Hippen Benjamin E, Hart George M, Maddux Franklin W
Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts, USA.
Interwell Health, Waltham, Massachusetts, USA.
Kidney Int Rep. 2024 Feb 9;9(6):1590-1600. doi: 10.1016/j.ekir.2024.02.004. eCollection 2024 Jun.
In the United States, kidney care payment models are migrating toward value-based care (VBC) models incentivizing quality of care at lower cost. Current kidney VBC models will continue through 2026. We propose a future transplant-inclusive VBC (TIVBC) model designed to supplement current models focusing on patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD). The proposed TIVBC is structured as an episode-of-care model with risk-based reimbursement for "referral/evaluation/waitlisting" (REW, referencing kidney transplantation), "primary hospitalization to 180 days posttransplant," and "long-term graft survival." Challenges around organ acquisition costs, adjustments to quality metrics, and potential criticisms of the proposed model are discussed. We propose next steps in risk-adjustment and cost-prediction to develop as an end-to-end, TIVBC model.
在美国，肾脏护理支付模式正朝着基于价值的护理（VBC）模式转变，这种模式以较低成本激励护理质量。当前的肾脏VBC模式将持续到2026年。我们提出了一种未来的包含移植的VBC（TIVBC）模式，旨在补充当前专注于晚期慢性肾病（CKD）和终末期肾病（ESKD）患者的模式。所提议的TIVBC构建为一种护理阶段模式，对“转诊/评估/等待名单”（REW，涉及肾脏移植）、“移植后首次住院至180天”以及“长期移植物存活”进行基于风险的报销。讨论了围绕器官获取成本、质量指标调整以及对所提议模式的潜在批评等挑战。我们提出了风险调整和成本预测的下一步措施，以发展成为一个端到端的TIVBC模式。
