Association of the End-Stage Renal Disease Treatment Choices Payment Model With Home Dialysis Use at Kidney Failure Onset From 2016 to 2022

Johansen, Kirsten L.; Li, Shuling; Liu, Jiannong; Weinhandl, Eric D.; Gilbertson, David T.; Kou, Iris; Knapp, Christopher D.; Wetmore, James B.

doi:10.1001/jamanetworkopen.2023.0806

Cited by 12 publications

(8 citation statements)

References 6 publications

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“…Whether financial incentives encourage physicians to increase prescription of home dialysis is uncertain 26 ; early analyses of the ETC model suggest a modest effect. 27,28 The costs of operating a home dialysis program are driven by staff and supply costs, including machines, dialysate, and disposable supplies. Ongoing contractual negotiations with home dialysis device and supply manufacturers are needed to ensure financial sustainability, to maintain a reliable supply chain, and to arrange additional support services.…”

Section: Economicsmentioning

confidence: 99%

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Setting Up Home Dialysis Programs

Abra,

Weinhandl,

Hussein

2023

CJASN

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Home dialysis utilization has been growing in the United States over the past decade but still lags behind similar socioeconomic nations. More than half of dialysis facilities in the United States either are not licensed to offer home dialysis or, despite a license, have no patients dialyzing at home and many programs have a relatively small census. Multiple stakeholders including patients, healthcare providers and payers have identified increased home dialysis use as in important goal. In order to realize these goals nephrologists and kidney care professions need a sound understanding of the key considerations in home dialysis center operation. In this review, we outline the core domains required to set up and operate a home dialysis program in the United States now and in the future.

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Section: Economicsmentioning

confidence: 99%

“…Whether financial incentives encourage physicians to increase prescription of home dialysis is uncertain 26 ; early analyses of the ETC model suggest a modest effect. 27,28…”

Section: Patient Trainingmentioning

confidence: 99%

Setting Up Home Dialysis Programs

Abra,

Weinhandl,

Hussein

2023

CJASN

Self Cite

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“…11 A recent analysis explicates the financial incentives of the ESRD Treatment Choices Model, which appear to have successfully increased home dialysis use and initiation. 12 These innovative models served as a call for valuebased care (VBC) in the nephrology community. Yet despite their benefit enhancements, aligned incentives, and impact potential, emerging kidney care models remain in an early stage of development.…”

Section: Introductionmentioning

confidence: 99%

“…Most prominently, the Model challenged the kidney care industry's status quo of in‐center dialysis and delayed transplantation—standards which adversely impact patient quality of life and health system cost burden 11 . A recent analysis explicates the financial incentives of the ESRD Treatment Choices Model, which appear to have successfully increased home dialysis use and initiation 12 …”

Section: Introductionmentioning

confidence: 99%

Chronic kidney disease and value‐based care: Lessons from innovation, iteration, and ideation in primary care

Berman,

Lowentritt

2023

Hemodialysis International

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Value‐based primary care has reduced health care costs, improved the quality of rendered care, and enhanced the patient experience. Value‐based care emphasizes prevention, outreach, follow‐up, patient engagement, and comprehensive, whole‐person health. Primary care Accountable Care Organizations have leveraged technology‐enabled workflows, practice transformation, and cutting‐edge data and analytics to achieve success. These efforts are increasingly aided by predictive modeling used in the context of patient identification and prioritization algorithms. Value‐based kidney care programs can glean salient takeaways from successful value‐based primary care methods and models. The kidney care community is experiencing unprecedented transformation as novel payer programs and financial models burgeon. The authors contend these efforts can be accelerated by the adoption of techniques honed in value‐based primary care. To optimize value‐based kidney care, though, nephrology thought leaders must transcend the archetype of value‐based primary care. To do so, the nephrology community must: (1) impel behavioral change among fee‐for‐service adherents; (2) harness emerging policy, guidelines, and quality measures; (3) adopt innovative tools, technologies, and therapies. In aggregating lessons from value‐based primary care—and leveraging novel methodologies and approaches—the kidney care community will be better equipped to achieve the quadruple aim for kidney care.

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“…2 The ETC is among the largest randomized tests of pay-for-performance incentives ever conducted in the US. Two prior evaluations have reported that the ETC model was associated with an increase 11 (among all adult incident patients) or no change 12 (among incident traditional Medicare beneficiaries ≥66 years) in home dialysis use. No prior study has examined the consequences of the ETC model on equity in kidney failure treatment.…”

mentioning

confidence: 99%

Social Risk and Dialysis Facility Performance in the First Year of the ESRD Treatment Choices Model

Koukounas,

Thorsness,

Patzer

et al. 2024

JAMA

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ImportanceThe End-Stage Renal Disease Treatment Choices (ETC) model randomly selected 30% of US dialysis facilities to receive financial incentives based on their use of home dialysis, kidney transplant waitlisting, or transplant receipt. Facilities that disproportionately serve populations with high social risk have a lower use of home dialysis and kidney transplant raising concerns that these sites may fare poorly in the payment model.ObjectiveTo examine first-year ETC model performance scores and financial penalties across dialysis facilities, stratified by their incident patients’ social risk.Design, Setting, and ParticipantsA cross-sectional study of 2191 US dialysis facilities that participated in the ETC model from January 1 through December 31, 2021.ExposureComposition of incident patient population, characterized by the proportion of patients who were non-Hispanic Black, Hispanic, living in a highly disadvantaged neighborhood, uninsured, or covered by Medicaid at dialysis initiation. A facility-level composite social risk score assessed whether each facility was in the highest quintile of having 0, 1, or at least 2 of these characteristics.Main Outcomes and MeasuresUse of home dialysis, waitlisting, or transplant; model performance score; and financial penalization.ResultsUsing data from 125 984 incident patients (median age, 65 years [IQR, 54-74]; 41.8% female; 28.6% Black; 11.7% Hispanic), 1071 dialysis facilities (48.9%) had no social risk features, and 491 (22.4%) had 2 or more. In the first year of the ETC model, compared with those with no social risk features, dialysis facilities with 2 or more had lower mean performance scores (3.4 vs 3.6, P = .002) and lower use of home dialysis (14.1% vs 16.0%, P &lt; .001). These facilities had higher receipt of financial penalties (18.5% vs 11.5%, P &lt; .001), more frequently had the highest payment cut of 5% (2.4% vs 0.7%; P = .003), and were less likely to achieve the highest bonus of 4% (0% vs 2.7%; P &lt; .001). Compared with all other facilities, those in the highest quintile of treating uninsured patients or those covered by Medicaid experienced more financial penalties (17.4% vs 12.9%, P = .01) as did those in the highest quintile in the proportion of patients who were Black (18.5% vs 12.6%, P = .001).ConclusionsIn the first year of the Centers for Medicare &amp; Medicaid Services’ ETC model, dialysis facilities serving higher proportions of patients with social risk features had lower performance scores and experienced markedly higher receipt of financial penalties.

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Association of the End-Stage Renal Disease Treatment Choices Payment Model With Home Dialysis Use at Kidney Failure Onset From 2016 to 2022

Cited by 12 publications

References 6 publications

Setting Up Home Dialysis Programs

Setting Up Home Dialysis Programs

Chronic kidney disease and value‐based care: Lessons from innovation, iteration, and ideation in primary care

Social Risk and Dialysis Facility Performance in the First Year of the ESRD Treatment Choices Model

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