Kidney Care Choices (KCC) Model

The Kidney Care Choices (KCC) Model was created by The US Centers for Medicare & Medicaid Services (CMS). Medicare beneficiaries who meet the following criteria will be eligible to be aligned to this model:

• Medicare beneficiaries with CKD stages 4 and 5.
• Medicare beneficiaries with ESRD receiving maintenance dialysis.
• Medicare beneficiaries who were aligned to a KCE by virtue of having CKD stage 4 or 5 or ESRD and receiving dialysis that then receive a kidney transplant.

The Kidney Care Choices model aims to delay the need for dialysis and encourage kidney transplantation. The model is also designed to help health care providers reduce the cost and improve the quality of care for patients with late-stage chronic kidney disease and End Stage Renal Disease (ESRD).

The patient is a key component of the Model design. The tendency now is for patients with kidney disease to follow the most expensive path, with little prevention of disease progression and an unplanned start to in-center hemodialysis treatment. By increasing education and understanding of the kidney disease process, aligned beneficiaries may be better prepared to actively participate in shared decision making for their care.

Beneficiary alignment will take into consideration where a beneficiary receives the majority of his or her kidney care. When an aligned beneficiary receives a kidney transplant, he or she will remain aligned to the model participant for three years following a successful kidney transplant or until the time a kidney transplant fails, at which point the beneficiary could be re-aligned if he or she meets the requirements for alignment by virtue of his or her ESRD.

Kidney Contracting Entities (KCEs) participating in the model are required to include nephrologists or nephrology practices and transplant providers, while dialysis facilities and other providers and suppliers are optional participants in KCEs. KCEs will receive adjusted payments for managing beneficiaries with CKD Stages 4 and 5 and ESRD and along with the kidney transplant bonus payment.

Background

Kidney Care Choices (KCC) builds upon the existing Comprehensive End Stage Renal Disease (ESRD) Care (CEC) Model structure – in which dialysis facilities, nephrologists and other health care providers form ESRD-focused accountable care organizations to manage care for beneficiaries with ESRD – by adding strong financial incentives for health care providers to manage the care for Medicare beneficiaries with chronic kidney disease (CKD) stages 4 and 5 and ESRD, to delay the onset of dialysis and to incentivize kidney transplantation.

The current Medicare payment system encourages in-center hemodialysis as the default treatment[RC1]  for patients beginning dialysis. According to the Government Accountability Office, in-center hemodialysis is the most common type of dialysis and was used by about 88 percent of dialysis patients in 2016. There are more than 430,000 Medicare Fee-for-Service beneficiaries with ESRD who spend an average of 12 hours a week receiving in-center hemodialysis. Many beneficiaries with ESRD suffer from poorer health outcomes, such as higher hospitalization and mortality rates, often the result of underlying disease complications and multiple co-morbidities.

Additional Information

Additional Information regarding the Kidney Care Choices Model can be found at https://innovation.cms.gov/innovation-models/kidney-care-choices-kcc-model.