Evaluating Overlapping Kidney Payment Models
An independent published methods example using 100% Traditional Medicare claims to assess whether overlapping clinician payment-model participation was associated with home dialysis use.
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Source published September 11, 2026 · Resource reviewed October 8, 2026
The research question
When nephrologists participate in the mandatory ESRD Treatment Choices (ETC) model, the voluntary Kidney Care Choices (KCC) model, both, or neither, are their attributed Traditional Medicare dialysis patients more likely to use home dialysis?
Data files and cohort construction
The authors linked 100% Traditional Medicare claims, Master Beneficiary Summary File enrollment, MD-PPAS clinician records, and payment-model rosters for 2016–2023. Adult ESRD dialysis beneficiary-months required Parts A and B without MA. Continuously practicing nephrologists were identified through MD-PPAS and dialysis claims; monthly physician billing assigned patients to nephrologists.
Measures and analytic design
Outpatient revenue and condition codes identified home dialysis. Four participation groups—neither model, ETC only, KCC only, or both—were compared using difference-in-differences: 2016–2020 versus 2022–2023, omitting 2021. Models adjusted for beneficiary characteristics, included year-month indicators, and clustered uncertainty by nephrologist.
Robustness checks and interpretation
Checks assessed pretrends, region and clinician adjustment, logistic specifications, and exclusion of 2016 or 2020. Voluntary participation, the restricted clinician panel, limited follow-up, and exclusion of MA constrain interpretation.
Practical application: make overlapping-program exposure explicit
The following are FastHSR implementation considerations, not additional procedures claimed for the published study. Build a clinician-year table with one mutually exclusive program-exposure value for every period: neither, program A only, program B only, or both. Link the table to a beneficiary-period cohort using a prespecified attribution rule, preserve enrollment eligibility, and calculate outcomes with the same observation window for every group. Present absolute percentage-point changes alongside relative changes.
Decisions to settle before reuse
Document how you assign beneficiaries to clinicians, how you handle clinician entry and exit, and whether an exposure begins at announcement, contract start, or first performance year. Specify the claims codes and timing window for home dialysis before looking at results. If voluntary participation is possible, inspect baseline differences and frame estimates as associations unless a stronger identification strategy is available.
Limitations for a local application
Traditional Medicare claims do not describe the growing MA ESRD population, so results should not be generalized automatically to all dialysis beneficiaries. Claims can identify billed care but may not capture barriers, preferences, or capacity that determine modality choice. A local analysis should also check whether the payment-model roster and participation dates are complete.
Source article and supplement
Tummalapalli SL, Reddy YN, Zhao Y, Bao Y, Zhu J, Navathe AS. Overlap Between Mandatory and Voluntary Value-Based Kidney Care Model Participation and Home Dialysis Use. JAMA Health Forum. 2026;7(9):e263046. doi:10.1001/jamahealthforum.2026.3046.
The full article and supplement listing were reviewed again on October 8, 2026. The separate supplement download could not be retrieved and was not independently read. Verify exact code definitions and model specifications before replication.
Frequently asked question
Why compare overlapping payment models separately?
A clinician can face incentives from more than one program. Modeling each participation combination separately avoids attributing a joint effect to only one program.