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Implementing the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model for CMS


  • A mandatory payment model with participants randomly selected across the 50 States and District of Columbia
  • Encourage greater use of home dialysis and kidney transplants for Medicare ESRD beneficiaries
  • The first CMS Innovation Center model to directly address health equity
The Challenge

The Centers for Medicare & Medicaid Services (CMS) developed the ESRD Treatment Choices (ETC) Model to encourage greater use of home dialysis and kidney transplants for Medicare ESRD beneficiaries, while reducing Medicare expenditures and improving quality of care. The ETC Model also aims to reduce health and socioeconomic disparities among Medicare ESRD beneficiaries. With our partners, Abt provides technical and operational support to CMS for the ETC Model related to the following areas: benchmark and performance rate calculations, development and maintenance of quality measures, as well as rulemaking support.

The Approach

We use data from Medicare Fee-For-Service claims, Medicare administrative data, and the Scientific Registry of Transplant Recipients to calculate home dialysis and transplant rates for benchmarking and scoring of ETC Participants’ performance. We assist CMS with making Medicare payment adjustments based on benchmarks and performance scores of ETC Participants. We also utilize Abt’s CommentCounts tool to help CMS collecting, tracking, and responding to public comments received on the proposed rules.

The Results

There are about 7,200 ESRD facilities and 2,300 Managing Clinicians enrolled in Medicare, providing care for over 383,000 ESRD beneficiaries that are eligible to be included the ETC Model. About 30 percent of the ESRD facilities and Managing Clinicians in the U.S. were selected to participate in the ETC Model. The Model began on January 1, 2021 and ends on June 30, 2026. Prior to the Model started, both home dialysis and kidney transplant rates were far below many of the developed countries. The ETC Model was estimated to generate $23 million in net Medicare savings.