Healio Special Report: Health Care and Politics

Healio Special Report: Health Care and Politics

September 11, 2019
2 min read

ESCO demonstration shows reduction in hospitalizations, more dialysis sessions

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A new report on the second performance year of the Comprehensive End-Stage Renal Disease Care Model shows improvements in patient outcomes, including reduced hospitalizations and more dialysis sessions prescribed to patients.

Data for the second year was gathered and analyzed by the Lewin Group.

The Comprehensive End-Stage Renal Disease Care Model (CEC) tests whether the creation of ESRD Seamless Care Organizations (ESCOs) can reduce Medicare expenditures while maintaining or improving quality of care, according to a summary on the CEC website. Each ESCO, made up of dialysis facilities, nephrologists and other providers, is a specialty oriented accountable care organization that assumes responsibility for the quality of care and Medicare Part A and Part B spending of their beneficiaries.

The CEC Model began Oct. 1, 2015 with 13 ESCOs, defined by CMS as wave 1. At the start of the second performance year on Jan. 1, 2017, 24 new ESCOs (wave 2) joined the model, totaling 37 ESCOs.

For the second performance year, seven dialysis organizations participated in the model, including three large dialysis organizations — Fresenius, DaVita and Dialysis Clinic Inc. — and four small dialysis organizations — Rogosin Institute, Atlantic Dialysis, Centers for Dialysis Care and Northwest Kidney Care. The providers represented 685 dialysis facilities (12% of the total ESRD population) and 71,677 Medicare beneficiaries who participated in the first 2 years (PY1 and PY2) of the CEC model.

Reduction in hospitalizations

The Lewin report showed a 4% decrease in the number of hospitalizations and nearly a 1% 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,” according to the report.

Overall, the CEC model reduced Medicare spending by $68 million during PY1 and PY2, or by 1.8%.

“These results were primarily driven by wave 1 ESCOs,” the Lewin report noted. “However, after accounting for the $114.3 million in shared savings that ESCOs received across PY1 and PY2, Medicare experienced aggregate net losses of $46.1 million.”

As part of the agreement between dialysis providers and CMS over participation in the ESCOs, Medicare agreed to share savings with dialysis providers depending on their willingness to take on risk for managing the cost of patients.

During performance year 2, the total Medicare Part A and Part B risk-adjusted payments decreased for CEC beneficiaries compared to non-CEC beneficiaries.

“Overall, the CEC Model showed promising results over the first 2 years, with improvements on some quality and health care utilization measures as well as a decrease in total spending,” according to the report. “At the same time, beneficiary-reported quality of life remained largely unchanged. Results from the first two performance years suggest that the reduction in Medicare payments for CEC beneficiaries has primarily been generated through a reduction in hospitalizations. The percent of beneficiaries with at least one (emergency department) visit or readmission also decreased. Additionally, ESCOs reported various interventions to improve adherence to dialysis. These resulted in an increase in the number of dialysis treatments and dialysis spending, but a decrease in spending for hospitalizations associated with dialysis complications.”

Better results than primary care demonstrations

Lewin reported that, for beneficiaries with ESRD, the CEC Model performed better than primary care-based ACOs.

“We saw meaningful improvements in spending and utilization outcomes under the CEC Model, whereas primary care-based ACOs showed no evidence of improved outcomes or reduced spending for beneficiaries with ESRD,” according to the report. “This suggests that beneficiaries with ESRD fare better in the specialized CEC Model than in primary care-based ACOs,” according to the report.

The ESCO-CEC model runs for 5 years, continuing through 2020.


Comprehensive End-Stage Renal Disease Care (CEC) Model

performance year 2 annual evaluation report. Lewin Group. September 2019. www.lewin.com