The human toll is rivaled by the economic toll. Again, according to the USRDS, cumulative Medicare Parts A, B, and D expenditures among dialysis patients with Medicare coverage during 2017 was $90,549 per patient-year. Of this total,$27,517 were attributable to inpatient facility payments and $3207 were attributable to physician payments in in-patient settings. Furthermore, another$3482 were attributed to skilled nursing facility payments, which are almost always subsequent to hospital discharge.1 Therefore, between 35% and 40% of all Medicare spending in the dialysis patient population is connected to hospitalization and post-acute care. As the cost of outpatient dialysis treatment is relatively fixed on a per-annum basis, it is clear that any serious attempt at reducing spending in the dialysis patient population begins—and possibly ends—with efforts aimed at lower hospitalization risk.