Medicare & Medicaid News for Senior Citizens

Medicare & Medicaid News

Medicare launches new dialysis model to improve kidney care

Medicare Annual Election Period Opens Oct. 15Affordable Care Act model designed to improve care for patients with kidney failure while reducing costs

Oct. 9, 2015 - More than 600,000 Americans have end-stage renal disease (ESRD), also known as kidney failure, and require life sustaining dialysis treatments several times per week. Medicare has a new plan. In 2012, ESRD beneficiaries comprised 1.1% of the Medicare population but accounted for an estimated 5.6% of total Medicare spending.

These individuals typically have many health problems, are at higher risk of hospital readmissions, and suffer from fragmented care.

The Centers for Medicare & Medicaid Services (CMS) has announced the participants for the Comprehensive ESRD Care (CEC) Model, a new accountable care organization (ACO) model made possible by the Affordable Care Act and conducted by the CMS Innovation Center.

 

CMS says it is part of the Department of Health and Human Services’ approach to building a health care delivery system that results in better care while using taxpayer dollars more wisely,

ACOs are groups of physicians and other health care providers who collectively take on responsibility for the quality and cost of care for a population of patients. The CEC Model is designed specifically for beneficiaries with ESRD and builds on experiences from other models and programs with ACOs, including the Pioneer ACO Model and the Medicare Shared Savings Program.  

In the CEC Model, dialysis facilities, nephrologists, and other providers have joined together to form ESRD Seamless Care Organizations (ESCOs) to coordinate care for ESRD beneficiaries.  ESCOs will be financially accountable for quality outcomes and Medicare Part A and B spending, including all spending for dialysis services, for their ESRD beneficiaries.

This model will encourage dialysis providers to think beyond their traditional roles in care delivery and support beneficiaries as they provide patient-centered care that will address beneficiaries’ health needs in and out of the dialysis facility.

“This new ACO model represents a paradigm shift in care for beneficiaries with end-stage renal disease; it promotes a patient-centered approach to their dialysis and non-dialysis care needs that will help accomplish our delivery system reform goals of better care, smarter spending, and healthier people,” said Patrick Conway, M.D., MSc, acting deputy administrator and chief medical officer, CMS.

The CEC Model includes separate financial arrangements for ESCOs with large and small dialysis organizations. ESCOs with participation by a dialysis facility or facilities owned by a large dialysis organization, which is an organization that owns 200 or more dialysis facilities, will be eligible to receive shared savings payments. They will also be liable for shared losses, and will have higher overall levels of risk compared with their smaller counterparts.

ESCOs with participation by a dialysis facility or facilities owned by a small dialysis organization, which is an organization that owns fewer than 200 dialysis facilities, will be eligible to receive shared savings payments, but will not be liable for shared losses.  

The CEC Model is part of the Department’s efforts to create opportunities for providers to enter into alternative payment models and meet the Secretary’s goal, announced on January 26th, to have 30% of traditional Medicare payments paid through alternative payment models by the end of 2016 and 50% by the end of 2018.

CMS issued an open call for applications for the CEC Model in April 2014.  The following applicants were selected to participate in the model:

Large Dialysis Organizations:

Dialysis Organization

ESCO Name

Location

DCI

Liberty Kidney Care Alliance, LLC

Newark, NJ

DCI

Palmetto Kidney Care Alliance LLC

Spartanburg, SC

DCI

Music City Kidney Care Alliance, LLC

Nashville, TN

DaVita

Phoenix-Tucson Integrated Kidney Care

Phoenix, AZ

DaVita

South Florida Integrated Kidney Care

Miami, FL

DaVita

Philadelphia - Camden Integrated Kidney Care

Philadelphia, PA

Fresenius

Fresenius Seamless Care of San Diego, LLC

San Diego, CA

Fresenius

Fresenius Seamless Care of Chicago, LLC

Chicago, IL

Fresenius

Fresenius Seamless Care of Charlotte, LLC

Charlotte, NC

Fresenius

Fresenius Seamless Care of Philadelphia, LLC

Philadelphia, PA

Fresenius

Fresenius Seamless Care of Columbia, LLC

Columbia, SC

Fresenius

Fresenius Seamless Care of Dallas, LLC

Dallas, TX

Small Dialysis Organization:

Dialysis Organization

ESCO Name

Location

Rogosin Institute

Rogosin Kidney Care Alliance

New York, NY

 

For more information on the CEC Model, please visit the CEC Model Web page.

The CMS Innovation Center was created by the Affordable Care Act to test innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. The CMS Innovation Center is committed to transforming Medicare, Medicaid and CHIP and is expected to help deliver better care for individuals, better health for populations, and lower growth in expenditures.

Medicare Annual Election Period Opens Oct. 15Related Medicare & Medicaid News - Senior Journal Archives

Big Medicare Part B price jump for some: 70 groups ask Congress to act

Part B will increase to $159 monthly for select beneficiaries in 2016; Part B deductible jumps to $223 for all on Medicare - Oct. 9, 2015

Medicare Advantage Plans to test more flexibility for seniors with chronic ills

Medicare Advantage Value-Based Insurance Design Model targets better cafe at less cost - Sept. 2, 2015

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