New US financial incentive fails to increase rates of home dialysis

The financial incentives offered by a recent US government programme for hospitals and clinicians to utilise home dialysis for end-stage kidney disease (ESKD) have not caused statistically significant changes in usage of the treatment. This is the conclusion of a study published by Yunan Ji (Georgetown University, Washington DC, USA) and colleagues to the JAMA Health Forum last month.

Estimates suggest that 85% of Medicare patients with ESKD are eligible for home dialysis, which is cheaper and equally or more effective than facility dialysis, but only 12.6% of those actually receive it. In an effort to increase this number to a target of 80%, the US Centre for Medicare and Medicaid Innovation (CMMI) employed a new payment incentive system, the End-Stage Renal Disease Treatment Choice (ETC) programme, to encourage clinicians to adopt home dialysis.

The ETC incentive system works through two methods. The first increases the reimbursement rate for home dialysis in the first three years of the programme, while the other increases or decreases the rate for home and facility treatment based on the rate of home dialysis and treatment. The authors of the study followed the ETC specifications with some minor adjustments to eligibility criteria.

In the randomised clinical trial, researchers examined the statistics from 302 hospital referral regions (HRRs) in the USA, including 91 randomised to the treatment group where financial incen-