Key facts about PD reimbursement and ETC

The ETC model is already a reality

The Centers for Medicare & Medicaid Services (CMS) continues to offer incentives for home therapy1

  • All dialysis modalities are reimbursed at the same prospective payment system (PPS) per-treatment payment rate, PD benefits under the bundle
  • The three-month waiting period for Medicare coverage is waived if patients choose home therapy over HD

How PD provides financial benefit to the healthcare system2

Average patient Average ICHD patient Average PD patient Net change ICHD vs.
PD patient
Number of reporting facilities NA 5,000 2,200 NA
Average revenue
per Medicare beneficiary year
$41,000 $41,000 $42,000 $1.000
Average cost
per Medicare beneficiary year
$41,000 $42,000 $37,000 ($5,000)
Average margin
per Medicare beneficiary year
$200 ($800) $5,700 $6,500
% margin
per Medicare beneficiary year
0.5% (2.0%) 13% 15%

Adapted from The Moran Company of Analysis 2014. Medicare Institutional Costs Reports submitted from over 4,750 chronic dialysis facilities.

The ETC model is already a reality

With Measurement Year 1 starting in January 2021, the ESRD Treatment Choices (ETC) model is well underway. ETC is a mandatory model that encourages greater use of home dialysis and kidney transplants by incentivizing dialysis facilities and clinicians to work with patients on the choice of treatment modality.  

ETC Calculator screen

How will the model impact your reimbursement?

Baxter’s ETC Calculator will help you understand how this payment model uses census data to calculate MPS points and ultimately reimbursement. The calculator provides useful information for scenario planning and only requires a few basic inputs. 

Do you know how ETC impacts your reimbursement?

There are two types of payment adjustments that arise from the ESRD Therapy Choices (ETC) Model




Home Dialysis



Chart showing home dialysis payment adjustment

Home Dialysis Payment Adjustment (HDPA) – positive adjustments applied for driving home therapy use1​. Dialysis Facilities and Managing Clinicians in the selected HRRs can earn the HDPA by caring for new and existing patients utilizing a home therapy HDPAs are currently adding 3% reimbursement for qualifying home patients








+4% -5% 

PPA can ADD +4% or SUBTRACT -5% on 2022 reimbursement for ALL qualifying HOME & ICHD PATIENTS. The magnitude of the reimbursement impact will escalate throughout the course of the model to ADD +8% or SUBTRACT -10%

PPA Measurement and payment schedule

Performance Payment Adjustment (PPA) – Positive or negative reimbursement adjustments to the Facility Bundle PPS and Clinician MCP payments are applied to all qualifying traditional Medicare dialysis patients (ICHD, PD and HHD)1

Baxter’s ETC Calculator will show your current reimbursement trajectory and how it can be adjusted with scenario planning. 

Reimbursement impact can be viewed by payment period, or on an annualized basis with the PPA and HDPA portions split out.

Alarm clock illustration


PPA Measurement Year 1 began in January 2021

Need additional support on the ETC Model, PD therapy or PD products?

Call 1-800-284-4060 for your local Baxter representative who can provide resources that help you grow your PD program or for more information email [email protected]