Report: Comprehensive End-Stage Renal Disease Care Model Results Show Promise

Nov. 9, 2019
Analysis of first specialty-focused ACOs identifies decrease in hospitalizations

An analysis following the second payment year of the Comprehensive End-Stage Renal Disease Care  (CEC) Model found that it led to a decrease in hospitalizations and an increase in outpatient dialysis sessions.

The CEC Model tests whether the creation of ESRD Seamless Care Organizations (ESCOs) can reduce Medicare expenditures while maintaining or improving quality of care. Each ESCO, which is made up of dialysis facilities, nephrologists and other providers, is a specialty-oriented accountable care organization (ACO) that assumes responsibility for the quality of care and Medicare Part A and Part B spending of their aligned beneficiaries. These ESCOs represent a variety of geographic regions, ownership structures and sizes.

 Data analyzed by the Lewin Group  showed there was a 4 percent decrease in the number of hospitalizations and nearly a 1 percent increase in the number of outpatient dialysis sessions for CEC beneficiaries relative to non-CEC beneficiaries. These results may be due to ESCOs targeting patients at a high risk of hospitalization, increasing access to urgent dialysis care at facilities, and coordinating care to reduce avoidable hospital admissions, the report said.

CEC beneficiaries experienced 6 percent fewer hospitalizations from ESRD complications and were 8 percent less likely to use a catheter compared to non-CEC beneficiaries. Overall, there was no evidence that the relative reductions in cost and utilization compromised quality.

 The Lewin Group report also found that the CEC Model reduced Medicare spending by $68 million or 1.8 percent during the combined payment years. These results were primarily driven by Wave 1 ESCOs. However, Medicare experienced aggregate net losses of $46 million after taking into account shared savings payments made to ESCOs.

 The CEC Model began Oct. 1, 2015, with 13 ESCOs (Wave 1). At the start of the second performance year on Jan. 1, 2017, 24 new ESCOs (Wave 2) joined the model, for a total of 37 ESCOs. Seven dialysis organizations participated in the model in payment year 2. These included three large dialysis organizations: Fresenius, DaVita, and Dialysis Clinic Inc., and four small dialysis organizations: Rogosin, Atlantic, Centers for Dialysis Care (CDC), and Northwest Kidney Care (NKC). In all, 12 percent of all U.S. dialysis facilities were in the model in payment year 2. Approximately 71,677 Medicare beneficiaries with ESRD participated in the first two years.

 The report noted that the CEC Model is the first Medicare ACO model that targets a particular clinical population. Results from the first two performance years of the CEC Model show specialty-oriented ACOs for beneficiaries with ESRD can reduce spending while improving key quality outcomes. Findings from the CEC evaluation can inform the development of future models focused on kidney disease as well as specialty-oriented ACO models focused on other chronic conditions.