CMS’ Financial Incentives May Not Be Enough to Encourage Home Dialysis
Financial incentives to encourage home dialysis may be failing to produce its intended effect, according to a first-year analysis of Medicare’s End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model. This model is a multi-year, mandatory participation program created and implemented by U.S. Center for Medicare & Medicaid Innovation
A random clinical trial was conducted, which included a primary outcome of the percentage of patients with ESRD who received any home dialysis during the first 90 days of treatment and a secondary outcome which included other measures of home dialysis and patient volume and characteristics. The participants included 18,621 ESRD patients who were initially started on dialysis within the 302 eligible hospital referral regions. Of the 302 eligible hospital referral regions (HRRs), 91 regions were randomly assigned to the treatment group and 211 regions were assigned to the control group.
Based on results of the trial, the primary outcome concluded the mean percentage of new patients with home dialysis in the first 90 days of treatment increased by a “non-significant” 0.12 percent. In addition, there were no significant secondary outcomes between the two groups regarding the average percentage of weeks a patient received home dialysis, and the number of home dialysis sessions during the first 90 days.
According to the corresponding author, “This raises questions about the efficacy of the financial incentives in the model and suggests that higher incentives may be necessary to affect behavioral change by dialysis clinicians and facilities. Further evaluation is needed as these incentives increase in subsequent program years.”
