End-Stage Renal Disease Treatment Choices Model and Use of Home Dialysis and Kidney Transplant

Did the Centers for Medicare & Medicaid Services’ End-Stage Renal Disease Treatment Choices (ETC) model, a mandatory randomized pay-for-performance program, increase home dialysis and kidney transplant after nearly 4 years after implementation?In this cross-sectional study of 795 232 traditional Medicare beneficiaries with kidney failure, home dialysis use increased similarly in ETC and control regions (3.9 percentage points [pp] vs 3.7 pp; difference-in-differences, 0.1 pp). Changes in kidney transplant and wait-listing rates did not differ, while the share of participating dialysis facilities receiving financial penalties increased from 13.8% in 2021 to 25.1% in 2023.The ETC model was not associated with increased home dialysis or kidney transplant.

Corresponding Author: Amal N. Trivedi, MD, MPH, Department of Health Services Policy and Practice, Brown University School of Public Health, 121 S Main St, Floor 6, Providence, RI 02907 (amal_trivedi@brown.edu).

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