Helping Kidney Patients Receive Better, More Affordable Treatment

February 2016
Dan Speece
Dan Speece

Each year, the Centers for Medicare & Medicaid Services (CMS) spends more than $33 billion on the care and treatment of End-Stage Renal Disease (ESRD) for over 636,000 Americans. "I find that most people are a little shocked at the number of people with kidney disease and the extent and cost of treatments," says Dan Speece.

Speece, a registered nurse, has led much of MITRE's work on the ESRD Quality Incentive Program (QIP) since its inception in 2008. "My team and I help CMS ensure that patients with this terrible disease get the best care that they can and enjoy the highest quality of life while undergoing kidney dialysis or awaiting a transplant."

MITRE works directly with CMS to develop the policies, procedures, and payment systems that will ensure quality care for ESRD patients while also promoting cost effectiveness in treatment. It's part of our work within the CMS Alliance to Modernize Healthcare—a federally funded research and development center—that MITRE operates for the Centers for Medicare & Medicaid Services and the Department of Health and Human Services.

Positive Impact on Quality of Care

With the passage of the Medicare Improvements for Patients and Providers Act of 2008, the government began to pay ESRD treatment providers with a single bundled payment. This law created the first value-based purchasing (VBP) system in the federal government. Value-based systems prioritize the quality of care and positive results over the quantity of services and medications provided.

One of MITRE's primary roles on the ESRD QIP is to help CMS draft final rules every year. We also assist the agency in selecting quality measures, scoring methodologies, and payment reduction tiers that help ensure patients get good care at their dialysis facilities.

"This is a project that has real impact to real Americans," Speece says. "Each year we help develop defined quality measures that all treatment centers must meet to get fully reimbursed. As such, it has a national impact on the quality of care they deliver.

"If the treatment facilities don't do well under these rules, they're penalized and receive reduced payments. It's critical that the rules are fair, make clinical sense, and systematically applied."

MITRE also provides support to our CMS sponsors in other areas. With our broad technical expertise in systems development and information technology, we serve as trusted advisors to help them oversee enterprise systems development that impact other value-based purchasing projects. We also share our expertise in developing a conceptual and strategic approach for alternative payment models across CMS. In addition, our economic and healthcare policy analysts assess the impacts and unintended consequences of the project on the ESRD population.

Teaching "Kidney School"

Shortly after starting work on the ESRD project, Speece developed a class that gives a basic overview of ESRD, chronic kidney disease and the ESRD QIP program. The course—which usually runs quarterly—is not just for MITRE staff but also for government and contractor staff working on the project. It has become wildly popular and helps everyone—programmers, system engineers, requirements analysts—understand the human aspects of ESRD and how they contribute to the well-being of these very sick patients.

"Early on, I realized I was the only nurse in the room, and the only one who had actually performed dialysis on a patient. It just made sense to start giving an overview so everyone has a basic understanding of the disease and its treatment options."

ESRD is one of the few diseases covered by Medicare regardless of age. "ESRD is very, very expensive for the government. Hence, there's a strong interest in making sure the government gets what it pays for in terms of quality."

New Recruits: Healthcare Jobs at MITRE

In response to increasing demand for healthcare expertise, MITRE is continuing to recruit new staff to support several sponsors including CMS, the Department of Veterans Affairs, and the Department of Defense.

Speece encourages new graduates to apply. "I tell people that MITRE offers a unique opportunity in healthcare that they won't find anywhere else in the country. It’s a great area to work in because it provides a lot of learning opportunities for less-experienced staff. Our work makes a difference, and this is the place to make an impact."

MITRE's priority is helping our sponsors achieve their goals. "We don't recommend pie-in-the-sky stuff that's completely unrealistic, expensive, and just not feasible," he explains. "It's a lot more difficult and rewarding to develop a system and move forward with a plan that the sponsor can reasonably do and still meet their objectives."

—by Kay M. Upham

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