ETC Model
CMS continues to incentivize the use of home therapies through regulatory reform, with finalization of the ESRD treatment choices (ETC) model
ETC model incentivizes the use of Home Therapies by offering financial incentives to clinicians and providers1,2
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
- Selected facilities and managing clinicians to participate in model from approximately 30% of the US ESRD providers
- One of first CMS models to directly address health equity and social determinants of health
ETC is a mandatory model
- ETC requires facilities and clinicians in selected HRRs 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
ETC Model – The Facts2,3
- The ETC Model applies to 30% of the adult ESRD patient population (Medicare Traditional beneficiaries only)
- There are two types of payment adjustments applicable to facilities and managing clinicians.
- Home Dialysis Payment Adjustment (HDPA) – positive adjustments applied to the Facility PPS and Clinician MCP payments for driving home therapy use
- 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)
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
Reimbursement under ETC Model2
- Measurement Year 2 (MY2) and Year 3 (MY3) are currently underway
- Resulting reimbursement adjustment from MY1 started in July 2022
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
- Performance achievement vs facilities/practices in like non selected HRR (Achievement score) OR
- 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
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 | |