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CMS’s Innovation Center “will really be the playing field” for developments in 2019 in an effort to move away from fee-for-service medicine and create new value-based care models, Robert Blaser, director of public policy for the Renal Physicians Association, said in a presentation here.

The first target will be development of a payment model to incorporate treatment of late-stage CKD into the nephrologist’s patient care approach. The RPA and other groups have met with CMS’s Innovation Center (CMMI) to help shape the plan, Blaser said. He predicted a proposal will come from the agency in the next few months. Its launch, noted Blaser, may be part of a second round of the Comprehensive ESRD Care demonstration, which ends a 5-year run in 2020.

Personal connection

Part of the motivation behind CMS’s interest in moving forward on new approaches to kidney care is personal experience with kidney disease among officials at the agency. The father of HHS Secretary Alex Azar II was on dialysis and later received a transplant, and CMS Deputy Administrator and Director of the Innovation Center Adam Boehler, who joined CMS in April 2018, has a family connection with dialysis.

Blaser noted the background of both administrators in health care is helping them get a better grasp on kidney care issues. Boehler was the founder and CEO of Landmark Health, a company that provides home-based medical care for chronically ill patients, before joining CMS. Landmark has more than 20 locations and more than 80,000 chronic patients under management.

“They have both become well detailed on kidney care issues ... [and] are knowledgeable” about relationships between dialysis providers and Medicare, Blaser said.

What to expect on Capitol Hill

Beyond the strong interest in developing incentives to treat CKD – and the agency’s push to help entrepreneurs develop new technology by partnering with the American Society of Nephrology on the KidneyX innovation competition – HHS chief Azar “will have his challenges” in moving Medicare policy and the agency forward, Blaser said, and that could be exacerbated if a new administration is elected into office in 2020.

New members of the Congressional Kidney Caucus may be helpful in keeping kidney care issues in the spotlight. Rep. Larry Bucshon, a cardiothoracic surgeon, and Rep. Suzan DelBene will chair the caucus, replacing the retiring Tom Marino, noted Blaser.

“Congress wants to feel they did something,” Blaser said. That could include the recently introduced Living Donor Protection Act of 2019 that gives organ donors more employee benefits. Recent comments by Azar in support of extending immunosuppression drug coverage for transplant recipients may give passage of the legislation a boost.

“The new [Congressional Budget Office] scoring looks better now,” Blaser said, referring to the estimated federal costs for extending coverage of transplant drugs that patients need to avoid organ rejection beyond the current 3 years provided by Medicare. That could lead to introduction of a bill by mid-year; a 10-year coverage plan vs. lifetime coverage might be offered, Blaser said.

Still, pressure remains on Medicare reimbursement for nephrologists for the upcoming year, as CMS’s agreement in 2018 to delay the merging of evaluation and management payment codes and codes for vascular access procedures for 1 year means that battle is on the horizon. The promise for telehealth services for the ESRD patient population, approved by Congress last year, awaits payment codes from Medicare Administrative Contractors – the same payment organizations who have yet to finalize language that will confirm long-fought efforts by the renal community to get coverage for more frequent hemodialysis for home patients. – by Mark E. Neumann