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Abstract: TH-PO900

An Early Look at the ESRD Treatment Choices (ETC) Payment Model's Impact on Organ Procurement and Transplant Network (OPTN) Medicare Kidney Transplant Waitlist Additions

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical


  • Placona, Andrew, United Network for Organ Sharing, Richmond, Virginia, United States
  • Shean, Brittany R., United Network for Organ Sharing, Richmond, Virginia, United States

Beginning on January 1st, 2021, CMS randomly assigned 30% of Health Referral Regions (HRR) to the ETC payment model. This payment model links dialysis reimbursements to two metrics, home dialysis and the transplant rate. The definition of transplant rate includes the proportion of a dialysis provider’s attributed patients on the kidney transplant waitlist. Our objective was to determine if the ESRD Treatment Choices (ETC) payment model was associated with an increased number of Medicare kidney registrations.


We obtained the data for all kidney waitlist additions between 2016 and 2021 from the OPTN database, the participating ETC sites data from CMS, and the zip code to HRR crosswalk from the Dartmouth Atlas. We utilized the archival transplant program-specific report data from the SRTR. We utilized the candidate's reported zip code and the Darthmouth Atlas' zip code to HRR crosswalk to create a panel dataset where the unit of analysis was a HRR for each year from the OPTN registration data. The dependent variable was the logarithmic transformation of the number of Medicare waitlist additions. The dependent variable was regressed on lagged waitlist additions, lagged size of the waitlist, one-year graft survival performance for the dominant transplant center the year prior, and percent Medicare in the HRR utilizing a difference-in-difference design via the first difference estimator.


Our sample included 237,850 total additions (106,626 Medicare) between 2016 and 2021. The ETC program was associated with a 6.60% increase in the change of (95 CI: 1.16% to 12.0%, p =.018) Medicare kidney transplant registrations.


The first year of ETC program resulted in faster growth in Medicare kidney transplant registrations in areas affected by the new payment policy


  • Other U.S. Government Support