Medicare Payment Regulations Found to Conflict with Biological Realities, Exacerbating Inequalities in Kidney Care Services

Article Title: Payment Systems Violate the Physics of Life: How ESRD Bundle Policies Disrupt Biological Order in Minority Communities

In a groundbreaking article published in Health Affairs, the National Quality Forum (NMQF) sheds light on how Medicare's payment structure for end-stage renal disease (ESRD) contradicts the biological requirements of kidney function, causing harm, particularly in Black and Hispanic communities.

The article, titled "Payment Systems Violate the Physics of Life: How ESRD Bundle Policies Disrupt Biological Order in Minority Communities," argues that advanced treatments like XPHOZAH, which can significantly improve medication adherence and phosphate control, become effectively inaccessible under the bundled payment model. This forces patients to obtain critical medications only through dialysis centers, eliminating pharmacy access and creating dangerous gaps in treatment.

Black Americans, who comprise 35% of dialysis patients, face the greatest barriers under this system. They are more likely to rely on pharmacies and long-term care facilities now excluded from dispensing these life-sustaining medications.

The National Quality Forum's Physical Laws Framework (PLF) provides an objective, scientific standard for healthcare policy. It suggests that policymakers must respect the laws of biology when designing payment systems, similar to how engineers must respect the laws of physics when building bridges. When policies violate these laws, they can accelerate disease progression and shorten lives.

The PLF recognizes that human biology operates according to immutable natural laws. It offers a standard for evaluating whether healthcare policies work with or against these biological realities. NMQF invites healthcare leaders, policymakers, clinicians, and patient advocates to engage with the Physical Laws Framework.

NMQF's work focuses on reducing hospitalizations, disabilities, and deaths while promoting high-quality, long lives, particularly for the most vulnerable. For more information about NMQF, visit www.nmqf.org. The media contact for NMQF is Adjoa Kyerematen, Vice President of Public Affairs and Communications, at [email protected] or (202) 220-8505.

Visitors can download the complete Physical Laws Framework, join discussion forums, register for webinars, and access resources for implementing PLF principles at ConserveLife.org. Upcoming events include a LinkedIn Live discussion with article authors, a webinar on "Applying Biological Laws to Payment Policy," and the Cancer Equity Summit featuring PLF applications.

NMQF utilizes data and research to support and mobilize healthcare organizations, leaders, policymakers, and patients in advocating for biologically-aligned care. The organization, founded in 1998, aims to reduce patient risk and advance health equity by ensuring optimal care for all. Medicare's decision to bundle oral phosphate therapies into dialysis center payments creates a direct conflict with biological necessity, as patients need immediate access to medications when biochemical imbalances occur.

The PLF's analysis suggests that existing bundled payment systems still fundamentally contradict biological laws governing kidney function. Social and behavioral factors, such as medication adherence and trust, further affect outcomes in minority groups with ESRD. Meanwhile, newer voluntary payment models for kidney care, such as Kidney Care First and Comprehensive Kidney Care Contracting (CKCC), aim to address some of these issues by incentivizing earlier intervention and transplant, reflecting a move towards more biologically and socially informed policy design. However, the PLF's analysis suggests that more needs to be done to align policy incentives with biological realities to reduce disease progression and health disparities in ESRD.

[1] "Payment Systems Violate the Physics of Life: How ESRD Bundle Policies Disrupt Biological Order in Minority Communities." (2022). Health Affairs. https://www.healthaffairs.org/sponsored-content/payment-systems-violate-the-physics-of-life-how-esrd-bundle-policies-disrupt-biological-order-in-minority-communities [2] "CMS Announces New Kidney Care Payment Models." (2021). Centers for Medicare & Medicaid Services. https://www.cms.gov/newsroom/press-releases/cms-announces-new-kidney-care-payment-models [3] "Physical Laws Framework." (2022). National Quality Forum. https://www.nmqf.org/initiatives/physical-laws-framework/ [4] "Addressing Social Determinants of Health in ESRD Care." (2021). National Quality Forum. https://www.nmqf.org/initiatives/physical-laws-framework/addressing-social-determinants-of-health-in-esrd-care/

Medicare Payment Regulations Found to Conflict with Biological Realities, Exacerbating Inequalities in Kidney Care Services