Lessons from ESRD Treatment Choices model can inform future kidney policy

Speaker outlines key takeaways from recent payment models and the future kidney care policy landscape.

Mar. 12, 2026 at 12:48pm

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Suzanne Watnick, MD, FASN, professor of medicine at University of Washington, Seattle, and American Society of Nephrology health policy scholar in residence, outlined lessons from the most recent payment models in nephrology and the future kidney care policy landscape during the Annual Dialysis Conference. She discussed the End-Stage Renal Disease Treatment Choices (ETC) model, the Kidney Care Choices (KCC) model, and upcoming models like the Increasing Organ Transplant Access (IOTA) model and the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model.

Why it matters

The lessons learned from the ETC and KCC models can help inform the development of future value-based kidney care models to improve outcomes for patients with end-stage renal disease. Understanding the policy landscape and getting involved as kidney care professionals can also help shape the direction of these new models.

The details

The ETC model, which began in 2021, mandated about 30% of dialysis facilities and nephrology practices to increase home dialysis and transplantation rates for Medicare beneficiaries with end-stage kidney disease. However, analyses showed no significant improvements in the desired outcomes, leading to the model's early termination. In contrast, the voluntary KCC model saw increases in preemptive kidney transplants, living donor transplants, home dialysis use, and decreased catheter use, but at a net loss of $300 million for Medicare.

  • The ETC model began in January 2021 and was terminated at the end of 2025.
  • The KCC model will continue through 2027 after revisions by CMS.
  • The IOTA model began on July 1, 2026.
  • The ACCESS model was announced in December 2026.

The players

Suzanne Watnick, MD, FASN

Professor of medicine at University of Washington, Seattle, and American Society of Nephrology health policy scholar in residence.

End-Stage Renal Disease Treatment Choices (ETC) model

A payment model that mandated about 30% of dialysis facilities and nephrology practices to increase home dialysis and transplantation rates for Medicare beneficiaries with end-stage kidney disease.

Kidney Care Choices (KCC) model

A voluntary care model that focused on incentivizing optimal dialysis starts and kidney transplant payment bonuses, leading to improvements in quality of care but a net loss of $300 million for Medicare.

Increasing Organ Transplant Access (IOTA) model

A new model that began on July 1, 2026, mandating that 50% of all U.S. transplant centers increase transplantation rates, lower kidney discard rates, and increase long-term transplant survival.

Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model

A new model announced in December 2026 that will focus on implementing new and emerging technologies for patients with Medicare fee-for-service, including in the cardio-kidney-metabolic disease and early cardio-kidney-metabolic disease tracks.

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What they’re saying

“Nephrologists have to understand how these models work and why they're so important.”

— Suzanne Watnick, MD, FASN, Professor of medicine at University of Washington, Seattle, and American Society of Nephrology health policy scholar in residence (Healio)

“People feel that they can't do a lot individually, but there is really so much we can do. You can have separate meetings with your local state representative and senator at local offices. If we do that and get our members of Congress to sign on to bills, those lists get longer on both sides of the aisle. You can get a bill passed that way.”

— Suzanne Watnick, MD, FASN, Professor of medicine at University of Washington, Seattle, and American Society of Nephrology health policy scholar in residence (Healio)

What’s next

The Expanding Remote Monitoring Access Act and the Honor Our Living Donors (HOLD) Act are two bills currently being proposed in Congress that could impact future kidney care models.

The takeaway

The lessons learned from the ETC and KCC models, as well as the policy landscape for new kidney care models, highlight the need for kidney care professionals to get involved and engage with policymakers to shape the future of kidney care and improve outcomes for patients with end-stage renal disease.