The Kidney Care Reimbursement Landscape
The census is fixed. The economics are decided by the payer — and the clock.
In dialysis, the same patient can be worth several times more or less depending on who pays, when, and how the coordination period is managed.
Under the ESRD Prospective Payment System, Medicare pays dialysis facilities a fixed per-treatment bundle — ESAs, IV iron, vitamin D analogs, and lab work all folded in — leaving thin, tightly managed margin. Commercial payers, by contrast, reimburse dialysis at large multiples of Medicare during the 30-month coordination period that follows a patient's Medicare eligibility. That window, together with Medicare-Secondary-Payer and out-of-network positioning, is the single most decisive lever in dialysis economics.
On the physician side, nephrologists bill the Monthly Capitation Payment for dialysis oversight — tiered by the number of face-to-face visits — alongside CKD evaluation-and-management. And the ground is shifting: Medicare Advantage enrollment in ESRD has climbed since the 21st Century Cures Act, CMS is pushing home dialysis through the ETC model, and value-based kidney care arrangements (Kidney Care Choices / CKCC) layer capitation and shared savings on top. The same census can be worth dramatically different amounts depending on how it is contracted, coordinated, and risk-managed — and that is precisely where Fulcrum works.
Illustrative composition. Replace with your confirmed figures before launch; reflects current CMS ESRD PPS methodology and public payer data, 2024–2026.
