unveiled that the Kidney Care Choices Model will welcome Cohort 2 in January 2023. CMS also provided guidance around payment mechanisms, policies and quality measures. New participants submitted applications earlier this month.
KCC is built upon the successes of the Comprehensive End-Stage Renal Disease Model. CMS offers several structures for participation in KCC:
- Comprehensive Kidney Care Contracting Options: This includes the CKCC Graduated Option, the CKCC Professional Option and the CKCC Global Option for kidney contracting entities. Participation in CKCC is open to Kidney Contracting Entities consisting of nephrologists, nephrology practices and transplant providers. KCEs can also include dialysis facilities and other providers and suppliers.
- Kidney Care First: A payment structure for individual nephrology practices and nephrology professionals only.
What is the application timeline for KCC Cohort 2?
Applications for Cohort 2 were due on March 25, 2022. Applicants will receive instructions to submit their initial participant lists via CMS’ online portal in April and will be notified of their conditional acceptance into the model in early May.What are the payment mechanisms for the KCC Model?
There are several payment structures for KCC:- Normal evaluation and management code claims will be replaced by quarterly capitated payments for the management of beneficiaries with stage 4 or 5 chronic kidney disease.
- CMS is addressing the payment difference between the nephrologist for-visit rate and the home dialysis rate in the monthly capitation payment for caring for ESRD patients. Going forward, CMS will provide an amount that functionally equalizes payment, instead of a flat visit rate regardless of the number of visits.
- A kidney transplant bonus payment of up to $15,000 will be paid to entities based on a successful transplant without going back to dialysis one, two and three years after the transplant date.
- Shared savings and losses (for CKCC only) will be implemented based on expenditures for aligned beneficiaries. CMS will examine expenditures and compare them against a cost benchmark to determine payouts or losses to be collected.
- For KCF, CMS will implement a performance-based adjustment based on performance relative to costs.
Have any changes been made to quality measures for KCC?
CMS is developing two new measures that may be included in the future quality strategy if they prove reliable and valid:- A mortality measure for both CKD and the ESRD populations
- A measure of progression from CKD to ESRD
How can my practice succeed under the KCC Model?
The new changes announced by CMS place an even greater emphasis on the need to accurately monitor your performance to thrive in Kidney Care Choices. DataGen can help you achieve this goal in a number of ways:- Trend and project KCC program revenue over time.
- Understand patterns of healthcare utilization and outcomes in your aligned beneficiary population by patient risk profile.
- Identify kidney care visits by beneficiary, practitioner and location.
- Monitor the impact of care interventions toward meeting your goals.
Contact us today and learn more about how DataGen can help you!
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