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ESRD Treatment Choices

What is this?

ESRD Treatment Choices (ETC) is a new payment model that the Centers for Medicare & Medicaid Services (CMS) launched in January 2021. The purpose of ETC is to increase the percentage of patients undergoing dialysis who (1) utilize home dialysis and (2) are waitlisted for a kidney transplant and/or receive a living donor kidney transplant.

Is provider participation in ETC mandatory or voluntary?

Participation in ETC is mandatory for all outpatient dialysis facilities and all nephrology providers who reside within 95 Hospital Referral Regions (HRRs) throughout the United States:

US map of HRRs that are participating in ETC.

For dialysis facilities and nephrology providers in the remaining 211 HRRs, ETC will have no direct effect on operations.

Which patients are included?

Original Medicare (fee-for-service) beneficiaries of adult age who are undergoing maintenance dialysis for the treatment of end stage renal disease.

Achievement Benchmarks in ETC Model

Year 1 - (January 1, 2021 – December 31, 2021)


The downloadable file below includes, for each Hospital Referral Region, the percentage of all dialysis patients utilizing a home dialysis modality on December 31, 2018 and the percentage of all patients aged <75 years who were registered on the kidney transplant waiting list during 2018. These statistics were tabulated from the Dialysis Facility Repots for Fiscal Year 2020. Although the specifications in the Dialysis Facility Reports are not the same as the specifications in ETC, these statistics can provide a general sense of relative performance in each region.

Dataset constructed from Dialysis Facility Reports (public use file) | Download


  • ESRD Treatment Choices Are Here! | CDRG Blog
  • ETC: The Final Solution Has Arrived | Part I | Part II
  • The Wrong Way to Design a Medicare Mandatory Demonstration | Op-Ed
  • Changes to ESRD Treatment Choices model carry some risk for providers | Article

Contact Us

The Chronic Disease Research Group can provide expertise and guidance in navigating the new ESRD Treatment Choices; contact us today.

The best scenario includes more kidney transplants and home dialysis and, most important, healthier lives for people with ESRD.

Eric Weinhandl, PhD, MS, Senior Epidemiologist

Contact Us

Chronic Disease Research Group

Hennepin Healthcare Research Institute

701 Park Ave.

Suite S2.100

Minneapolis, MN 55415


Tel: 612.873.6200

Mon-Fri: 8:00 AM - 4:30 PM CT

The Chronic Disease Research Group (CDRG) is a division of the Hennepin Healthcare Research Institute (EIN 1568208), located in Minneapolis, MN.