In its first year, the Centers for Medicare and Medicaid Services’ End-Stage Renal Disease Treatment Choices (ETC) Model disproportionately penalized dialysis facilities with higher rates of social risk, according to data published in JAMA. The study noted that dialysis facilities disproportionately serving populations with high social risk have a lower use of home dialysis and kidney transplant, which suggests these sites may fare poorly in the payment model. Kalli G. Koukounas, MPH, and colleagues conducted a cross-sectional study of 2,191 US dialysis facilities to examine the first-year ETC model performance scores and financial penalties across dialysis facilities stratified by social risk. Compared to facilities with no social risk features, dialysis facilities with 2 or more had lower mean performance scores and lower use of home dialysis. Additionally, these facilities had higher receipt of financial penalties, often had the highest payment cut of 5%, and were less likely to achieve the highest bonus of 4%. Financial penalties also were markedly higher compared to other facilities, primarily due to the use of home dialysis.