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Medical Coding News Archives

New Initiative Aims to Improve End-Stage Renal Disease Care

 
February 21, 2013:

Trudy Whitehead, CPC-H, CMAS, Clinical/Technical Editor

The Centers for Medicare & Medicaid Services (CMS) has announced a new initiative to identify, test, and evaluate new and innovative ways to improve care of Medicare beneficiaries who have end-stage renal disease (ERSD). Through partnership with health care providers and suppliers, CMS will test the effectiveness of a new payment and service delivery method that is patient-centered and provides high-quality care.

“This initiative puts Medicare beneficiaries living with end-stage renal disease at the center of their care,” says CMS Acting Administrator Marilyn Tavenner. “Through enhanced care coordination, these beneficiaries will have a more patient-centered care experience, which will ultimately improve health.”

Patients with ESRD have significant health care requirements and make up 1.3 percent of the Medicare population. They account for an estimated 7.5 percent of Medicare spending, totaling over $20 billion in 2010. Underlying disease complications, including multiple comorbidities, such as hypertension and coronary artery disease, result in high costs and often lead to high rates of hospital admissions and readmissions. Additionally, the mortality rate for those suffering with ESRD is much higher than that for the general Medicare population.

As part of this Comprehensive ESRD Care initiative, CMS will work with groups of health care providers and suppliers in entities called “ESRD seamless care organizations” (ESCOs) to provide beneficiaries with more patient-centered coordinated care. To participate, organizations must include at least one dialysis facility, a nephrologist, and one other Medicare supplier or provider.

Organizations that participate will assume financial as well as clinical responsibility for a group of beneficiaries with ESRD. These beneficiaries will keep their right to see any Medicare provider they wish, and the organizations will be evaluated on their performance quality measures, including beneficiary health and experience. Organizations that improve beneficiary health outcomes while lowering the per capita cost of beneficiary care will share in the Medicare savings with CMS.

 

 
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