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Kidney Week

Abstract: PO0953

Characteristics and Treatment Patterns of Dialysis Providers Randomly Assigned to the Medicare ESRD Treatment Choices Model

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis


  • Wilk, Adam S., Emory University, Atlanta, Georgia, United States
  • Drewry, Kelsey M., Emory University, Atlanta, Georgia, United States
  • Wang, Zhensheng, Emory University, Atlanta, Georgia, United States
  • Thorsness, Rebecca, Brown University, Providence, Rhode Island, United States
  • Trivedi, Amal, Brown University, Providence, Rhode Island, United States
  • Patzer, Rachel E., Emory University, Atlanta, Georgia, United States

In January 2021, Medicare’s End-stage Renal Disease Treatment Choices (ETC) model randomly assigned 30% of US dialysis facilities to receive financial bonuses and penalties on the basis of home dialysis use, waitlisting, and living-donor transplantation among their patients, compared with benchmarks from non-ETC-assigned facilities. We assessed whether sampling variance may influence ETC performance assessments by comparing pre-ETC treatment use among ETC-assigned and non-assigned facilities.


We compared rates of transplantation (living and deceased donor transplant, waitlisting) and home dialysis use (peritoneal dialysis, home hemodialysis) at 12 months among patients with incident kidney failure during July 2014-June 2018 in future ETC and non-ETC dialysis facilities (n=7527 facilities, n=192755 patients). In logistic regression models with region random effects and Bonferroni-adjusted robust standard errors, we assessed the adjusted relationships between ETC-assignment and facility characteristics (ownership, home dialysis offerings, staffing), patient case-mix (demographic, clinical, and insurance characteristics; mortality), and area-level socioeconomic status (e.g., median household income).


Prior to ETC implementation, patients in ETC-assigned facilities had 22% (0.71 pp) higher rates of living-donor transplant receipt (p=0.005), 24% (0.89 pp) higher rates of deceased-donor transplant receipt (p<0.001), and 9% (3.3 pp) lower mortality rates (p<0.001) at one year versus in non-assigned facilities. Rates of home dialysis use were similar. Relative to non-assigned dialysis facilities, ETC-assigned facilities were 21% (2.0 pp) more likely to be owned by a small for-profit chain and 16% (5.8 pp) more likely to be owned by the second largest dialysis organization (p<0.001). Adjusting for other factors, dialysis facilities were more likely to be ETC-assigned if their patients were younger and if they had a lower percentage of patients who were Hispanic (both p<0.001).


Due to sampling variance, ETC-assigned facilities may be disproportionately likely to receive bonuses (vs penalties) under the model, even if they do not increase home dialysis treatment and transplant receipt among their patients.


  • NIDDK Support