CMS finalizes payment model aimed at boosting access to home dialysis, kidney transplants

The Trump administration has finalized a rule aimed at boosting access to home dialysis and translation for patients with end-stage renal disease.

The Centers for Medicare & Medicaid Services estimates that the End-Stage Renal Disease Treatment Choices Model will save Medicare $23 million over the next five years. The value-based model is designed to incentivize providers to offer home dialysis as an alternative to clinic dialysis.

Providers that participate in the model would have the opportunity to build up their home dialysis capabilities, CMS said.

"All of this matters because you get what you pay for," Department of Health and Human Services Secretary Alex Azar said on a call with reporters on Friday. "What we’re going to deliver is much better health for kidney patients."

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For eligible patients, home dialysis offers both a more convenient and more comfortable experience, experts say. Because home peritoneal dialysis or hemodialysis is conducted more frequently, the negative side effects patients experience between sessions are lessened.

Home dialysis has drawn interest from the private sector as well, with companies like CVS Health investing in new systems for treatment.

The model also aims to increase access to kidney transplants, by rewarding them financially based on their transplantation rates. Tranplantation is considered the "optimal" treatment for patients with ESRD, CMS said, but waits for organs can be quite long.

Reforming kidney care has been a critical health priority at HHS and CMS under President Donald Trump. The administration has also launched other payment models in the space and formed KidneyX, an accelerator aimed at kidney care in partnership with the American Society of Nephrology.

Private payers have also been investing in programs to improve kidney care, especially as ESRD patients will be eligible to enrolling Medicare Advantage beginning in 2021. Humana, for instance, has unveiled a slew of partnerships across a number of states to improve kidney care for its largely MA membership.