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CMS Launches New Dialysis ACO Model

Care could improve and costs could decrease for patients with kidney failure

The Centers for Medicare and Medicaid Services (CMS) has announced a list of organizations that will take part in a new program meant to improve care to patients with end-stage renal disease (ESRD) on dialysis.

The Comprehensive ESRD Care (CEC) model is specifically for ESRD patients and builds on experiences from other accountable care organization (ACO) models and programs.

According to CMS, in the CEC model, dialysis facilities, nephrologists, and other providers have joined to form ESRD Seamless Care Organizations (ESCOs) to coordinate care for ESRD beneficiaries. ESCOs will be financially accountable for quality outcomes and Medicare Part A and B spending, including all spending for dialysis services, for their ESRD beneficiaries. This model will encourage dialysis providers to think beyond their traditional roles in care delivery and to support beneficiaries as they provide patient-centered care that will address beneficiaries’ health needs in and out of the dialysis facility.

“This new ACO model represents a paradigm shift in care for beneficiaries with end-stage renal disease; it promotes a patient-centered approach to their dialysis and nondialysis care needs that will help accomplish our delivery system reform goals of better care, smarter spending, and healthier people,” said Patrick Conway, MD, MSc, acting deputy administrator and chief medical officer of CMS.

The CEC model includes separate financial arrangements for ESCOs with large and small dialysis organizations. ESCOs with participation by a dialysis facility or facilities owned by a large dialysis organization (an organization that owns 200 or more dialysis facilities) will be eligible to receive shared savings payments, but they will also be liable for shared losses and will have higher overall levels of risk compared with their smaller counterparts. ESCOs with participation by a dialysis facility or facilities owned by a small dialysis organization (an organization that owns fewer than 200 dialysis facilities) will be eligible to receive shared savings payments but will not be liable for shared losses.

Of the large dialysis organizations, six focus on Fresenius facilities: Fresenius Seamless Care of San Diego, LLC, in San Diego; Fresenius Seamless Care of Chicago, LLC, in Chicago; Fresenius Seamless Care of Charlotte, LLC, in Charlotte, North Carolina; Fresenius Seamless Care of Philadelphia, LLC, in Philadelphia; Fresenius Seamless Care of Columbia, LLC, in Columbia, South Carolina; and Fresenius Seamless Care of Dallas, LLC, in Dallas.

Of the other organizations involving large dialysis providers, three include DCI dialysis facilities — the Liberty Kidney Care Alliance, LLC, in Newark, New Jersey; the Palmetto Kidney Care Alliance, LLC, in Spartanburg, South Carolina; and the Music City Kidney Care Alliance, LLC, in Nashville, Tennessee. Three include DaVita facilities: Phoenix-Tucson Integrated Kidney Care, in Phoenix, Arizona; South Florida Integrated Kidney Care, in Miami, Florida; and Philadelphia -Camden Integrated Kidney Care, in Philadelphia.

One small dialysis organization appears on the list: the Rogosin Kidney Care Alliance, focused on the Rogosin Institute in New York, New York.

Source: CMS, October 7, 2015.

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