End-stage Renal Disease (ESRD) Disease Management Demonstration: Fresenius Medical Care North America (FMCNA) and Fresenius Medical Care Health Plan (FMCHP)

The End-stage Renal Disease (ESRD) Disease Management Demonstration increased the opportunity for Medicare beneficiaries with ESRD to join integrated care management systems. In this demonstration, dialysis companies partnered with Medicare Advantage (MA) organizations to offer MA plans that enroll only beneficiaries with ESRD in specified service areas. The dialysis/MA organization provided all Medicare covered benefits. Organizations serving ESRD patients received the same risk-adjusted ESRD capitation payments as the MA program overall with separate rates for dialysis, transplant, and post-transplant modalities. The actual payment amount, however, was reduced by 5 percent, which was available to the organizations depending on performance on quality measures. CMS determined six dialysis-related indicators on which performance was assessed. These indicators are adequacy of dialysis, anemia management, serum phosphorous, serum calcium, fistulas, and catheters. These indicators and standards were developed in consultation with participating organizations and with the CMS implementation contractor, Arbor Research Collaborative for Health.