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September 24, 2020

New Chronic Kidney Disease Payment Model Approved by CMS

CMS recently released a final rule for the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model. The ETC Model, to be implemented on January 1, 2021, is designed to determine whether an increased use of home dialysis and kidney transplantation will improve the quality of care furnished to Medicare beneficiaries suffering from chronic kidney disease. The final rule shifts Medicare payments from a traditional fee-for-service model to a model where providers are incentivized to encourage home dialysis and kidney transplants. 

Two forms of payment adjustments will apply under the ETC Model. First, the Home Dialysis Payment Adjustment (HDPA) will be a positive adjustment on Medicare claims for home dialysis and home dialysis-related claims. Second, the Performance Payment Adjustment (PPA) could be either a positive or negative adjustment on Medicare claims and will apply to both home and in-center dialysis claims. This value-based payment model is structured to encourage providers to invest in their home dialysis programs.  The ETC Model will also incentivize transplantation by financially rewarding kidney care providers based on their transplant rate.