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What to Know About the Advancing American Kidney Health Executive Order

Posted by Deborah Brouwer-Maier RN, CNN on Nov 6, 2019

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President Donald Trump signed an executive order in July  designed to “improve the lives of Americans suffering from kidney disease, expand options for American patients, and reduce healthcare costs.”

The Advancing American Kidney Health Act has three goals for improving kidney health:

  1. Reduce the number of Americans with end-stage renal disease (ESRD) by 25% by 2025
  2. Have 80% of new ESRD patients receiving either home dialysis or kidney transplants by 2025
  3. Double the number of kidneys available for transplant by 2030

How could the Advancing American Kidney Health Act impact patients, dialysis clinics and kidney care staff? And how will the changes proposed be implemented? Let’s take a deeper look.

The executive order will use four voluntary payment models and one mandatory payment model from the Center for Medicare and Medicare Innovation (CMMI). These Comprehensive Kidney Care Contracting (CKCC) initiatives drive the three changes it has proposed, and they will provide financial incentives for better management of ESRD patients and improve rates of home dialysis and kidney, kidney-pancreas transplants.

How the Payment Models Work

The voluntary models have three distinct accountability frameworks, according to CMS.

CKCC Graduated Model: This model is based on the existing CEC Model One-Sided Risk Track and allows certain participants to begin under a lower-reward one-sided model and incrementally phase into a greater risk and greater potential reward.

CKCC Professional Model: This model is based on the Professional Population-Based Payment option of the Direct Contracting Model with an opportunity to earn 50% of shared savings or be liable for 50% of shared losses based on the total cost of care for Part A and B services.

CKCC Global Model: This model is based on the Global Population-Based Payment option of the Direct Contracting Model with risk for 100% of the total cost of care for all Parts A and B services for aligned beneficiaries.

The voluntary models are expected to run from January 1, 2020, through December 31, 2023.

For the mandatory model — the ESRD Treatment Choices (ETC) Model — managing clinicians and dialysis clinics in certain geographic areas throughout the country that treat 50% of Medicare patients would be randomly selected to participate.

Get a better understanding of how the executive order could affect your patients.

A clinic can be excluded if it:

  • Is in a U.S. territory
  • Treats too few patients
  • Treats pediatric patients

Patients can be excluded if they:

  • Live outside the U.S.
  • Receive dialysis due to acute kidney injury
  • Have dementia
  • Are under 18
  • Are in hospice

Patients can’t opt out of the ETC Model if they’re at a clinic that’s been selected, but they can choose whether to receive dialysis from a provider under the model.

This model would also extend kidney disease education to nurses, dietitians and social workers, Medicare patients with Stage 5 CKD and patients who have received an ESRD diagnosis within the last six months.

Because the majority of ESRD patients in the U.S. receive treatment in dialysis clinics, the Advancing American Kidney Health act has the potential to fundamentally alter treatment for these patients. According to Kaiser Health News, 726,000 patients have ESRD in the United States. Of these, about 88% receive treatment in dialysis clinics with the other 12% receiving home dialysis.

Read more about how the Advancing American Kidney Health act could affect dialysis clinics, kidney staff and patients in our newest resource.

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