At mHealth Intelligence, a website dedicated to developments in mobile health, telemedicine, and related topics, Senior Editor Eric Wicklund reports that the Centers for Medicare & Medicaid Services recently announced a plan to remove Medicare Advantage (MA) plan enrollment barriers for the roughly 700,000 Americans with end-stage kidney disease (ESKD), also known as end-stage renal disease (ESRD).*

More of an Advantage

CMS’s proposed plan gives end-stage renal disease patients who participate in the MA plan access to more telehealth benefits, allowing them to receive care at home. This would save time and money, and spare severely compromised patients the effort and inconvenience of frequent doctor visits.

The proposal is CMS’s response to two federal mandates:

1. The 21st Century Cures Act of 2016,  aimed at expediting research and development to improve health care, delivery, and outcomes in a variety of areas; and
2. An executive order issued in 2019 specifically designed to accelerate improved health care and outcomes for people with kidney disease, particularly ESKD.

The proposal, which would impact Medicare parts C and D, includes:

• home-based dialysis programs
• in-home visits from nephrologists on an as-needed basis between office visits
• remote monitoring systems of vital signs for patient care coordination and management
• programs that use telehealth technology to improve kidney acquisition
• relaxation of requirements for beneficiaries of telehealth services in rural areas
• access to telehealth benefits unavailable in fee-for-service plans in some specialty areas
• a second “preferred” tier for part D involving lower costs for beneficiaries

Patient-Centered Care

The order also mentions an incentivized payment system for healthcare providers. Under this system, healthcare providers would be paid for actual positive health outcomes rather than just services rendered. In other words, they would get paid for results, ensuring that they only take actions that are in the best interests of their patients.

In its proposal fact sheet, the CMS sums up its intentions this way:

“By removing the barrier that beneficiaries with ESRD now face in terms of enrolling in MA plans, we are empowering [people with ESRD] to choose the type of Medicare coverage that best meets their needs.”

Refer to MHealth Intelligence’s article on CMS’s telehealth plan for more details.

*Wicklund, E. (2020, February 7). CMS to Add MA Telehealth Coverage for Kidney Disease, Specialty Care. mHealth Intelligence.