Do you or a loved one use Medicare insurance? If so, you should know that changes were made in 2022 that may affect how doctors treat chronic kidney disease (CKD). The Centers for Medicare and Medicaid Services (CMS) released the Kidney Care Choices (KCC) Model, which builds upon the existing Comprehensive End-Stage Kidney Disease Care (CEC) Model. Learn more about the KCC Model and how it may affect you.* 

Why Was the KCC Model Needed?

For years, Medicare has incentivized doctors and providers to focus on ESKD patients by reimbursing them only for the cost of dialysis and transplant care. Until the recent KCC Model, Medicare had never assembled a coordinated program to treat patients before the kidney fails. 

Patients in earlier stages are often not well educated on preventing or slowing the progression of their disease, nor are they generally well informed about the different dialysis modalities available and the benefits to each. 

What Is The KCC Model Changing?

In July 2019, President Trump signed an executive order aimed at improving outcomes for individuals with kidney disease. One of the major goals was to treat and care for patients with kidney disease much sooner to help slow it down. Thus, the KCC Model was created.

“One of the goals of this model is to delay the need for dialysis and encourage kidney transplantation. Doing so reduces expensive hospitalizations paid for by Medicare while improving patient outcomes,” Terry Ketchersid, M.D., MBA, chief medical officer of the Integrated Care Group at Fresenius Medical Care North America, and co-chief medical officer of InterWell Health told Nephrology News & Issues.

Some companies are taking the initiative to have an interdisciplinary team, similar to dialysis, to help manage CKD patients in earlier stages. Under the direction of a nephrologist, patients may have access to a nurse, social worker, renal dietitian, and more. 

“I have spoken with 14 companies over the last two years that are entering the CKD management business. Several have now contracted with major insurers and health systems,” Brent W. Miller, M.D, a member of the Nephrology News & Issues Editorial Advisory Board, said. “My employer, Indiana University Health, the largest health care system in Indiana, has approximately 45,000 patients with CKD stage 3 and above. I think about those 45,000 people daily – some are members of my family. Algorithms that identify risk progression and tools that address the genetics, epigenetics, proteomics, and metabolomics of CKD will soon appear. Therapies that are specific to each patient will follow.”

What Are Potential Barriers to the KCC Model?

While the goal of the KCC Model is ideal, Miller does admit to having reservations about its effectiveness. 

“The major problems are the scale of the economic upside and downside of the program, the delays in implementation, and the complexity and continuous changing of the rules,” Miller said. “Because of this, very few people are engaged in the program…it won’t change practice for the overwhelming majority of nephrologists or patients.”

Miller believes the payment structure and rules are too complex and not feasible for smaller nephrology practices. However, he does believe in the goal of treating patients with earlier stages of CKD. 

“It is heartening and among CMS’ best efforts in my professional career. That is important to recognize. The shortcomings of the implementation do not take away from the ultimate goals and hopefully will not end those efforts,” Miller concludes.

*Neumann, M. E. (2022, January 19). CKD moves to center stage with launch of Kidney Care Choices model. Healio. https://www.healio.com/news/nephrology/20211228/ckd-moves-to-center-stage-with-launch-of-kidney-care-choices-model?utm_source=selligent&utm_medium=email&utm_campaign=news&M_BT=5572075039969