The End-Stage Renal Disease Treatment Choices (ETC) Model, introduced to improve patient outcomes and control healthcare costs, released their second annual evaluation on the impact of the ETC program. This article will explore some key findings – and maybe some missteps – in their area of focus.
The ETC Model, implemented by the Centers for Medicare & Medicaid Services (CMS), spans approximately 30 percent of Hospital Referral Regions (HRRs) across the United States. These regions, selected through a random process using a U.S. Census Region stratified design, include Maryland, integrated with the ongoing Maryland Total Cost of Care Model. Participation in the ETC Model is mandatory for dialysis facilities and managing clinicians within these selected HRRs.
These entities receive adjustments to certain Medicare fee-for-service (FFS) payments based on their performance under the Model. The performance evaluation criteria encompass various metrics, such as levels of home dialysis utilization, rates of waitlisting for deceased donor transplants, living donor transplantation, and, for specific participants, pre-emptive transplantation, all measured among FFS beneficiaries under their care.
Beginning Jan. 1, 2022, the ETC Model also incorporated health equity provisions aimed at mitigating disparities in access to home dialysis and transplantation. These provisions represent a significant addition to the Model, emphasizing the importance of ensuring equitable access to kidney disease treatment options for all eligible individuals across the covered regions.
Let’s delve into the findings, implications, and potential future impacts of this model.
One of the primary goals of the ETC Model has been to encourage the adoption of home dialysis. From 2017-2019 to 2021-2022, home dialysis rates increased by 12 to 15.2 percent in ETC areas and 12.7 to 15.9 percent in the comparison group. Although an 8-percent increase in home dialysis training was observed, the majority of this growth occurred in 2021. Thus, there was no significant difference between the ETC model and the comparison group in the growth of home dialysis utilization.
The ETC Model did not yield statistically significant differences in waitlisting and living donor transplant rates during its initial two years. While overall transplantation rates saw a 10 percent increase and deceased donor transplant rates rose by 11 percent, this growth was concentrated in 2021 and was not sustained in 2022.
No significant findings were observed in total Medicare Parts A, B, and D payments per patient, per month, between ETC areas and the comparison group. Likewise, hospitalizations and readmissions showed no significant differences relative to the comparison group.
The analysis featured interviews with ETC participants, end-stage renal disease (ESRD) facilities, and managing clinicians, which found no notable shift in behavior beyond existing practices to increase home dialysis in response to the model’s incentives.
Disparities in kidney disease rates and outcomes based on race and ethnicity are publicly known, and historically significant, particularly for Black, Native American, Asian, and Hispanic individuals. However, the evaluation of the ETC Model did not reveal early detectable patterns of different effects of the model on underserved populations.
Through its initial two years, the ETC Model has yielded minimal results. While home dialysis rates experienced a modest increase, the significance of this improvement attributable to the ETC Model remains questionable, compared to conventional nephrology and kidney care practices. The results illuminate several key concepts that appear to be overlooked in the study findings, reflecting external opinions. Much like other healthcare and disease management models, the focus predominantly lies on addressing logistical interventions towards the later stages of kidney care, attempting to resolve complex and longstanding behavioral and disease process issues, with limited success.
The ETC Model doesn’t stand out in its approach, as efforts primarily concentrate on reducing the cost of care by promoting home dialysis over clinic-based treatments and advocating for transplantation, rather than placing emphasis on preventive measures and enhanced management of ESRD from the outset. The study identifies Social Determinants of Health (SDoH) factors, particularly those related to environmental and supportive services necessary for managing home dialysis, as the primary barriers to its adoption, yet this was only recently added, with no structure to address these key areas other than the well-known SDoH assessment tools released in the last couple of years. Additionally, it highlights that facility and clinician practices under the ETC Model were not notably different from the comparison group, suggesting that the metrics were already standards of practice within the ESRD community. This implies that simply augmenting funding within a fee-for-service disease-based model does not inherently incentivize the transformative change necessary for preventing and managing ESRD patients effectively.
EDITOR’S NOTE: The author of this article used AI-assisted tools in its composition, but all content, analysis, and conclusions were based on the author’s professional
The Centers for Medicare & Medicaid Services (CMS) operates a surveillance platform called the Fraud Prevention System (FPS) that analyzes Medicare claims across the full
Please log in to your account to comment on this article.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s third quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s second quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
