CMS Ends Largest U.S. Experiment for Incentivizing Home Dialysis and Transplantation

The Centers for Medicare and Medicaid Services (CMS) has decided to end its End-Stage Renal Disease Treatment Choices (ETC) model on December 31, 2025. This decision comes after analyses showed that the ETC model did not succeed in increasing the number of patients receiving home dialysis or transplants. The ETC program was the largest healthcare experiment of its kind in the U.S., involving 30% of the nation's dialysis providers. It aimed to incentivize providers financially to shift more end-stage kidney disease patients toward home dialysis treatments and transplantation processes. Early evaluations, including studies from 2021 and 2024, demonstrated no meaningful impact, with participating providers not achieving higher home dialysis or transplant rates compared to control groups. This outcome suggests challenges in altering care delivery through payment incentives alone in this clinical domain. The termination of the ETC model refocuses attention on alternate strategies to manage end-stage renal disease, such as enhancing patient education, improving infrastructure for home dialysis, and addressing barriers to transplantation access. Going forward, CMS and affiliated providers will need to consider multifaceted approaches involving clinical, operational, and patient engagement improvements to improve patient outcomes and resource utilization in end-stage renal disease care.