As healthcare costs continue to rise beyond sustainable levels, both payors and providers are seeking ways to reduce their costs without sacrificing quality. End-stage renal disease (ESRD) accounts for a significant portion of Medicare expenditures, despite efforts over the years to alter the reimbursement scheme to control costs. Providers must now find a way to deliver care that both meets CMS quality standards and doesn’t exceed reimbursement amounts. Time and resource constraints have lead to registered dietitians reporting difficulty with providing important medical nutrition therapy to patients. Hiring dietetic technicians may be a cost-effective way to help improve nutrition therapy within the scope of the Medicare Conditions for Coverage for ESRD.