Although patients receiving kidney replacement therapy (KRT) constitute 1% of the Medicare population, they account for>7% of Medicare spending.1 Outpatient dialysis treatments make up>25% of this spending. Close to 90% of patients undergoing dialysis use in-center hemodialysis (HD), a trend that has persisted for more than 2 decades despite evidence suggesting that home dialysis has similar patient outcomes,2 greater patient satisfaction,3 and reduced Medicare costs.1 In July 2019, the “Advancing American Kidney Health” (AAKH) Executive Order4 was signed, which aims to reduce the dominance of in-center HD in the United States.