U.S. proposal would raise dialysis payment rate to $299.55 in 2027

Key Facts

The U.S. Centers for Medicare & Medicaid Services proposed setting the base dialysis payment rate at $299.55 for 2027 as part of its annual proposal for the End-Stage Renal Disease Prospective Payment System. That compares with a base rate of $281.71 set by Medicare for 2026, according to the agency's payment update document. Next year's amount remains a proposal and was not finalized in the document issued by the agency responsible for payments. This year's update includes a 2.1% productivity-adjusted increase in the sector's market basket of costs, according to the dialysis payment document. Next year's proposal also includes expanding the payment adjustment for low-volume facilities by changing the treatment-volume threshold for eligibility.

On competition, Senator Richard Blumenthal said in a letter to the Federal Trade Commission that DaVita and Fresenius Medical Care control at least 77% of the U.S. dialysis market. The estimate of their national market share came as he urged the commission to curb concentration in the sector and publish the findings of its investigation. Blumenthal said the companies "control at least 77% of the national dialysis market." DaVita, for its part, disclosed in a filing with the U.S. Securities and Exchange Commission that it received 2 civil investigative demands from the Federal Trade Commission in April 2024. The company said the demands were part of the commission's investigation into the sector.

In his letter, Blumenthal relayed complaints from patients receiving care at DaVita and Fresenius Medical Care about staffing conditions and treatment procedures at clinics. The complaints cited by the senator included understaffing, safety shortcuts and rushed treatment, presented as patient accounts he relayed in calling for intervention. He described what patients had reported to him as "deeply troubling problems," without those complaints constituting established investigative findings. In a separate competition action, the Federal Trade Commission required DaVita to divest 3 dialysis clinics in the Provo area. The settlement order named Sanderling Renal Services as the recipient of the clinics as part of a settlement concerning DaVita's acquisition of University of Utah clinics.

On its service network, Fresenius Medical Care said it had completed its U.S. dialysis clinic network optimization plan for 2026. The company said implementation included exiting about 100 U.S. clinics, according to its second-quarter earnings statement. It described the move as completing the optimization of its clinic footprint, confirming that this year's plan had concluded. In another area of kidney care, the U.S. Department of Health and Human Services announced an initiative to support innovation and empowerment in the field. When announcing the initiative, the department said about 100,000 Americans were on the kidney transplant waiting list, a figure referring to those awaiting transplants at the time of the announcement.

Fresenius Medical Care's depositary receipts trade on the New York Stock Exchange under the ticker FMS, according to the company's depositary receipt program page. The ticker FSNUY, meanwhile, belongs to Fresenius SE, according to Fresenius Group data, a separate entity from the dialysis company. The group holds a financial investment of about 25% in Fresenius Medical Care, according to its description of the stake on its website. The group describes the dialysis company as independent and separately listed, while retaining that financial stake. FMS receipts therefore represent the dialysis services provider, while FSNUY receipts represent the group holding the financial investment in the company, according to the entities' listing and ownership information.

Under the proposed change to payments for low-volume facilities, the Centers for Medicare & Medicaid Services plans to raise the treatment-volume threshold for eligibility for the adjustment from 4,000 to 8,000 treatments. Expanding the threshold would bring a wider range of treatment volumes within the adjustment, according to the 2027 proposal. The measure concerns low-volume facilities' eligibility for a payment adjustment, alongside the proposed base rate for the dialysis system. On the corporate reporting calendar, Fresenius Medical Care plans to release its third-quarter 2026 results on November 3, 2026, according to its published investor calendar. The company is scheduled to hold its earnings conference on the same day, alongside the release of its quarterly financial disclosure.