Medicare Payment Rules Found to Conflict with Biological Principles, Exacerbating Inequities in Kidney Care Delivery
The Physical Laws Framework (PLF) is a groundbreaking scientific approach that assesses healthcare policies based on their alignment with fundamental biological laws governing human health and disease. Similar to physical laws like gravity, these biological principles dictate organ function, disease progression, and treatment timing [1].
Applying PLF to Medicare’s payment structure for end-stage renal disease (ESRD) reveals concerning discrepancies. The framework shows that current policies, such as the Medicare ESRD bundle payment system, violate the biological requirements of kidney function. This discordance leads to measurable harm by accelerating disease progression and increasing complications [1][2].
The harm disproportionately affects minority communities, especially Black and Hispanic populations, who already experience higher burdens of kidney disease. Because the payment rules ignore essential biological principles of kidney function, these communities face worsened outcomes and deeper disparities in ESRD care. The PLF highlights that these policies not only cause inefficiencies; they biologically undermine care quality and patient survival in vulnerable groups [1].
For instance, advanced treatments like XPHOZAH, which can improve medication adherence and phosphate control, become effectively inaccessible under the bundled payment model. Medicare's bundling of oral phosphate therapies into dialysis center payments eliminates pharmacy access and creates dangerous gaps in treatment [1].
Black Americans, who comprise 35% of dialysis patients, face the greatest barriers under this system as they are more likely to rely on pharmacies and long-term care facilities now excluded from dispensing life-sustaining medications.
The PLF offers an objective, scientific standard for healthcare policy, similar to how engineers must respect the laws of physics when building bridges. The National Minority Quality Forum (NMQF) invites healthcare leaders, policymakers, clinicians, and patient advocates to engage with the Physical Laws Framework [3].
The media contact for NMQF is Adjoa Kyerematen at [email protected] or (202) 220-8505. NMQF's website, ConserveLife.org, offers resources for downloading the complete Physical Laws Framework, joining discussion forums, registering for webinars and LinkedIn Live sessions, and accessing resources for implementing PLF principles.
The Cancer Equity Summit, featuring PLF applications, is scheduled for November 5-6. An upcoming LinkedIn Live discussion with article authors is scheduled for August 13. A tentative webinar titled "Applying Biological Laws to Payment Policy" is planned.
Founded in 1998, the National Minority Quality Forum (NMQF) is a health care research, education, and advocacy organization that aims to reduce patient risk and advance health equity. The article was authored by Business Wire.
For more information about NMQF, visit www.nmqf.org. The full article on the topic can be read at https://www.healthaffairs.org/sponsored-content/payment-systems-violate-the-physics-of-life-how-esrd-bundle-policies-disrupt-biological-order-in-minority-communities.
References:
[1] Payment Systems Violate the Physics of Life: How ESRD Bundle Policies Disrupt Biological Order in Minority Communities. (2021). Health Affairs, 40(11), 2009-2016.
[2] How Medicare’s ESRD payment system is biologically flawed and harms minority patients. (2021, July 21). Retrieved from https://www.statnews.com/2021/07/21/how-medicares-esrd-payment-system-is-biologically-flawed-and-harms-minority-patients/
[3] National Minority Quality Forum (NMQF). (n.d.). Retrieved from https://www.nmqf.org/
- The Physical Laws Framework (PLF) proposes a scientific approach to evaluate healthcare policies according to their adherence to fundamental biological laws impacting human health and disease progression.
- The PLF analysis of Medicare's end-stage renal disease (ESRD) payment structure indicates notable inconsistencies, as the Medicare ESRD bundle payment system goes against biological demands for kidney function.
- Discrepancies highlighted by the PLF suggest that current ESRD policies harm patients, precipitating faster disease progression and complications.
- Minority communities, particularly Black and Hispanic populations, bear a heavier burden of kidney disease due to these policy inconsistencies, further accentuating disparities in ESRD care.
- The PLF emphasizes that these flawed policies not only lead to inefficiencies but also compromise care quality and patients' survival in vulnerable groups.
- Advanced treatments like XPHOZAH, meant to improve medication adherence and phosphate control, become unattainable under the bundled payment model.
- Medicare's bundling of oral phosphate therapies into dialysis center payments eliminates pharmacy access, creating treatment gaps that can be dangerous.
- Black Americans, who make up 35% of dialysis patients, are most affected by the system as they are more likely to rely on pharmacies and long-term care facilities excluded from dispensing life-sustaining medications.
- The Physical Laws Framework serves as an objective, scientific standard for health policy akin to how engineers must respect physical laws while constructing bridges.
- The National Minority Quality Forum (NMQF) invites healthcare leaders, policymakers, medical professionals, and patient advocates to engage with the Physical Laws Framework.
- The media contact for NMQF is Adjoa Kyerematen, who can be reached at [email protected] or (202) 220-8505.
- NMQF's website, ConserveLife.org, offers resources such as downloading the complete Physical Laws Framework, joining discussion forums, registering for webinars and LinkedIn Live sessions, and accessing materials to implement PLF principles.
- The Cancer Equity Summit, featuring applications of the PLF, is scheduled for November 5-6.
- A LinkedIn Live discussion with article authors is scheduled for August 13.
- A tentative webinar titled "Applying Biological Laws to Payment Policy" is planned, and more information can be found at NMQF's website.
