End-Stage Renal Disease (ESRD) Disease Management Demonstration: DaVita/SCAN

The End-Stage Renal Disease (ESRD) Disease Management Demonstration has increased the opportunity for Medicare beneficiaries with ESRD to join integrated care management systems. This demonstration has allowed Medicare Advantage (MA) organizations to partner with dialysis organizations to enroll beneficiaries with ESRD in specified service areas. The dialysis and MA organization partnership must provide all Medicare covered benefits. Organizations serving ESRD patients receive the same risk-adjusted ESRD capitation payments as for the MA program overall with separate rates for dialysis, transplant, and post-transplant modalities. The actual payment amount, however, has been reduced by five percent. This amount is available to the organizations depending on their performance on quality measures. CMS determined six dialysis-related indicators on which performance will be 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.