Cohort study reveals voluntary kidney models boost home dialysis use among dialysis patients, indicating no synergistic effect from overlapping mandatory model participation.
Key Points
To determine whether simultaneous participation by nephrologists in mandatory and voluntary value-based kidney care models is associated with greater home dialysis use compared with participation in either model alone or neither model.
Cohort study analyzing 100% of traditional Medicare claims for beneficiaries with end-stage renal disease receiving dialysis premodel (2016-2020) vs postmodel (2022-2023) implementation.
Categorized nephrologists into 4 groups: mandatory ESRD Treatment Choices (ETC) only (n = 839 [14.4%]), voluntary Kidney Care Choices (KCC) only (n = 1798 [30.9%]), both models (n = 1124 [19.3%]), and neither model (n = 2059 [35.4%]).
Participation in the mandatory ETC model only was not associated with changes in home dialysis use among attributed patients compared with neither model.
Participation in KCC only was associated with an 8.4% relative increase (95% CI, 3.0%-13.8%; 0.95 percentage points [pp]; 95% CI, 0.34-1.56 pp) and dual participation with an 11.8% relative increase (95% CI, 5.0%-18.6%; 1.29 pp; 95% CI, 0.55-2.03 pp) in home dialysis use compared with neither model.
Dual participation yielded increases in home dialysis use that did not significantly differ from KCC participation alone (incremental increase, 0.34 pp; 95% CI, -0.37 to 1.05 pp; P = .34).