ETC
End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model
The End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model is a mandatory model intended to encourage greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD. It aims to reduce Medicare expenditures while preserving or enhancing the quality of care. The model provides additional support to health care providers treating dually eligible beneficiaries and those receiving Low-Income Subsidy assistance.
Innovation
Applies two types of payment adjustments: a uniformly positive adjustment on Medicare claims for home dialysis during the initial three years, and a positive or negative adjustment to the per treatment payment for dialysis based on the rate of home dialysis and transplant rate.
The Problem
Many patients with end-stage renal disease do not receive education about their treatment options, including home dialysis or kidney transplants. The rate of home dialysis in the U.S. falls far below other developed nations, and transplant rates are also comparatively low.
The Solution
CMS makes payment adjustments to encourage participating ESRD facilities and Managing Clinicians to ensure beneficiaries have access to and receive education about their kidney disease treatment options, specifically home dialysis and transplants.
Expected Outcomes
Patients have greater independence and flexibility by receiving home dialysis and have longer, healthier lives resulting from a kidney transplant. The model also aims to reduce Medicare expenditures and preserve or enhance quality of care.
Strategy
Aligns with the CMS Innovation Center’s statutory mandate to protect taxpayers and help Americans live healthier lives.
Model Goals
- Encourage greater use of home dialysis and kidney transplants
- Reduce Medicare expenditures
- Preserve or enhance the quality of care furnished to beneficiaries with ESRD
- Give ESRD beneficiaries the freedom and choice of ESRD treatment that best works with their lifestyles
Patient Eligibility
Medicare beneficiaries with End-Stage Renal Disease (ESRD).
- Adult ESRD beneficiaries
- Attributed on a month-by-month basis to the ESRD facility accounting for the most dialysis claims and the Managing Clinician billing the first MCP for the month
Provider Eligibility
ESRD facilities and Managing Clinicians located in randomly selected geographic areas.
- Located in randomly selected geographic areas accounting for approximately 30 percent of ESRD facilities and Managing Clinicians in the 50 States and D.C.
- Includes facilities and clinicians in Maryland
- Excludes certain facilities and clinicians serving low volumes of adult ESRD beneficiaries
- Managing Clinician must be a Medicare-enrolled physician or non-physician practitioner who furnishes and bills the monthly capitation payment (MCP) for managing adult ESRD beneficiaries
Care Categories
Nephrology
CMS Benchmarks & Thresholds
financial
operational
population
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