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September 22, 2020

Around the nation: CMS finalizes mandatory Medicare payment model for kidney care

Daily Briefing

    The five-year payment model aims to reduce Medicare spending on services for end-stage renal disease by creating payment incentives for home dialysis and kidney transplants, in today's bite-sized hospital and health industry news from Maryland, Massachusetts, and Tennessee.

    • Maryland: CMS on Friday finalized a new, mandatory five-year payment model called the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model, which aims to reduce Medicare spending on services for beneficiaries with chronic kidney disease. The payment model—which is scheduled to take effect on Jan. 1, 2021—aims to promote the use of home dialysis and kidney transplants for beneficiaries through new provider payment incentives. Under the ETC model, participating ESRD facilities and managing clinicians will receive a payment bump on Medicare claims for home dialysis and related services during the model's first three years. In addition, beginning July 1, 2022, and running through June 30, 2027, participating providers will receive a positive or negative payment adjustment on Medicare claims for home dialysis, in-center dialysis, and related claims. CMS will determine that payment adjustment based on participants' home dialysis rates, transplant waitlist rates, and living donor transplant rates (Brady, "Transformation Hub," Modern Healthcare, 9/18; Liss, Healthcare Dive, 9/18; Stein, Inside Health Policy, 9/18 [subscription required]; ETC Model fact sheet, 9/18).

    • Massachusetts: Mass General Brigham CEO Anne Klibanski in an email sent to employees on Wednesday announced that the health system is creating two new senior executive positions that are aimed at promoting unity and cohesion among the health system's individual hospitals. Klibanski announced that Ron Walls, who currently serves as COO and EVP of Brigham and Women's Hospital, has been tapped to serve as Mass General's COO and will oversee collaboration across the health system's clinical departments, the development of specialty hospital services, and the consolidation of departments. Klibanski wrote that the health system also plans to appoint a presidentwho will oversee the health system's community hospitals—including North Shore Medical Center and Wellesley Hospital—and serve as EVP of value-based care (Edelman, Boston Globe, 9/16; Gooch, Becker's Hospital Review, 9/17).

    • Tennessee: CMS Administrator Seema Verma on Friday said Tennessee's Medicaid waiver proposal to convert the state's Medicaid financing structure to a type of fixed block-grant system remains under review, but has been delayed by America's novel coronavirus epidemic. Verma said the proposal "is a high priority," but CMS has been "focused on" the epidemic. Verma did not provide a timeline for CMS to complete the proposal's review (Kelman, Tennessean, 9/18).

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