CMS announces participants in new ACO dialysis model

CMS announced the participants selected to take part in a new accountable care organization (ACO) model that will coordinate treatment for individuals suffering from end-stage renal disease (ESRD). The new ACO model, known as the Comprehensive ESRD Care (CEC) Model, is intended to improve patient care while lowering costs. CMS released the list of the CEC Model participants, which includes various dialysis organizations located across the country.

ESRD

More than 600,000 individuals in the U.S. suffer from ESRD, or kidney failure, which requires dialysis treatments multiple times per week. Individuals suffering from ESRD also experience many other health problems and are at a heightened risk of receiving fragmented care and higher hospital readmissions. In 2012, ESRD beneficiaries made up 1.1 percent of the Medicare population and accounted for 5.6 percent of total Medicare spending.

ACOs

Section 3022 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) established ACOs, which are groups of physicians and health care providers who work together and are collectively responsible for the quality and cost of the health care provided to the ACO patients. The new CEC model is part of HHS’ efforts to encourage providers to use alternative payment models.

ESCOs

The CEC model will bring together dialysis facilities, nephrologists, and other providers to form ERSD Seamless Care Organizations (ESCOs) in order to coordinate beneficiary care. The ESCOs are financially accountable for their quality outcomes and Part A and Part B spending, which includes all dialysis services.

Financial arrangements

Under the CEC model, the ESCOs have separate financial arrangements depending on their size. ESCOs that include dialysis facilities that are owned by large dialysis organizations with 200 or more facilities will be eligible for shared savings, but must also be liable for shared losses. Those ESCOs will also have higher overall risk than those with smaller dialysis organizations. ESCOs that include dialysis facilities that are owned by small dialysis organizations with fewer than 200 facilities will be eligible for shared savings, but will not be liable for shared losses.