New Initiative
Last month the US government Centers for Medicare & Medicaid Services (CMS) announced a “new initiative designed to identify, test, and evaluate new ways to improve care for Medicare beneficiaries with End-Stage Renal Disease.” Through the initiative, CMS will “partner with health care providers and suppliers to test the effectiveness of a new payment and service delivery model in providing these beneficiaries with patient-centered, high-quality care.”
This should be welcome news to the estimated 1.3% of people on Medicare who have ESRD and who, according to the CMS, “have significant health care needs” and “accounted for an estimated 7.5% of Medicare spending, totaling over $20 billion in 2010.” According to the CMS, “These high costs are often the result of underlying disease complications and multiple co-morbidities, such as coronary artery disease and hypertension, which often lead to high rates of hospital admission and readmissions, as well as a mortality rate that is much higher than the general Medicare population.”
CMS continues: “Through the Comprehensive ESRD Care Initiative, CMS will enter into agreements with groups of health care providers and suppliers called ESRD Seamless Care Organizations who will work together to provide beneficiaries with a more patient-centered, coordinated care experience. Participating organizations must include at least a dialysis facility, a nephrologist, and one other Medicare provider or supplier. This initiative is being run through the CMS Innovation Center, which was created by the Affordable Care Act to test new models of delivering health care that can potentially lower costs and improve patient care.”
Although it is much too early in the game even to speculate on what may come of the federal government’s renewed interest in improving options for Medicare recipients with ESRD, this is an initiative deserving of support. The current approach to treating ESRD appears to be less than cost-effective, and any initiative aimed at improving service to people with ESRD and reducing some strain on the Medicare budget is probably a positive thing.
Under the initiative, “participating organizations will assume clinical and financial responsibility for a group of beneficiaries with ESRD, based on where these beneficiaries receive services. Beneficiaries will retain the right to see any Medicare provider they choose and these organizations will be evaluated on their performance on quality measures, which include beneficiary health and experience. Those organizations successful in improving beneficiary health outcomes and lowering the per capita cost of care for beneficiaries will have an opportunity to share in Medicare savings with CMS.”
This seems a promising initiative, and certainly one that ought to be observed closely as it unfolds. For the sake of senior kidney disease sufferers, other people with ESRD, and the health of the Medicare system, let us hope it bears some fruit.
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