On October 13, the Centers for Medicare & Medicaid Services (CMS) announced results from the first performance year of the Comprehensive ESRD Care (CEC) Model. The CEC Model was designed by the Center for Medicare & Medicaid Innovation, in collaboration with the kidney care community, to test and evaluate a new payment and care delivery model aimed at improving clinical outcomes and patient experiences, and decreasing expenditures for Medicare beneficiaries with end-stage renal disease (ESRD).
The CEC Model builds on accountable care organization experience from the Pioneer Accountable Care Organization (ACO) Model, Next Generation ACO Model, and the Medicare Shared Savings Program to test the first and only disease-specific ACO for ESRD beneficiaries. In the CEC Model, dialysis clinics, nephrologists and other providers join to create an ESRD Seamless Care Organization (ESCO) to coordinate care for matched beneficiaries. ESCOs are accountable for clinical quality outcomes and financial outcomes measured by Medicare Part A and B spending, including all spending on dialysis services for their aligned ESRD beneficiaries.
During the first performance year, 13 ESCOs serving more than 16,000 Medicare beneficiaries participated. Between October 2015 and December 2016, the CEC Model achieved the following results in savings and quality:
- All 13 ESCOs produced shared savings with CMS, generating a gross savings of $75 million in 2016, which is more than the $68 million saved by Pioneer ACOs and the $48 million saved by NextGen ACOs in the same period.
- Eight of the 12 ESCOs receiving shared savings earned between $1.45 million and $4.7 million, with the remaining four earning between $5.6 million and $12.3 million.
- All 13 ESCOs reported quality measures and achieved maximum reporting rate, with all ESCOs earning incentive payments for their reporting accomplishments.
- High-quality care was demonstrated in the following areas: ICH CAHPS: Nephrologist Communication and CaringICH CAHPS: Providing Information to PatientsICH CAHPS: Dialysis Center Care and Operations
- ICH CAHPS: Nephrologist Communication and Caring
- ICH CAHPS: Providing Information to Patients
- ICH CAHPS: Dialysis Center Care and Operations
During the second performance year, 24 additional ESCOs are participating in the CEC Model. The 37 total ESCOs serve more than 33,000 Medicare beneficiaries. While CMS currently does not have plans to open a third round of solicitation, interested providers may participate by joining an existing ESCO at the start of the performance year.
McGuireWoods’ healthcare group has represented more than 20 nephrology group practices in developing, owning and operating ESCOs. If you have any questions regarding joining an existing ESCO or the CEC Model generally, please contact one of the authors.