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Kidney Week

Abstract: PO1242

Home Dialysis and Kidney Transplant Assessments in the ESRD Treatment Choices Payment Model

Session Information

  • Home Hemodialysis
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 702 Dialysis: Home Hemodialysis


  • Kubisiak, Kristine, Fresenius Medical Care, Waltham, MA, Bouvet Island
  • Weinhandl, Eric D., Fresenius Medical Care, Waltham, MA, Bouvet Island
  • Dalrymple, Lorien S., Fresenius Medical Care, Waltham, MA, Bouvet Island
  • Kossmann, Robert J., Fresenius Medical Care, Waltham, MA, Bouvet Island

The End Stage Renal Disease (ESRD) Treatment Choices (ETC) Model is a proposed mandatory payment model that assigns financial bonuses and penalties to dialysis facilities as a function of home dialysis prevalence and kidney transplant incidence among patients with Medicare fee-for-service coverage. We used claims data to estimate distributions of facility-level home dialysis prevalence and kidney transplant incidence.


Using Medicare Limited Data Sets, we identified all Part B claims for outpatient dialysis for the treatment of ESRD in 2017. In each dialysis facility with ≥132 adult patient-months, we estimated the percentage of patient-months with any home dialysis treatment. Using Part A claims in 2017, we also estimated the number of kidney transplants among dialysis patients in the facility.


We identified 6263 dialysis facilities and 3,645,655 dialysis patient-months. Overall home dialysis prevalence was 10.8%. The distribution of facility-level home dialysis prevalence exhibited three features, as displayed: (1) over 54% of facilities with exactly 0% home dialysis prevalence; (2) among facilities with any home dialysis utilization, a unimodal distribution with peak prevalence near 12%; and (3) a small subset of facilities (4%) with home dialysis prevalence >90%. Regarding kidney transplant incidence, over half of facilities had ≤1 transplant. The 75th and 90th percentiles of transplant count were 2 and 4, respectively.


In patients with Medicare fee-for-service coverage, facility-level home dialysis prevalence exhibits a nonnormal distribution, while kidney transplant incidence typically manifests few (or no) events per year. Both patterns will complicate statistical analysis of performance in the ETC model. Alternative methodology should consider assessments in regional clusters of facilities.


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