Accountable Care Model: Fit for Nephrology, but Room for Improvement in CMS Proposal

The concepts of “accountable care”—by which health care providers are fi nancially rewarded if they improve patient care while lowering costs—offer great potential for nephrology. “The basic principles of accountable care are very attractive to me as a nephrologist and as somebody who recognizes that the renal industry is a collaboration of many different players and parts,” said Franklin W. Maddux, MD, Senior Vice President and Chief Medical Information Offi cer of Fresenius Medical Care. “When you look at the fundamental value proposition of accountable care, it fi ts renal disease quite well.” While Robert Provenzano, MD, Vice President of Medical Affairs for DaVita, shares Dr. Maddux’s enthusiasm for the concept, he considers the regulations proposed by the Centers for Medicare & Medicaid Services (CMS) to be “almost heartbreaking” because they put too much risk and expense on physicians. “They could have made this easier,” he said. He and others interviewed for this article are optimistic that, while CMS may have paid little attention to nephrology in the proposed rule for accountable care organizations (ACOs) issued March 31, the agency will eventually fi nd a way to apply accountable care concepts to kidney care. After a comment period that ends June 6, CMS will consider feedback and issue its fi nal rule in time for ACOs to begin contracting with the Medicare program as of Jan. 1, 2012. “I’ve never seen a rule from CMS with so many requests for the community to make open comments about particular areas of it,” Dr. Maddux said. “Everything from who can be an ACO to how patients are attributed to an ACO to how the payment and risk work is open for substantial comment.”