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The ESRD Treatment Choices (ETS) Model incentivizes providers who support home-based dialysis and care – and could open the door to more telehealth and remote patient monitoring programs.

By Eric Wicklund

September 18, 2020 – Federal officials have unveiled a new treatment model for patients living with kidney disease that could boost interest in telehealth and remote patient monitoring programs.

The Centers for Medicare & Medicaid Services’ End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model aims to shift from the traditional Medicare fee-for-service format to one that incentivizes providers to encourage home-based care, including home dialysis and kidney transplants. Officials say the ETC model would impact roughly 30 percent of kidney care providers and result in an estimates savings of $23 million over the next five to six years.

“This new payment model helps address a broken set of incentives that have prevented far too many Americans from benefiting from enjoying the better lives that could come with more convenient dialysis options or the possibility of a transplant,” HHS Secretary Alex Azar said in a press release.

The model builds on President Donald Trump’s 2019 Executive Order that called on the nation’s healthcare system to expand home-based dialysis care, as well as CMS’ prosed changes to the ESRD Prospective Payment System (PPS), unveiled in June. The agency estimates that 20 percent of traditional Medicare dollars, or about $114 billion a year, are spent on Americans with kidney disease.

Roughly 30 million Americans, or 15 percent of the adult population, are affected by chronic kidney disease. Of that number, more than 660,000 have kidney failure, and almost 470,000 are on dialysis. More than 193,000, meanwhile, have a functioning kidney transplant, which requires them to follow a very strict daily medication regimen.

According to CMS, more than 85 percent of Medicare fee-for-service beneficiaries living with ESRB travel to a facility three times a week for dialysis, spending an average of 12 hours a week connected to a machine that, under the right circumstances, could be located at home.

According to the National Kidney Foundation, telemedicine offers a promising alternative to in-person care, most often delivered in a doctor’s office or dialysis clinic. Clinicians can remotely monitor a patient’s blood pressure and other vital signs, as well as offering resources for medication adherence and diet plans.

According to CMS, the ETC Model “will encourage participating care providers to invest in and build their home dialysis programs, allowing patients to receive care in the comfort and safety of their home. Home dialysis gives patients the freedom to choose the therapy that works best with their lifestyles, without being tied to the dialysis facility’s schedule.”

The new model also offers incentives for providers and patients who choose kidney transplants, noting that route “is widely viewed as the optimal treatment for most patients with ESRD, generally increasing survival and quality of life while reducing medical expenditures.”

Telehealth and mHealth have played a significant role in that process as well, with tools to improve donor matching and waitlist management and platforms that help patients undergoing transplants to recover more quickly at home and stay in touch with providers for ongoing care management and health and wellness needs.

Among the organization’s responding quickly to today’s announcement was Kidney Care Partners. The coalition said it was concerned that the new model didn’t put enough emphasis on educating patients about home-based care.

“While the Model would expand the Kidney Disease Education benefit, we know that early education before patients enter the dialysis facilities is essential to helping patients understand and adopt home dialysis modalities,” KCP said in a press release. “Yet, the waivers provided do not include dialysis facilities and their multi-disciplinary care teams, which is something that Members of Congress have specifically sought to do in The Chronic Kidney Disease Improvement in Research & Treatment Act.”

“It remains critical that the patient and physician voice be in the forefront regarding access and choice for care settings – such as home care – that are most desirable and appropriate for the patient given the healthcare needs and associated co-morbidities, their home support and the home environment itself,” the group added.

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