Come January, there may be many more people like Mary Prochaska.

Prochaska, 73, a retired social worker in Chapel Hill, N.C., has advanced chronic kidney disease and relies on dialysis to filter waste from her blood while she awaits a kidney transplant, her second. But she no longer visits a dialysis center three times a week, the standard treatment.

Instead, she has opted for dialysis at home. "It's easier on your body and better for your health," she said.

With her husband's help, she performs peritoneal dialysis; after a surgeon implanted a tube in her side, her abdominal lining acts as the filter. She received training for a couple of weeks and then began using a home machine called a cycler to remove excess fluid and impurities. "When you get up, you're done," she said. "It's like having a normal life."

For decades, health advocates and many nephrologists have encouraged more patients to consider home dialysis. Studies have found that home dialysis patients report a greater sense of independence and autonomy and experience a better quality of life. But few choose it.

This fall, however, Medicare announced a mandatory program intended to transform that system, covering about 30% of beneficiaries with advanced chronic kidney disease, close to 400,000 people. Starting Jan. 1, it will use payment bonuses — and later, penalties — to try to increase the proportion of patients using home dialysis and receiving transplants.

Experts have called this approach the biggest change for kidney patients since 1972, when President Richard Nixon signed legislation providing Medicare coverage for those in kidney failure, regardless of age.

"There are a lot of incentives for providers to do things they have not traditionally done," said Richard Knight, president of the American Association of Kidney Patients.

Some patients begin dialysis when a health crisis sends them to an emergency room. With scant time to explore, they wind up at centers. Many don't know they have alternatives. In a 2016 study, almost half the patients receiving in-center hemodialysis said it had not been their choice.

"There are patients who don't know they could do dialysis at home," said Dr. Suzanne Watnick, chief medical officer of Northwest Kidney Centers in Seattle. "To me, that's a travesty."