Washington launches plan to boost competition in dialysis market where two companies control 74%
Key Facts
The U.S. Department of Health and Human Services launched the National Kidney Care Plan on 20 October 2026, aiming to boost competition in a market where it says two companies control about 74%. The plan makes lowering barriers to entry for new providers and treatments a priority, alongside expanding patients' care options. The department said its approach includes expanding access to home care as part of measures to improve dialysis services. The plan's priorities extend to preventing kidney failure and reforming organ transplantation, including care before dialysis and other treatment options. The announcement thus combines measures targeting competition among providers with priorities spanning prevention, treatment and kidney transplantation.
For dialysis facilities, the department said in the plan's fact sheet that it is exploring opportunities to streamline the regulatory conditions for coverage of services at facilities treating patients with end-stage kidney disease. Its review also includes streamlining service certification procedures as part of its stated effort to reduce barriers to entry for new care providers. The department is considering updating requirements governing service delivery to make it easier for patients to receive more care at home. In another set of proposals, it intends to examine potentially anticompetitive payment strategies and legal practices used by major companies, according to the fact sheet. These areas fall within the measures the department is considering to change the conditions for service delivery and market entry and expand access to home treatment.
The initiative comes amid widespread chronic kidney disease, which the department estimates affects 37 million adults in the United States. It also estimates that 87% of adults with the disease are unaware they have it, while making kidney failure prevention a priority of the national plan. The department believes incentives for early intervention are weakened by the separation between the entity bearing the cost of prevention and the entity benefiting from its results. It described this imbalance in the plan's fact sheet, saying "the entity that pays for prevention is rarely the entity that benefits from it." Alongside the announcement, the department said it is investing up to $4.67 million in the "KidneyX" competition to support prevention and kidney health.
In its response to the plan, DaVita disputed the suggestion that kidney care lacks innovation or that company size is an obstacle to it. The company said in its statement: "Where we disagree is the suggestion that kidney care has lacked innovation or that company size stands in its way." DaVita serves about 298,500 patients, according to figures published on its investor website on its business at the end of June 2026. The company provides services through 3,266 outpatient dialysis centers, according to the same figures dated 30 June 2026. Fresenius Medical Care, for its part, welcomed the U.S. Department of Health and Human Services' release of the National Kidney Care Plan, according to a statement published by the company.
The plan aims to expand home care following an increase in its use in previous years, according to the historical comparison provided by the department in the fact sheet. Home dialysis use stood at 10.5% in 2017 before rising to 16% in 2023. On organ transplantation, the department said kidney transplants increased by 24% between 2019 and 2023. The plan makes organ transplantation reform a priority, alongside improving dialysis and expanding the options available to patients who need care. The measures it is considering to expand treatment at home include updating requirements and streamlining certification, as part of a regulatory effort running alongside the priority of organ transplantation reform.
In the next phase, the department said its agencies will use the plan to develop actions across policy, payments, research, regulation and oversight. The announced work includes reviewing service delivery requirements and examining potentially anticompetitive practices, alongside priorities for prevention and expanding treatment options. On the corporate reporting calendar, DaVita has scheduled its investor call to discuss third-quarter results for 29 October 2026. The company said the call will begin at 5:00 p.m. U.S. Eastern time, according to its published announcement. It will be followed by Fresenius Medical Care's third-quarter 2026 earnings call, which the company announced it will hold on 3 November 2026.