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ETC Model

CMS continues to incentivize the use of home therapies through regulatory reform, with finalization of the ESRD treatment choices (ETC) model

Chart showing timeline of home therapies

ETC model incentivizes the use of Home Therapies by offering financial incentives to clinicians and ESRD facilities1,2

ETC Model – Overview2,3

Policies to encourage greater home and transplant utilization

The ETC has 3 goals:

  • Encourages greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD
  • 30% of US clinicians and ERSD facilities selected to participate
  • One of CMS's first models to directly address health equity 

ETC is a mandatory model

  • ETC requires facilities and clinicians in selected Hospital Referral Regions (HRR) to meet increasing home dialysis and transplant targets
  • ETC has 2 reimbursement components
  • HDPA: Positive reimbursement adjustment applicable to Home Patients for driving home therapy use (2021-2023)
  • PPA: Positive or negative reimbursement adjustments applicable to ALL Patients when driving home therapy use and transplant (2022-2027)
Final Rule of the Mandatory ETC Model Published September 2020 Upheld These Goals
Patients looking at digital tablet

ETC Model – The Facts2,3

There are two types of payment adjustments applicable to facilities and managing clinicians. 

  1. Home Dialysis Payment Adjustment (HDPA) – positive adjustments applied to the Facility PPS and Clinician MCP payments for driving home therapy use 
  2. Performance Payment Adjustment (PPA) – Positive or negative reimbursement adjustments to the Facility PPS and Clinician MCP payments are applied to all qualifying traditional Medicare Primary dialysis patients (ICHD, PD and HHD) for driving home therapy use and transplantation 
  • ETC Model is a 6.5 year model effective on January 1, 2021 through June 30, 20272
  • The Kidney Disease Education (KDE) benefit allows more of the nephrologist’s clinical staff to provide the sessions and more patients to receive them (CKD Stage V and the first 6 months of ESRD), in addition to CKD Stage IV)

Payment Adjustments

ETC HDPA Home Dialysis Payment Adjustment

Positive adjustments applied for growing home therapy use

ETC PAA Performance Payment Adjustment

Positive and negative adjustments applied for growing home therapy use (including self-care dialysis @ 50%) and transplant (including waitlist)

Hospital Referral Regions in the ETC Model

Map showing Hospital Referral Regions in the ETC Model

Reimbursement under ETC Model2

- Measurement Year 2 (MY2) and Year 3 (MY3) are currently underway

- Resulting reimbursement adjustment from MY1 started in July 2022

chart showing Performance Payment Adjustments (PPA) Measurement and Payment Schedule

Each measurement year becomes your benchmark in future measurement years

Clinician monthly capitation PPA overview2,3

Performance Payment Adjustments (PPA) Overview2

  • Positive or negative reimbursement adjustments to the Facility Prospective Payment Systems (PPS) and Clinician Monthly Capitation Payment (MCP) applied to all qualifying traditional Medicare dialysis patients (ICHD, PD and HHD) and based on home dialysis and transplant utilization.
  • Performance is scored based on 
  1. Performance achievement vs facilities/practices in like non selected HRR (Achievement score) OR
  2. Performance improvement for measurement year vs. your own facility/ practice scoring from the related benchmark year (Improvement score)
  • You can score a maximum of 6 points under the PPA: 4 for home dialysis + 2 for transplant
Healthcare Professionals in discussion

Financial Impact for clinicians2,4

Final Managing Clinician PPA Amounts and Schedule

Achievement and Improvement Score Scale
MPS 1 and 2 3 and 4 5 and 6 7 and 8 9 and 10
Clinical Performance Payment Adjustment ≤6 +4.0% +5.0% +6.0% +7.0% +8.0%
≤5 +2.0% +2.5% +3.0% +3.5% +4.0%
≤3.5 +0.0% +0.0% +0.0% +0.0% +0.0%
≤2 -2.5% -3.0% -3.5% -4.0% -4.5%
≤0.5 -5.0% -6.0% -7.0% -8.0% -9.0%

Managing Clinician Financial Impact12

Impact on a Clinical Practice with 100 Medicare Qualifying Patients - Annually
MPS 1 and 2 3 and 4 5 and 6 7 and 8 9 and 10
Adjustment to 2022 Clinician MCP Annually Impact - $354.90/mo. (90%HD/10%PD) ≤6 $17,035 $21,294 $25,553 $29,812 $34,070
≤5 $8,518 $10,647 $12,776 $14,906 $17,035
≤3.5 $0 $0 $0 $0 $0
≤2 -$10,647 -$12,776 -$14,906 -$17,035 -$19,165
≤0.5 -$21,294 -$25,553 -$29,812 -$34,070 -$38,329

Related Pages

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PD is cost-effective and offers significant financial benefits

Cost Effective and Reduced Hospitalization

Next page

Prioritize PD for the majority of patients, regardless of age, race or socio-economic background, by offering equal access to treatment options and patient support services

Equal Access
References

  1. ESRD Treatment Choices (ETC) Model. Centers for Medicare & Medicaid Services. . Accessed August 14, 2021. 

  2. CMS Calendar Year 2024 Medicare Physician Fee Schedule.

  3. Department of Health & Human Services, Center for Medicare & Medicaid Services, 42 CFR Parts 412, 413, and 512, 2022 ESRD Final Ruling, November 8, 2021.

  4. Department of Health & Human Services, Center for Medicare & Medicaid Services, , Medicare Program CY 2024 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies, November 19, 2021.