Home dialysis initiation marginally increased after implementation of The Centers for Medicare & Medicaid Services End-Stage Renal Disease Treatment Choices (ETC) payment model in January 2021. The ETC grants financial incentives or penalties to mandated providers, such as dialysis facilities and nephrologists.

In the study of 750,314 adults with chronic kidney disease, use of home dialysis increased 1.0% more in markets randomly assigned to ETC vs not assigned, Kirsten L. Johansen, MD, of Hennepin Healthcare System Inc in Minneapolis, Minnesota, and colleagues reported in JAMA Network Open. However, the annual rate of increase did not differ significantly between groups.

Home dialysis use in the US overall increased from 10.0% in January 2016 to 17.4% in June 2022. The annual rate of adoption increased from 0.86% to 1.66% per year.

Continue Reading

According to the investigators, “these clinically relevant and statistically significant early increases in home dialysis initiation after ETC implementation are clearly not large enough to achieve ambitious targeted increases in home dialysis use by the end of the payment model in 2027.”

Of the cohort, 31.2% received care from providers assigned to mandatory ETC participation. A third of patients overall had Medicare fee-for-service coverage. The cohort comprised 26.2% Black patients, 17.4% Hispanic patients, and 49.1% White patients. Half of patients were aged 65 years or older.

These results extend an earlier report to 18 months of ETC follow-up and to all patients initiating dialysis with all payers.

“Immediate increases in home dialysis use suggest that professionals providing nephrology services responded to financial bonuses by increasing use of home dialysis, but it will be important to monitor whether this increase continues when the incentive structure changes to performance payment adjustments,” the investigators wrote.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Johansen KL, Li S, Liu J, et al. Association of the end-stage renal disease treatment choices payment model with home dialysis use at kidney failure onset from 2016 to 2022. JAMA Netw Open. Published online on February 27, 2023. doi:10.1001/jamanetworkopen.2023.0806