Kidney Community Submits to CMS Comments on ESRD Proposed Payment System, Quality Incentive Program and ESRD Treatment Choices Model

August 8, 2022

WASHINGTON – Kidney Care Partners (KCP) – the nation’s largest non-profit, non-partisan coalition of more than 30 organizations representing patients, professional care providers, and a wide range of kidney care stakeholders – thanks the Centers for Medicare & Medicaid Services (CMS) for proposing new policies in the CY 2023 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System and Quality Incentive Program Proposed Rule that seek to address recommendations KCP has made related to both the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and the End-Stage Renal Disease Quality Incentive Program (QIP)

“We appreciate this opportunity to work with the Administration to improve access to high-quality kidney care and address health inequities too often seen in this population,” said John P. Butler, chair of KCP. “Our comments address policies that will greatly impact access to innovations and the quality of care for the approximately 37 million Americans living with kidney disease.”

In its comments, KCP asks CMS to implement policy changes to help address the workforce crisis – which has a direct impact on the quality of care – that is threatening access to dialysis facilities and ensure that current policies do not make it more difficult for dialysis patients to obtain phosphate binders and phosphate lowering drugs.

In the context of the ESRD quality program, KCP requests that CMS suspend the penalties in the value-based purchasing program, given the ongoing impact on the ability to report quality data and the problems created by the pandemic.

Moreover, KCP applauds CMS for including a Request for Information (RFI) that recognizes the problems with the current “no new money” policy related to adding a new product to the bundle. Under the current policy, CMS would not adjust the payment rate when certain new, innovative products are added to the bundle.  Given the chronic underfunding of this program, protecting patient access to innovative treatment options means that CMS should assess the payment rate and add new dollars even if the product being added to the bundle comes within what CMS has designated as an “existing functional category.”  KCP also asks CMS to review the RFI comments and propose a policy for CY 2024 that will adjust the payment rate to support the long-term sustainable adoption of innovative products.

The comments also call on CMS to ensure incentives to adopt innovation apply to patients enrolled in Medicare Advantage plans, targeting case-mix and facility-level adjustors, outlier policies, addressing concerns about oral-only drugs potentially coming into the bundle in 2025, and similar policies to prevent millions of dollars from being trapped within the federal government and not spent on patient care. KCP also supports providing flexibilities that support care coordination among those who provide services to individuals living with kidney disease and kidney failure.

On quality, KCP notes that the ESRD QIP value-based purchasing program provides important quality performance information that promotes patient-driven decision-making. However, the pandemic has disrupted data reporting and skewed measure outcomes, making it inappropriate to apply penalties to facilities still battling the pandemic. KCP asks CMS to suspend the penalties for these facilities, just as it has done for hospitals and other Medicare providers with value-based purchasing programs. Given that individuals living with kidney disease are particularly at-risk for COVID-19 infection, re-infection, and experiencing complications from the disease, the kidney care community asks CMS to consider the public health emergency’s impact on the dialysis population and on reporting.

Finally, KCP notes its support for streamlining the QIP and ensuring that performance evaluation measures are meaningful to individuals who require dialysis and reflect the actual performance of dialysis facilities. While KCP recognizes and appreciates the efforts CMS has made to address some of the ongoing concerns the kidney care community shares with regard to the use of certain measures, the group also highlighted recommendations that have not been resolved. This includes the release of specific measures, universal rate measures, addressing health inequities, and promoting transparency.

“As a community, we look forward to continued work with CMS and applaud its recognition that there is a real need to increase funding for innovative kidney care. We hope the end policy result will provide for continued and sustainable, high-quality care for every American living with kidney disease and kidney failure,” Butler concluded.

To view KCP’s QIP comment letter, click here.

To view KCP’s PPS comment letter, click here.