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Focus on Regulation

CMS Innovation Center Launches New Medicare ESRD Shared Savings Program

The Centers for Medicare and Medicaid Services (CMS) recently announced the launch of the Comprehensive ESRD Care (CEC) Initiative to test an innovative Medicare payment model to improve care for Medicare beneficiaries with End Stage Renal Disease (ESRD), while decreasing costs to Medicare. CMS hosted a call to discuss the new initiative on February 5, 2013, and also posted FAQs and a fact sheet regarding the new initiative.

Through this initiative, CMS plans to test the hypothesis that comprehensive medical management of, and better care coordination for, ESRD beneficiaries will result in improved outcomes and reduced costs. The CMS Innovation Center anticipates funding between 10-15 entities, similar to Accountable Care Organizations (ACOs), called ESRD Seamless Care Organizations (ESCOs). Each ESCO must have participant-owners that include a dialysis facility, a nephrologist/nephrology group practice, and another Medicare enrolled provider/supplier that is not a Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) supplier, an ambulance supplier, or a drug and/or device manufacturer. Through these entities, providers will take responsibility for the quality and costs of care provided to patients with ESRD, and will generally share in both savings and losses generated through the program. Mirroring the ACO model, CMS expects ESCOs to provide beneficiaries with a patient-centered, coordinated care experience, and beneficiaries who are matched to an ESCO will stay in fee-for-service Medicare.

The Request for Applications is available online. Letters of intent must be submitted by March 15, 2013. While the letter is non-binding, only applicants that have submitted a letter of intent will be permitted to submit a full application. Applications must be submitted by May 1, 2013.