Kidney Care Choices Cohort 2: Rules and Deadlines

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?

What are the payment mechanisms for the KCC Model?

• 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?

1. A mortality measure for both CKD and the ESRD populations
2. A measure of progression from CKD to ESRD

How can my practice succeed under the KCC Model?

• 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.