Improving Dialysis and Transplantation: Assessing the Impact of the End-Stage Renal Disease Treatment Choices (ETC) Model

Improving Dialysis and Transplantation: Assessing the Impact of the End-Stage Renal Disease Treatment Choices (ETC) Model

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.

Home Dialysis Growth and Related Measures

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.

Waitlisting and Transplantation

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.

Medicare Spending and Utilization

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.

Patient Behavior

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.

Health Equity

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.

Conclusion and Future Implications

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.

Print Friendly, PDF & Email

Tiffany Ferguson, LMSW, CMAC, ACM

Tiffany Ferguson is CEO of Phoenix Medical Management, Inc., the care management company. Tiffany serves on the ACPA Observation Subcommittee. Tiffany is a contributor to RACmonitor, Case Management Monthly, and commentator for Finally Friday. After practicing as a hospital social worker, she went on to serve as Director of Case Management and quickly assumed responsibilities in system level leadership roles for Health and Care Management and c-level responsibility for a large employed medical group. Tiffany received her MSW at UCLA. She is a licensed social worker, ACM, and CMAC certified.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Frank Cohen shows you how to leverage the Comprehensive Error Rate Testing Program (CERT) to create your own internal coding and billing risk assessment plan, including granular identification of risk areas and prioritizing audit tasks and functions resulting in decreased claim submission errors, reduced risk of audit-related damages, and a smoother, more efficient reimbursement process from Medicare.

April 9, 2024
2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
Mastering Healthcare Refunds: Navigating Compliance with Confidence

Mastering Healthcare Refunds: Navigating Compliance with Confidence

Join healthcare attorney David Glaser, as he debunks refund myths, clarifies compliance essentials, and empowers healthcare professionals to safeguard facility finances. Uncover the secrets behind when to refund and why it matters. Don’t miss this crucial insight into strategic refund management.

February 29, 2024
2024 SDoH Update: Navigating Coding and Screening Assessment

2024 SDoH Update: Navigating Coding and Screening Assessment

Happy World Health Day! Our exclusive webcast is just $99 for a limited time! Use code WorldHealth24 at checkout before April 12th to claim this discount.

Dive deep into the world of Social Determinants of Health (SDoH) coding with our comprehensive webcast. Explore the latest OPPS codes for 2024, understand SDoH assessments, and discover effective strategies for integrating coding seamlessly into healthcare practices. Gain invaluable insights and practical knowledge to navigate the complexities of SDoH coding confidently. Join us to unlock the potential of coding in promoting holistic patient care.

May 22, 2024
2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

HIM coding expert, Kay Piper, RHIA, CDIP, CCS, reviews the guidance and updates coders and CDIs on important information in each of the AHA’s 2024 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 15, 2024

Trending News

Happy World Health Day! Our exclusive webcast, ‘2024 SDoH Update: Navigating Coding and Screening Assessment,’  is just $99 for a limited time! Use code WorldHealth24 at checkout.

SPRING INTO SAVINGS! Get 21% OFF during our exclusive two-day sale starting 3/21/2024. Use SPRING24 at checkout to claim this offer. Click here to learn more →